Buprenorphine SC (weekly/monthly)
BRIXADI
Pronunciation: byoo-pre-NOR-feen (brix-AH-dee)
“Bricks for addicts”
bumper cars → buprenorphine
syringes → weekly or monthly subcutaneous injection
H cape → heroin, the opioid use disorder it treats
What it isLong-acting partial mu-opioid agonist and kappa antagonist injection (BRIXADI, 2023); moderate-to-severe opioid use disorder.
Why this oneWeekly BRIXADI can start after a tolerated 4 mg transmucosal buprenorphine test dose; monthly BRIXADI is for patients already on buprenorphine. Apparent half-life 3-5 d (weekly) / 19-26 d (monthly).
What limits itInjection-site reactions and precipitated withdrawal can end treatment; benzodiazepines magnify respiratory risk.
FDA-approved for
- opioid use disorder (moderate-severe) (2023)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression and dependence remain possible, especially with benzodiazepines, alcohol or other sedatives.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Moderate-to-severe opioid use disorder (weekly) | Adults; after transmucosal buprenorphine tolerated | 16 mg SC (then +8 mg within 3 days to reach 24 mg) in first week | 24 mg weekly | 32 mg weekly |
| Moderate-to-severe opioid use disorder (monthly) | Adults already on buprenorphine | 64/96/128 mg SC q28 days (based on weekly-equivalent dose) | individualized (64-128 mg monthly) | 128 mg monthly |
Renal Undefined
Hepatic Not recommended in pre-existing moderate to severe hepatic impairment; not studied for Brixadi
Weekly may be given +/-2 days, monthly +/-1 week around the scheduled time point
Instructions
- Subcutaneous injection only — do NOT give IV/IM/intradermal
- Administered only by a healthcare provider; single injection, do not divide
- Weekly given q7 days, monthly q28 days; rotate weekly injection sites
- Weekly and monthly formulations are not interchangeable/combinable
- Strongly consider prescribing an opioid overdose reversal agent
Available strengths
- inj 8, 16, 24, 32 mg (weekly)
- inj 64, 96, 128 mg (monthly)
Cautions
- Addiction, abuse, and misuse
- Life-threatening respiratory depression (esp. with benzodiazepines/CNS depressants)
- Neonatal opioid withdrawal syndrome
- Adrenal insufficiency
- Opioid withdrawal with abrupt discontinuation or in full-agonist-dependent patients
- Hepatitis/hepatic events
- Latex allergy (needle cap)
Adverse reactions
- Injection site pain
- Headache
- Constipation
- Nausea
- Injection site erythema/pruritus
- Insomnia
- Urinary tract infection
Pregnancy Limited human data do not indicate increased malformation risk from buprenorphine; prolonged use can cause neonatal opioid withdrawal syndrome; dose adjustments may be needed in pregnancy.
Lactation Buprenorphine and norbuprenorphine present in low levels in human milk; monitor breastfed infant for drowsiness and breathing difficulty.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 8 mg | inj | per unit | not offered | |
| 16 mg | inj | per unit | not offered | |
| 24 mg | inj | per unit | not offered | |
| 32 mg | inj | per unit | not offered | |
| 64 mg | inj | per unit | not offered | |
| 96 mg | inj | per unit | not offered | |
| 128 mg | inj | per unit | not offered |
Other forms: Buprenorphine (SUBUTEX) · Buprenorphine buccal film (BELBUCA) · Buprenorphine ER injection (SUBLOCADE) · Buprenorphine patch (BUTRANS)
Available combined with: Buprenorphine/ naloxone (SUBOXONE)
Open Buprenorphine SC (weekly/monthly) in the interactive console ↗
Memory aids: interaction avatars
Open Buprenorphine SC (weekly/monthly) in the interactive console ↗
Self-check
- Which BRIXADI form permits initiation without prior transmucosal stabilization?
Weekly form. - What apparent half-life is listed for monthly BRIXADI?
19–25 days.