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 oneUnlike other buprenorphine depots, the weekly form allows initiation without prior transmucosal stabilization; apparent half-life 3-5 d (weekly) / 19-25 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)
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)
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
- Risk from concomitant use with benzodiazepines
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression and dependence remain possible, especially with benzodiazepines, alcohol or other sedatives.
Open Buprenorphine SC (weekly/monthly) in the interactive console ↗
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Open Buprenorphine SC (weekly/monthly) in the interactive console ↗