Brixadi Injection: A Breakthrough in Opioid Addiction Treatment

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Brixadi is a brand name for a slow-release, injectable medication made subcutaneously (under the skin). It contains buprenorphine, which received FDA approval on May 23, 2023, to treat moderate to severe opioid dependence.

This article breaks down everything you need to know about the Brixadi injection.

What Are the Available Brixadi’s Dosage Forms and Strengths?

Brixadi treatment is an extended release injection designed to release slowly into the body over time.

When injected, it transforms into a biodegradable gel with liquid crystalline properties. This gel releases buprenorphine at a steady rate.

It can be injected in:

  • Weekly doses: administered once every seven days.
    • Dosage strengths available are 8 mg, 16 mg, 24 mg, and 32 mg.
  • Monthly doses: administered once every 28 days.
    • Dosage strengths available are 64 mg, 96 mg, and 128 mg.

What Are The Dosage and Administration Instructions For Brixadi?

The dosage of Brixadi is decided based on whether the patient has started buprenorphine (the active ingredient in Brixadi) or not.

They have to be in withdrawal, showing objective mild to moderate symptoms first for the treatment to be beneficial.

If You Aren’t Currently Receiving Buprenorphine Treatment

You will be receiving a 4 mg test dose of buprenorphine for tolerance testing. This test dose is absorbed through mucous membranes of the mouth beneath the tongue or between the cheek and gum in film or tablet form.

If it’s tolerated well, you will be taking an initiating dose of Brixadi weekly at 16 mg. Three days later, an additional dose of 8 mg will be administered to reach the recommended weekly dose of 24 mg.

If needed, an additional 8 mg of Brixadi is injected 24 hours after the last dose but during the first week of treatment. Making the week’s total dose 32 mg of Brixadi.

The subsequent weekly doses will be based on the total dose received during the first week of treatment. Adjustments to the dose can be made during visits, but the maximum weekly dose is 32 mg. A missed weekly dose should be received as soon as possible.

If You Are Currently Receiving Buprenorphine Treatment

You can be switched directly to either weekly or monthly Brixadi.

Transiting Between Weekly and Monthly Injections

You can transition from a weekly to a monthly dose as seen fit by your healthcare professional according to the following table:

Weekly Injection Dosage Strength

Monthly Injection Dosage Strength

16 mg

64 mg

24 mg

96 mg

32 mg

128 mg

Where Is Brixadi Injected?

Brixadi is injected slowly under the skin of your upper arm, abdomen (stomach), thigh, or buttocks. For the weekly injections, it’s recommended to alternate or rotate injection sites with each administration.

For patients who are just beginning buprenorphine treatments, the upper arm should only be considered an injection site after receiving four doses of Brixadi. This is done to ensure the medication’s effective absorption and distribution within the body, as the upper arm site yields results in roughly 10% lower plasma levels.

Brixadi is initially injected as a liquid, forming a gel beneath the skin. This gel form (depot) may not always be felt. Under no circumstances should you attempt to dislodge the depot.

Advantages of Brixadi Injection

Brixadi has many advantages compared to other buprenorphine formulas and administration routes.

  • The extended release injection allows for less frequent dosing, therefore, better treatment adherence and risk of relapse.
  • Brixadi is only given by certified health care providers and, therefore, poses a lower risk for diversion and abuse or misuse.
  • It offers a steady release of buprenorphine, which steadies its level in the blood without peaks and valleys. This keeps cravings at bay and provides better treatment outcomes.
  • It’s the only buprenorphine injection method that offers both weekly and monthly dosing. This is more convenient and provides time autonomy to patients compared to daily dosing, which translates into fewer clinic visits and alleviates the burden of both the recovering patient and the health care provider.
  • Brixadi being administered in a healthcare setting means you’re being monitored for any adverse reactions or complications to the medication, providing safety and ease of mind.

Comparing Injectable Buprenorphine Drugs

The two commonly used injectable buprenorphine preparations are Brixadi and Sublocade. Both are designed to be extended-release and have comparable effectiveness and side effects.

The key difference is that Brixadi offers higher administration flexibility with both weekly and monthly injections, while Sublocade only offers monthly injections. Brixadi also offers a variety of strengths for the medication, while Sublocade comes in three strengths: 100 mg, 300 mg, and 300/100 mg.

Another important difference is the injection site. Brixadi can be injected in multiple locations, reducing the risk of injection site pain, discomfort, and inflammation. Sublocade can only be injected into the abdomen.

You can check a more thorough comparison between Brixadi and Sublocade here.

Non-Injectable Forms of Buprenorphine: A Quick Comparison

Buprenorphine is administered through films or tablets that are sublingual (under the tongue), buccal (between the gum and the cheek), or nasal spray.

Each drug delivery method serves a different purpose for the patient and carries a certain risk that one might want to avoid.

1. Sublingual Administration

The sublingual route of administration is different. The drug is absorbed through the fine tissue lining the inside of the mouth, which is rich in blood supply and, therefore, reaches systemic circulation before it’s metabolized by the liver.

Sublingual tablets are easy to use and don’t require going to the doctor. However, that lends way to misuse and diversion. Adherence to the treatment regimen can also be a hassle due to the frequency of dosing, which may pose a risk of relapse.

Moreover, a study comparing subcutaneous injection and sublingual buprenorphine showed that the bioavailability (the proportion of the medication that enters the bloodstream to produce the desired effects) was 5.7- to 7.7-fold higher in subcutaneous injection than in sublingual administration.

2. Buccal Films

Similarly, buccal films are equally accessible and require frequent dosing. According to the Food and Drug Administration (FDA), patients who take buprenorphine medications orally are at an increased risk of dental issues even if they didn’t have dental issues beforehand.

3. Sprays

Buprenorphine sprays are typically applied through the nostrils with ease to aid with the withdrawal symptoms.

However, as with all the modes of administration that take place outside of a healthcare setting, they carry the risk of serious harm. Whether it’s for misuse, abuse, or otherwise, children and adults accidentally administering the medication can lead to illicit opioid use, respiratory distress, overdose, and death.

Why Aren’t There Oral Medications?

Buprenorphine is metabolized in the liver and discarded in the stool, and the reason is that there aren’t oral formulations of this drug.

If buprenorphine is ingested, it will be broken down by the digestive enzymes and absorbed through the intestines into the bloodstream to be broken down directly and entirely by the liver before it reaches the systemic circulation, and thus, the active ingredient will be significantly reduced.

Medication-Assisted Addiction Recovery Isn’t Out of Reach

The opioid epidemic remains a pressing public health issue that necessitates innovative treatment approaches. Overall, Brixadi is a valuable addition to the arsenal of treatments for opioid use disorder. It addresses key challenges facing those recovering.

If you or a loved one need help managing opioid use disorder, book an appointment with Curednation to start your recovery journey today.

Resources

U.S. Food and Drug Administration – Highlights of Prescribing Information  for Brixadi (Buprenorphine) Extended-Release Injection for Subcutaneous Use CIII

Long-acting buprenorphine injectables: Opportunity to improve opioid use disorder treatment among rural populations

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