The United States Food and Drug Administration (FDA) has approved three drugs for the treatment of opioid use disorder (OUD), one of which is buprenorphine.
Brixadi and Sublocade are subcutaneous injectable versions of buprenorphine, which means they’re given via an injection just beneath the skin.
Although they have the same active ingredient, there are differences in their dosage, effectiveness, safety, and cost. In this article, we will explore these differences between Brixadi and Sublocade.
Brixadi vs Sublocade: How Do They Work?
The brain is largely made of cells called neurons. Just like all cells in the body, neurons are covered with proteins called receptors. These receptors are specific and bind to only certain chemicals, leading to chemical and physical changes in the brain’s activity.
One type of receptor is the opioid receptor, which binds to opium molecules or opioid drugs like heroin. This leads to the release of brain chemicals (called neurotransmitters), which cause euphoria (a feeling of happiness) and addiction.
Brixadi and Sublocade have the same mechanism of action as opioids—they both contain buprenorphine (an opioid medicine) that can bind to opioid receptors.
But unlike narcotics, buprenorphine does not activate these receptors to their full extent. This is why it is called a partial agonist, which means that by activating opioid receptors to a smaller extent, it produces weaker euphoric effects than stronger opiates like heroin.
Because of this mechanism of action, Brixadi and Sublocade have two main uses—treatment of opioid dependence and pain management.
Opioid Dependence
In people who are addicted to opioids, buprenorphine is used for opioid detoxification in a complete treatment program that includes therapy and counseling.
Because it activates opioid receptors weakly, it does not cause the same, extreme level of euphoria that is experienced with an opioid like heroin. But it does cause some level of euphoria, which is enough to stop the need for a stronger opioid without causing addiction or any severe opioid withdrawal symptoms.
This is done to avoid the lack of stimulation after their bodies are detoxified from opioids. It reduces cravings, helps patients focus on treatment, and prevents relapse.
Pain Management
Buprenorphine is also approved for use in short-term or long-term pain management. It is indicated for emergency treatment of pain that is severe and not controlled by regular painkillers. Examples of such scenarios include:
- Major surgery: Strong painkillers are often required due to the moderate to severe pain after a surgical procedure. Buprenorphine is preferred over other opioid medicines because it has a lower risk of respiratory depression and addiction.
- Severe injury: In injuries such as falls, crush injuries, or severe fractures, buprenorphine provides emergency medical control of acute pain. This allows patients to undergo diagnostic procedures as well as treatment without delay.
- Cancer: Cancer patients suffer from severe pain that is either due to the disease itself or due to chemotherapy, surgery, or radiation. Buprenorphine is especially helpful in cancer patients who have developed tolerance to other opioids, meaning they don’t respond to them anymore.
Brixadi vs Sublocade: Dosage
Although Brixadi and Sublocade are both buprenorphine injection forms, they have different doses:
Brixadi Dosage
Brixadi is available in weekly and monthly doses. The strengths of the weekly doses are:
- 8 mg
- 16 mg
- 24 mg
- 32 mg
The strengths of the monthly doses are:
- 64 mg
- 96 mg
- 128 mg
A wide variety of doses allows greater flexibility for patients, especially those who can’t tolerate high levels of the drug in their system. The availability of lower doses allows these patients to switch to a lower dose without completely stopping treatment.
Brixadi is available as a short-term release version as well as an extended-release version. The short-release version is good for situations where an immediate effect is required, such as pain control after an injury.
The extended-release version of Brixadi releases a sustained amount of buprenorphine in the blood over a long period. This makes it useful for situations where long-term effects are required, such as addiction management.
Sublocade Dosage
Unlike Brixadi, a Sublocade injection does not have a short-term release version and comes only as an extended-release formula.
You also don’t get dosage flexibility as the drug is given only as a monthly dose of 100g or 300g.
Brixadi vs Sublocade: Which Is More Effective?
There have been no studies that compare the effectiveness of Brixadi and Sublocade. But we know that both versions of buprenorphine are effective at treating severe opioid use disorder.
Brixadi’s Efficacy
Data about the efficacy of Brixadi comes from a randomized phase III trial conducted on 428 people with OUD.
In the study, one group of participants received Brixadi injections every week for 12 weeks. The other group received sublingual buprenorphine, which was placed under their tongue.
Over 24 weeks, up to 35% of participants in the Brixadi group had opioid-negative urine samples. In comparison, only 28% of participants in the oral buprenorphine group achieved opioid-negative urine samples.
Sublocade’s Efficacy
Sublocade was studied in a six-month long multi-institutional phase III trial with 665 participants. Participants received either 300g of Sublocade, 100g of Sublocade, or a placebo drug.
The study saw no difference in the abstinence rates between the two groups of Sublocade patients.
But when compared to the placebo group, there was a significant improvement in the Sublocade groups with 21-24% versus 2% of patients achieving self-reported abstinence from illegal opioids.
Brixadi vs Sublocade: Which Is Safer?
According to a review article published in the Journal of Managed Care and Specialty Pharmacy, the rate of adverse events for both drugs is low. The most common adverse effects seen with both Brixadi and Sublocade were pain at the site of injection, headache, inability to sleep, and gut issues.
But Sublocade might have a slightly better side effect profile than Brixadi. In the phase III trial that evaluated its efficacy, adverse injection site effects were seen in 16.5% of participants compared to 9% in those who received a placebo. On the other hand, in the phase III trial that evaluated Brixadi, injection site adverse events were seen in 18.8% of patients who received the drug.
Since both Brixadi and Sublocade have the same active ingredient, you can expect similar side effects from each. These include:
- Injection site pain: Pain at the site of administration is the most common side effect. It is not an alarming symptom and usually goes away within a few days.
- Nausea/vomiting: Nausea and vomiting are also commonly seen in individuals who start buprenorphine treatment or have a recent increase in their dose. These effects persist for a few days before wearing off.
- Headache: Some people may experience headaches or migraines after buprenorphine administration. They are usually of moderate severity and last for a week at most.
- Constipation: Opioids are known to cause constipation by slowing down gut motility. Buprenorphine is no different.
- Excess sweating: Excess sweating or diaphoresis can also occur in some patients, along with cold, clammy hands. This may be accompanied by palpitations or an increased heart rate.
- Anxiety: Although less common, anxiety is a side effect of buprenorphine. It can also manifest as irritability but is usually transient.
- Allergy: Some patients may develop an allergic reaction after administration of buprenorphine. They can experience itching, swelling, and a rash on the body. In severe cases, the blood pressure may drop, which warrants a visit to the doctor.
- Respiratory depression: Although weak, buprenorphine is still classified as an opioid. Just like all opioids, it can depress brain centers that control breathing. If administered in inappropriately high doses, both Sublocade and Brixadi can cause respiratory depression. If you feel dizzy, faint, or confused after getting a dose, seek emergency medical attention.
- Intravenous administration: if either drug is administered intravenously, it can cause a life-threatening thrombo-embolic event where particles of the crystalline gel can block large blood vessels that feed the lungs, brain, or heart.
Brixadi vs Sublocade: Which Is Cheaper?
Before we discuss the cost of Brixadi and Sublocade, it is important to know that both are healthcare provider-administered medications, which means that they are not available at retail pharmacies and can be accessed only through a verified physician.
Brixadi’s Cost
The cost of Brixadi depends on the dose of the drug. Here is a breakdown:
- 8 mg/0.16 mL—$460
- 16 mg/0.32 mL—$460
- 24 mg/0.48 mL—$460
- 32 mg/0.64 mL—$460
- 64 mg/0.18 mL—$1800
- 96 mg/0.27 mL—$1800
- 128 mg/0.36 mL—$1800
Patients may be eligible for the Brixadi Copay Savings Program if they have commercial insurance that allows them to buy Brixadi at no cost. Those who participate in a state or federally-funded insurance program are not eligible for the Copay Savings Program. Similarly, patients whose commercial insurance does not cover Brixadi are also not eligible for the program.
Sublocade’s Cost
The cost of a monthly 100 mg or 300 mg dose of Sublocade is $2016.52.
Patients who have private insurance and have been prescribed Sublocade may be eligible for the InSupport Copay Savings Program, which covers the entire cost for the first two doses of a calendar year.
Similarly, people who have Medicare may end up paying an out-of-pocket cost of around only $97, depending on their insurance plan. People who have Medicaid pay an average out-of-pocket cost of around $3.
Brixadi vs Sublocade: Which Is the Right Drug for Me?
Brixadi and Sublocade are both FDA-approved drugs for OUD. Both are injectables for placement under the skin and contain buprenorphine as their core ingredient.
But only Brixadi is available as a weekly or monthly dose, compared to Sublocade (which is available only as a monthly dose).
When it comes to effectiveness, both Brixadi and Sublocade are similarly effective for the treatment of OUD and both have a favorable side effect profile.
With that said, the decision to choose between Brixadi and Sublocade rests with a verified physician and depends on the patient’s unique situation. The occurrence of side effects, the ability to tolerate them, and an assessment of the response to the drug all help determine whether Brixadi or Sublocade is the right choice for someone.
Frequently Asked Questions
Can You Use Brixadi or Sublocade for Opioid Overdose?
No, Brixadi or Sublocade are not used for opioid overdose. Opioid overdose is treated with another drug called naloxone.
What Are Alternatives to Brixadi or Sublocade?
Other versions of buprenorphine include Suboxone, Subutex, and Zubsolv. But these forms are not given via an injection. They are placed under the tongue.
Access Medically-Assisted Opioid Use Disorder Treatment Today…
At Curednation, we offer accessible and safe treatment plans tailored to your needs by expert healthcare professionals to provide a smooth recovery from OUD. If you’d like to discuss Brixadi vs Sublocade with an experienced addiction specialist, book an appointment today.
