Brixadi is the brand name of an injectable drug that contains buprenorphine and is used to treat opioid use disorder (OUD).
Suboxone is the brand name of an orally-administered drug that contains a combination of buprenorphine and naloxone.
When treating OUD, a doctor will prescribe Brixadi at the beginning. It needs close monitoring, so this part of the treatment is supervised directly by the physician.
As the treatment progresses and the patient starts improving, the physician may switch to Suboxone, which does not require the same level of supervision by a physician.
Read on to understand how Brixadi and Suboxone work, the similarities and differences between them, and their side effects and costs.
Brixadi vs Suboxone: Mechanism of Action
Dopamine is a neurotransmitter, which is a brain chemical responsible for causing feelings of happiness and pleasure.
Opioids produce a feeling of euphoria (extreme happiness) by altering chemical pathways in the brain. They bind to receptors on the surface of neurons, which causes the release of more dopamine.
Brixadi and Suboxone both contain the drug buprenorphine, which works by blocking the activation of opioid receptors in the brain, but Suboxone has an extra “safeguard” to prevent misuse and addiction by adding naloxone to its formula. Let’s look at both drugs more closely:
Brixadi
Brixadi is an extended-release, injectable form of buprenorphine, which is an opioid-like medication. However, unlike strong opioids such as heroin, buprenorphine causes partial activation of the opioid receptors, not letting them release the same amount of dopamine. This is why it is also called a “partial agonist”.
Brixadi is used to treat opioid dependence because it has enough effect to satisfy the cravings of a substance abuse patient without causing addiction like a strong opioid would.
It is given as a subcutaneous injection (injection under the skin) and has various doses depending on the strength required.
Suboxone
Suboxone is a sublingual buprenorphine drug, which partially activates opioid receptors to satisfy cravings. That said, some patients can also become addicted to the effects of buprenorphine, which is where the addition of the drug naloxone comes in.
Naloxone is an opioid “antagonist”, which means it binds to opioid receptors but does not activate them (even to a small degree). It also prevents stronger opioids from binding opioid receptors, which stops dopamine release and prevents euphoria.
Suboxone is available as a pill or a film and is taken sublingually (by placing it under the tongue or against the cheek). The naloxone component of suboxone is not absorbed sublingually, which means that it does not produce any effect when suboxone is taken properly.
But if someone becomes addicted to buprenorphine and tries to misuse suboxone by injecting it directly into a vein, naloxone will take effect and block the effects of buprenorphine.
Brixadi vs Suboxone: Precautions to Take
Certain risks should be considered before starting Brixadi or Suboxone. Because both contain buprenorphine, these risks are similar for both drugs. They include:
- Potential for drug abuse: Although Brixadi and Suboxone are used to treat OUD, they can be misused to sustain opioid addiction. This is because although buprenorphine is a weak opioid, it can produce similar effects to a strong opioid if taken in high doses.
The risk of addiction is lower with Suboxone because it contains naloxone, which causes unpleasant side effects if the drug is misused.
- Withdrawal symptoms: If buprenorphine is discontinued prematurely or the dose is decreased suddenly, it can cause withdrawal symptoms such as watery eyes, runny nose, and goosebumps. It is important to strictly follow the dose prescribed by your doctor.
- Drug interactions: When buprenorphine is taken along with other drugs, the risk of side effects increases. Drugs such as alcohol, marijuana, benzodiazepines, and barbiturates all depress brain function (just like buprenorphine does). If buprenorphine is taken alongside these substances, patients may present similarly to opioid overdose and go into a coma.
- Allergies: If someone has had an allergic reaction to buprenorphine in the past, they should tell their doctor before beginning treatment regardless of the episode’s severity. Even if there is no history of allergy to buprenorphine, you should provide a detailed history of any other allergies you might have to your doctor. This is important because an allergic reaction to buprenorphine can be life-threatening if severe and require emergency treatment.
- Pregnancy concerns: Buprenorphine can slightly raise the risk of birth defects when used during the first two months of pregnancy. It’s best to avoid it during this period or use it at the minimum dose possible.
- Breastfeeding concerns: Buprenorphine can pass from the mother to the infant during breastfeeding. If you’re taking Brixadi or Suboxone while breastfeeding and notice your baby becomes excessively sleepy, see a healthcare provider.
- Injuries: Buprenorphine can cause lightheadedness and dizziness. It can also cause sleepiness in some patients, so activities such as driving or operating heavy machinery should be avoided while taking Brixadi or Suboxone.
- Intravenous administration: if Brixadi 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. If untreated, it can lead to organ injury and death.
Brixadi vs Suboxone: Side Effects
Brixadi
Side effects of Brixadi are caused entirely by buprenorphine. They include:
- Injection-site pain: Pain at the site of injection is one of the most common occurrences after buprenorphine injection. The pain usually lasts a few days before fading away.
- Nausea/vomiting: It’s especially common in individuals who start Brixadi treatment or have their dose increased. It usually wears off after a few days.
- Dizziness: Some people feel lightheaded after taking Brixadi, especially when they stand up from a sitting position. These patients should be cautious when performing activities such as driving or operating heavy machinery until they understand how Brixadi can affect them.
- Sleepiness: When beginning Brixadi treatment, some people find themselves sleepy and drowsy after taking the drug. This side effect persists for some days until the body adjusts to buprenorphine’s effects.
- Constipation: Buprenorphine slows down gut motility, which can cause constipation. You want to adjust your diet by increasing water, fruits, and vegetables to prevent constipation.
- Headache: Headaches are commonly experienced when beginning buprenorphine treatment. They can be treated with over-the-counter painkillers.
- Liver damage: Liver damage due to buprenorphine is rare but possible. This can manifest as jaundice (yellowing of the skin) and abdominal pain. This is why doctors monitor liver health by blood testing when someone is on Brixadi.
- Respiratory depression: All opioids depress the breathing centers in the brain. Buprenorphine is no different. Although it acts weakly compared to a strong opioid, it can slow down breathing. In extreme cases, it can cause breathing to stop, leading to death.
- Allergic reaction: Some individuals are allergic to buprenorphine. They may develop skin rashes and itching upon Brixadi administration. In severe cases, they may also develop swelling of the lips, face, and tongue and find it difficult to breathe.
Suboxone
The majority of Suboxone’s side effects are similar to those seen with Brixadi because both drugs contain buprenorphine.
The exception is injection-site pain, which does not occur with Suboxone because it’s taken orally.
In addition, the naloxone component of Suboxone does not cause side effects when it is taken by mouth because it is not absorbed by the body that way.
If someone tries to inject Suboxone into their veins, naloxone produces strong opioid withdrawal effects, such as:
- Watery eyes
- Runny nose
- Sweating
- Goosebumps
- Yawning
- Shivering
- Diarrhea
- Restlessness
Brixadi vs Suboxone: Cost
Treatment for OUD usually begins with Brixadi, and patients are then moved to Suboxone, which doesn’t require supervised administration. That means the cost of Brixadi and Suboxone is usually not a point of comparison because they are different parts of the same treatment regimen.
That said, here is how Brixadi and Suboxone compare cost-wise.
Brixadi
Brixadi’s cost depends on its dose. Here is a breakdown:
- 8 mg/0.16 mL—$460
- 16 mg/0.32 mL—$460
- 24 mg/ 0.48 mL—$460
- 32 mg/ 64 mL—$460
- 64 mg/0.18 mL—$1808
- 96 mg/0.27 mL—$1808
- 128 mg/0.36 mL—$1808
Patients who have commercial insurance may be eligible for the Brixadi Copay Savings Program, which can help them access the drug at no cost. However, individuals who participate in state or federally-funded insurance programs, like Medicare and Medicaid, are not eligible for the Copay Savings Program.
Suboxone
The cost of Suboxone is not fixed and depends on multiple factors. For example, it is available both as a tablet and as a strip, both of which have different costs. Suboxone also has a range of doses, which influences its cost.
The cost can range from $5 to $170 per month depending on whether you have insurance. People with private insurance who have been prescribed Suboxone are eligible for the INSUPPORT® Copay Assistance Program.
Brixadi vs Suboxone: The Final Verdict
Brixadi and Suboxone are both buprenorphine-based drugs used in the medication-assisted treatment of OUD. They both work by reducing the activation of opioid receptors in the brain.
Suboxone has an extra safeguard to prevent the potential addiction that can happen with buprenorphine, which is a major difference between how Brixadi and Suboxone work.
This is why Brixadi is usually given at the start of OUD treatment under the direct supervision of a doctor. As patients start improving, they’re switched to Suboxone, which can be taken without the supervision of a doctor because it has a built-in mechanism to prevent misuse.
Frequently Asked Questions
Is Brixadi a Narcotic?
A narcotic is defined as a psychoactive compound with numbing properties. By that definition, Brixadi can be called a narcotic because it activates opioid receptors in the brain and produces a calming effect.
Which Is Better: Suboxone or Brixadi?
Suboxone and Brixadi can’t be compared because they are both part of the treatment plan for OUD. Brixadi is used at the start of the plan under medical supervision, while Suboxone is used towards the end of the treatment.
Access Medically-Assisted Opioid Use Disorder Treatment Today…
If you, or a loved one, are starting on your recovery journey from opioid use disorder and have other questions about medically-assisted OUD treatment, feel free to book an appointment with one of our addiction specialists at Curednation.
