If you've been managing opioid use disorder with daily sublingual buprenorphine (Suboxone, Subutex, or a generic film or tablet) and are looking for something that doesn't require thinking about medication every day, you've likely come across two names: Sublocade and Brixadi. Both are long-acting, injectable forms of buprenorphine, and both can significantly reduce the burden of daily dosing. But they aren't identical products, and understanding how they differ can help you have a more informed conversation with your provider about which one might fit your life better.
What Sublocade and Brixadi Have in Common
Sublocade and Brixadi are both extended-release formulations of buprenorphine, and both are FDA-approved specifically for moderate-to-severe opioid use disorder in adults. They share several important features. Both are injected subcutaneously, meaning under the skin — never into a vein (IV) or muscle (IM). This matters clinically: because the medication forms a solid depot under the skin that releases buprenorphine slowly over time, injecting it the wrong way can cause serious harm.
Both medications also require that you already be established and stabilized on transmucosal (sublingual, or under-the-tongue) buprenorphine before you start. This isn't a formality — it confirms your body tolerates buprenorphine well and helps your provider determine an appropriate starting dose. And both are provider-administered only. Neither Sublocade nor Brixadi is a take-home injection or something you'd draw up and inject yourself; a clinician gives the shot at an office visit. Because of this, both products are distributed under a federal Risk Evaluation and Mitigation Strategy (REMS) program rather than through a standard retail pharmacy.
Dosing Schedule Differences
Sublocade's initiation process is structured and sequential. It begins with a single 4mg sublingual test dose of buprenorphine, which you take under observation for one hour to confirm tolerability. From there, you receive two loading injections of 300mg each, with the second dose given anywhere from one week to one month after the first. After the loading phase, you move to a maintenance dose of 100mg injected monthly, with a minimum of 26 days required between injections. If 100mg isn't providing an adequate response, a 300mg monthly maintenance dose is available as an option.
Brixadi works differently in that it isn't a single dosing path — it comes in two distinct formulations, and you and your provider choose which fits best. The weekly formulation is dosed at 8mg, 16mg, 24mg, or 32mg, given every 7 days. The monthly formulation is dosed at 64mg, 96mg, or 128mg, given every 28 days. This built-in flexibility means Brixadi can be adjusted to a more frequent, lower-per-dose schedule or a less frequent, higher-per-dose schedule, potentially even switching between the two over the course of treatment.
| Sublocade | Brixadi | |
|---|---|---|
| Dosing options | Monthly only | Weekly or monthly |
| Typical maintenance dose | 100mg monthly (300mg option available) | 8-32mg weekly or 64-128mg monthly |
| Administration | Subcutaneous injection by a provider | Subcutaneous injection by a provider |
| Starting requirement | Stabilized on transmucosal buprenorphine | Stabilized on transmucosal buprenorphine |
According to FDA prescribing information, Sublocade follows a fixed loading-then-maintenance schedule: two 300mg injections followed by 100mg (or 300mg, if needed) every month, with no weekly option available. Brixadi's FDA label instead offers two separate formulations from the start — a weekly injection (8-32mg) or a monthly injection (64-128mg) — giving providers and patients more flexibility in choosing an interval up front.
Getting Started on Either Medication
Because both Sublocade and Brixadi are only administered by a healthcare provider, you can't fill a prescription for either one at a regular retail pharmacy and take it home. Each medication is distributed exclusively through its own REMS program, which restricts distribution to certified healthcare settings and pharmacies that, in turn, dispense the medication only to a provider for administration — never directly to a patient. In practice, this means every dose is given as part of a clinical visit, whether that's your first loading injection or a routine monthly follow-up. If you're starting treatment, your provider will first confirm you're stabilized on sublingual buprenorphine, then schedule the injection visit(s) needed to begin either product.
Which One Is Right for You?
There's no single "better" option between Sublocade and Brixadi — the right fit depends on a few personal and clinical factors. One is simply how you feel about visit frequency: some patients prefer the lower visit burden of a monthly injection, while others like the more frequent check-ins and dose flexibility that a weekly schedule provides, at least initially. Another factor is where you are in treatment — Sublocade's structured loading-dose approach was studied specifically as a path from daily sublingual buprenorphine into monthly dosing, while Brixadi's weekly-or-monthly design offers more flexibility to titrate a dose up or down as your needs change. Your prior treatment history, how you've responded to buprenorphine so far, and your provider's clinical judgment all factor into the decision as well. Rather than deciding on your own, this is a conversation to have directly with your provider, who can weigh these factors against your specific history and goals.
The American Society of Addiction Medicine's National Practice Guideline notes that extended-release injectable buprenorphine carries no risk for patient diversion or misuse, unlike sublingual forms which carry some risk. It also points to a reduced dosing burden compared to taking medication daily, and less fluctuation in blood buprenorphine levels between doses — both of which can support more stable, consistent treatment.
This article is for general educational purposes and isn't a substitute for individualized medical advice. Your treatment plan should be developed with your own provider based on your specific health history.