Can a patient on Suboxone 4 mg/1 mg buprenorphine‑naloxone be switched to Brixadi (buprenorphine‑naloxone film) or Sunlocade (buprenorphine‑naloxone tablet) using the same dose and schedule?

Switching from Suboxone 4/1 mg to Brixadi

A patient on Suboxone 4 mg/1 mg can be switched directly to Brixadi 8 mg weekly, but cannot be switched to Sublocade at this dose level, as Sublocade only offers 100 mg and 300 mg monthly formulations without the dosing flexibility needed for lower-dose patients.

Key Clarification

First, it's important to clarify the terminology in your question:

• Brixadi is the long-acting injectable buprenorphine depot (available in weekly and monthly formulations)
• Sublocade is a different long-acting injectable buprenorphine depot (monthly only, with limited dose options)
• Neither is a "film" or "tablet" - both are subcutaneous injections
• Suboxone is the sublingual film/tablet you're currently using

Switching to Brixadi (Recommended Option)

Dose Conversion

According to the FDA-approved Brixadi labeling, patients on ≤6 mg daily sublingual buprenorphine should receive Brixadi 8 mg weekly 1. Your patient on Suboxone 4/1 mg falls into this category.

Transition Protocol

The switch can occur within 24 hours of the last sublingual dose 1:

• Day 1: Administer first Brixadi 8 mg weekly injection subcutaneously (buttock, thigh, abdomen, or upper arm)
• Continue weekly: Repeat Brixadi 8 mg every 7 days
• Dose adjustments: Can be made at weekly appointments if needed, though 8 mg weekly is appropriate for this patient's current dose

Important Considerations

• No monthly option initially: Brixadi monthly formulations are only for patients already on transmucosal buprenorphine at higher doses (≥8 mg daily) 1
• Monitoring: Assess for withdrawal symptoms, cravings, and injection site reactions at each visit
• Flexibility: Recent evidence suggests same-day transitions are well-tolerated with minimal withdrawal (4% requiring additional support) 2

Why Not Sublocade?

Sublocade is not appropriate for this patient because:

• Sublocade only comes in 100 mg and 300 mg monthly doses 3
• The FDA labeling requires patients to be on at least 8-10 mg daily sublingual buprenorphine before switching
• Your patient at 4 mg daily is below this threshold
• Sublocade lacks the dosing flexibility that Brixadi offers for lower-dose patients

Clinical Advantages of This Approach

Brixadi's weekly formulation provides several benefits for this patient:

• Improved adherence: Eliminates daily dosing burden 3
• Reduced diversion risk: No take-home medication
• Maintained stability: The 8 mg weekly dose provides equivalent coverage to 4 mg daily sublingual
• Treatment retention: Studies show >90% retention when switching formulations 4

Common Pitfalls to Avoid

• Don't wait for withdrawal: Unlike traditional buprenorphine induction, patients already stable on sublingual buprenorphine can switch within 24 hours without precipitated withdrawal 1, 2
• Don't underdose: Ensure the full 8 mg weekly injection is given; this is not the same as 8 mg total per week divided into daily doses
• Don't confuse products: Brixadi and Sublocade are different products with different dosing schemes and cannot be used interchangeably

Monitoring Plan

After initiating Brixadi:

• Weekly visits for first month to assess response and injection site
• Evaluate: Withdrawal symptoms, cravings (VAS scale), treatment satisfaction
• Adjust: Can increase to 16 mg weekly if clinically indicated, though most patients at this baseline dose remain stable on 8 mg weekly 1