How long must a patient be on Suboxone (buprenorphine) before starting Sublocade (buprenorphine)?

Duration of Suboxone Treatment Before Starting Sublocade

Patients should be on a stable dose of at least 8 mg daily of sublingual buprenorphine (Suboxone) for at least 7 days before transitioning to Sublocade (extended-release buprenorphine injection). This stabilization period ensures the patient can tolerate buprenorphine and minimizes the risk of precipitated withdrawal when starting the long-acting injectable formulation.

Buprenorphine Stabilization Requirements

• Patients must be on a stable dose of sublingual buprenorphine (Suboxone) before initiating Sublocade to ensure tolerance and avoid withdrawal symptoms 1
• The stabilization period on sublingual buprenorphine should be at least 7 days before transitioning to the injectable formulation 1
• The recommended minimum dose of sublingual buprenorphine during this stabilization period is 8 mg daily 1

Rationale for Stabilization Period

• Buprenorphine is a partial mu-opioid receptor agonist that can precipitate withdrawal if initiated in patients with full opioid agonists still in their system 2
• The stabilization period ensures:
  • Patient tolerability to buprenorphine is established 2
  • Risk of precipitated withdrawal is minimized 2
  • Appropriate dosing needs are identified 2

Transition Process from Suboxone to Sublocade

• After the stabilization period on sublingual buprenorphine, patients can receive their first Sublocade injection 1
• Initial Sublocade dosing typically starts with 300 mg subcutaneously for the first two months 3
• Subsequent monthly maintenance doses may be adjusted to 100 mg or continued at 300 mg based on clinical response 3

Special Considerations

• The transition should be individualized based on:
  • The patient's current sublingual buprenorphine dose 2
  • Risk of relapse 2
  • Treatment history with buprenorphine 2
• For patients on higher doses of sublingual buprenorphine (>8 mg daily), the 300 mg initial dose of Sublocade is particularly appropriate 3

Emerging Approaches

• Recent research has explored "direct-to-inject" approaches that bypass the sublingual stabilization period, but these are not yet standard practice and require further evaluation 4
• Traditional approaches with sublingual stabilization remain the standard of care and have demonstrated better safety profiles 1, 3

Treatment Outcomes

• Monthly Sublocade injections have shown high retention rates (approximately 50-75% at 12 months) 3
• The extended-release formulation eliminates daily dosing requirements, potentially improving adherence and reducing misuse risk 1
• Patients report improved quality of life with the monthly injection compared to daily sublingual administration 1