Sublocade 100 mg to Suboxone Conversion
Sublocade 100 mg monthly injection is approximately equivalent to 8-16 mg/day of sublingual Suboxone (buprenorphine/naloxone), though the extended-release formulation provides sustained therapeutic levels that differ from daily sublingual dosing patterns.
Understanding the Conversion Context
The conversion between Sublocade (extended-release subcutaneous buprenorphine) and Suboxone (sublingual buprenorphine/naloxone) is not a straightforward 1:1 equivalency due to fundamental differences in pharmacokinetics:
- Sublocade 100 mg delivers sustained buprenorphine levels over one month through a depot injection formulation 1
- Sublingual Suboxone requires daily dosing with variable bioavailability (40 minutes to 3.5 hours to peak concentration) and extensive first-pass metabolism 2
- The extended-release injection maintains more stable plasma concentrations compared to the peaks and troughs of daily sublingual administration 1
Clinical Equivalency Guidelines
Transitioning FROM Sublingual TO Sublocade 100 mg
Patients should be stabilized on a minimum of 8 mg/day sublingual buprenorphine before initiating Sublocade 100 mg 1. This represents the lower threshold for appropriate conversion.
Transitioning FROM Sublocade 100 mg TO Sublingual
When discontinuing Sublocade, a single 100 mg injection can facilitate complete opioid cessation in patients previously maintained on low-dose sublingual buprenorphine (specific doses not exceeding 8-16 mg/day range) 3. This demonstrates that 100 mg Sublocade provides coverage equivalent to ongoing daily sublingual therapy in this dose range.
Practical Dosing Algorithm
For patients currently on sublingual buprenorphine:
- 8-16 mg/day sublingual → Sublocade 100 mg monthly is appropriate 3, 1
- Higher doses (>16 mg/day) → Consider Sublocade 300 mg for initial dosing (not the 100 mg formulation)
For patients transitioning off Sublocade 100 mg:
- Resume sublingual dosing at 8-16 mg/day if returning to daily therapy 3
- Alternatively, use the 100 mg injection as a final taper dose to facilitate complete discontinuation 3
Critical Pharmacokinetic Considerations
Bioavailability Differences
- Sublingual buprenorphine has extensive first-pass metabolism with variable bioavailability 2
- Sublocade bypasses first-pass metabolism entirely, providing more consistent drug exposure 1
- The terminal elimination half-life of buprenorphine ranges from 3-44 hours, contributing to sustained effects even with sublingual dosing 2
Depot Characteristics
- Sublocade provides sustained release over 30 days with detectable plasma levels extending beyond one month 1
- This eliminates daily dosing compliance issues inherent to sublingual formulations 1
Common Pitfalls to Avoid
Do not assume direct mg-to-mg equivalency: 100 mg of Sublocade delivered over one month is NOT equivalent to 100 mg total of sublingual buprenorphine over that same period. The depot formulation provides therapeutic coverage roughly equivalent to 240-480 mg total sublingual buprenorphine over 30 days (8-16 mg × 30 days) 3, 1.
Avoid premature conversion: Patients must be stabilized on sublingual therapy before transitioning to Sublocade to prevent precipitated withdrawal 1.
Monitor for CYP3A4 interactions: Buprenorphine undergoes extensive N-dealkylation via CYP3A4, and inhibitors or inducers of this enzyme can alter drug levels regardless of formulation 2.
Special Population Considerations
- Renal impairment: Buprenorphine dosage adjustment is generally not required, as only 10-30% is excreted renally 2
- Hepatic impairment: CYP3A4 activity may be decreased in severe chronic liver disease, potentially altering metabolism of both formulations 2
- Pregnancy and lactation: Buprenorphine crosses the placenta and enters breast milk regardless of formulation 2