Switching from Suboxone to Sublocade
Patients must be stabilized on a transmucosal buprenorphine dose of 8-24 mg daily for at least 7 days before initiating Sublocade, with the first injection being 300 mg subcutaneously monthly.
Pre-Transition Requirements
Stabilization Phase
- Ensure the patient is on a stable dose of sublingual buprenorphine/naloxone (Suboxone) of 8-24 mg daily for a minimum of 7 days before administering the first Sublocade injection 1
- The typical stabilization dose is 16 mg daily, with a range of 4-24 mg for maintenance treatment of opioid use disorder 2
- Verify adherence and adequate symptom control (withdrawal suppression and craving management) on the current Suboxone regimen before proceeding 3
Transition Protocol
Initial Sublocade Dosing
- Administer 300 mg of Sublocade subcutaneously as the first injection 1
- The standard dosing schedule is 300 mg monthly for the first two months, followed by 100 mg monthly for maintenance 1
- Continue the patient's daily Suboxone dose on the same day as the first Sublocade injection and for the first 24 hours to maintain therapeutic buprenorphine levels during the transition 4
Injection Site Selection
- Approved injection sites include the abdomen (standard), upper arm, thigh, or buttocks 1
- All sites provide comparable bioavailability and maintain therapeutic buprenorphine plasma concentrations at approximately 2 ng/mL or above 1
- The upper arm and thigh produce approximately 39% and 52% higher peak concentrations (Cmax) respectively compared to the abdomen, but this does not increase adverse events 1
Post-Transition Monitoring
First Week Considerations
- Discontinue Suboxone after the first 24 hours following Sublocade injection 4
- Monitor for withdrawal symptoms, cravings, and adverse effects during the first week, as this is when most issues emerge 5, 3
- Assess injection site for pain, tenderness, erythema, induration, and swelling 1
Ongoing Management
- Continue monthly Sublocade injections (300 mg for month 2, then 100 mg monthly thereafter) 1
- Regular monitoring for treatment response, including withdrawal symptom control and craving management 3
- Urine drug screening to detect illicit opioid use 3
Common Pitfalls and Cautions
Critical Warnings
- Do not initiate Sublocade in patients not already stabilized on transmucosal buprenorphine, as this may precipitate severe withdrawal 6
- Avoid concomitant use with QT-prolonging agents, as this is contraindicated 6, 4
- Be aware of multiple potential drug-drug interactions that may result in QT-interval prolongation, serotonin syndrome, or paralytic ileus 6
Patient Selection Considerations
- Sublocade is particularly appropriate for patients with adherence challenges to daily sublingual dosing 3
- Consider patient preference for injection site, as chronic treatment requires repeated injections 1
- Patients with a recent history of relapse, concurrent psychiatric disorders, or limited social support require closer monitoring during the transition 2
Expected Side Effects
- Approximately 50% of patients report adverse events during the first 4 weeks, decreasing to 26.6% at 4 months 5
- Common side effects include headache and constipation, which may be more pronounced initially 2
- Injection site reactions are expected but generally well-tolerated across all injection sites 1