Which buprenorphine injection is better, Brixadi or Sublocade?
Brixadi and Sublocade are both on the market, and both are approved by the Food and Drug Administration, or FDA, for moderate to severe opioid use disorder, which is the label’s name for opioid addiction. When I first wrote this article in 2019, Sublocade was two years old and Brixadi was still waiting on the FDA. That wait ended on May 23, 2023, and the question is no longer whether Brixadi is coming, but which injection is right for you.
Some people call both of them the Suboxone shot. The nickname is a shortcut, and it is wrong on the ingredient, because Suboxone contains naloxone and neither injection does. They are buprenorphine, the same medication found in Suboxone, ZubSolv, and the old Subutex tablets, delivered as a depot under the skin instead of a film under the tongue.
I have spent more than two decades treating medication and drug dependence and addiction as an osteopathic physician, and buprenorphine has been in my hands for most of that time. So, with two injections on the shelf, how are they different, and does the difference matter to you?
Both injections are the same medicine in a different package.
Buprenorphine is a partial opioid agonist. It binds tightly to the opioid receptor, holds on, and activates it only part of the way, which is why it relieves withdrawal and craving without the highs and lows of a full opioid. Physical dependence is not addiction, and buprenorphine treatment addresses both, the dependence by keeping the receptor occupied and the addiction by taking the daily hunt for opioids off the table.
Sublocade, made by Indivior, was approved by the FDA on November 30, 2017, as a once-monthly injection. Brixadi, made by Braeburn, followed on May 23, 2023, in a weekly form and a monthly form. Each one is a liquid in a prefilled syringe that turns into a small depot under the skin, Sublocade as a solid mass and Brixadi as a gel, and the depot lets buprenorphine out slowly as it dissolves.
The medicine is the same. The calendar is not.
How often is each one given, and in what strengths?
Sublocade is a monthly injection, and it comes in two strengths, 100 mg and 300 mg. The Sublocade prescribing information calls for two initial doses of 300 mg, the second as early as a week after the first, then 100 mg each month with at least 26 days between maintenance injections, and it allows a 300 mg monthly maintenance dose for a patient who tolerates 100 mg but does not do well enough on it. That is the whole menu.
Brixadi comes in seven. The weekly injection is available in 8 mg, 16 mg, 24 mg, and 32 mg, and the monthly injection in 64 mg, 96 mg, and 128 mg, according to the Brixadi prescribing information. A patient can move from weekly to monthly, or from monthly back to weekly, on the doctor’s judgment, and an extra 8 mg weekly dose can be added inside a dosing interval up to the labeled maximum.
So, Brixadi is the more adjustable product on paper. Does the extra menu matter? Only if your dose is still moving.
Where does the shot go, and does it need a refrigerator?
For years the answer for Sublocade was the abdomen only, and I wrote exactly that in 2019. The current Sublocade prescribing information, revised in February 2025, allows the abdomen, the thigh, the buttock, or the back of the upper arm. While Brixadi lists the buttock, thigh, abdomen, and upper arm, its label adds one caveat: in a patient new to buprenorphine, the weekly injection goes in the arm only after four consecutive doses, because arm injections run about 10 percent lower in blood level.
Storage is the difference that survived. Sublocade lives in a refrigerator, though the label now allows it to sit at room temperature for up to 12 weeks before it must be discarded. Brixadi is stored at room temperature, with no cold chain at all, which is a real convenience for a small office and a small point for a patient.
A refrigerator has never given anyone medical advice, yet, it has decided which injection more than one clinic stocks. Keep that in mind when a clinic tells you which product it prefers. The preference may be about the office, not about you.
How do you start, and what do the two have in common?
Both labels require that you tolerate buprenorphine under the tongue before anything goes under the skin. Sublocade, since the February 2025 label, can follow a single transmucosal dose, meaning a film or tablet under the tongue or in the cheek, after one hour of observation, and the old rule of a full week on films first is gone. Brixadi weekly can also follow a single test dose, while Brixadi monthly is only for a patient who is already taking buprenorphine, according to its prescribing information.
If you are already stable on films or tablets, either product can take over directly. In fact, the person already on buprenorphine is the easy case for both, and the person who has never taken it is the careful case for both, because a depot cannot be taken back the way a film can.
Yet, the two injections share most of their fine print. Each carries a boxed warning that injecting it into a vein could cause serious harm or death, and each is available only through a Risk Evaluation and Mitigation Strategy, or REMS, program.
Each is prepared and given by a doctor or nurse in a certified setting, never handed to the patient. Injection site pain and itching, headache, constipation, and nausea are common on both labels, and the Sublocade depot can be surgically removed within 14 days of the injection if it must come out.
The product that wins on paper is not always the one that wins in the clinic.
I wrote this in 2019, and I believe it more today. Brixadi has the more flexible label: two schedules, seven strengths, four sites, and no refrigerator. Sublocade has something that no label can list, nearly nine years of real patients, and patients have told me that the monthly injection felt as steady as their daily films, minus the films.
While this is not a perfect analogy, choosing between the two from their labels is like choosing a car from the brochure. The brochure with more features is not automatically the car you want to drive every morning. What tells you how the car drives is the test drive, and in medicine the test drive is other patients, over years, in ordinary life.
Of course, that is not a knock on Brixadi. While its patients are still accumulating their years, they are accumulating them, and the label gives them more room to adjust along the way. Read the label, then ask what happened in the clinic, because you need both answers.
Which patients does each injection suit?
The best candidate for either injection is a person who is already stable on buprenorphine, tolerates it well, and is tired of the daily ritual. If films get lost, argued over, or counted in your house, or your work makes daily dosing awkward, a depot solves a real problem.
Is your dose settled, or still moving? Do you want to commit to a week or to a month? Do you plan to be off of buprenorphine within the year, or not at all? Those three questions sort most patients.
Sublocade suits the patient whose dose is settled and who wants the product with the longest track record. Brixadi suits the patient whose dose is still being adjusted, or who wants to try an injection for a week before committing to a month of it.
And, the films and tablets still have their place. While an injection means an in-person visit at a certified office every week or every month, sublingual buprenorphine can be adjusted this week, filled at the least expensive pharmacy, and prescribed by telemedicine.
Unfortunately, there is no one-size-fits-all answer, and I would distrust any clinic that says otherwise. Fortunately, there are now three good forms of the same medicine, and the choice is yours to make with a doctor who knows you. There is more on who the depots suit on the Sublocade and Brixadi information page, and more on the films on the buprenorphine treatment page.
What do Brixadi and Sublocade cost?
While both are expensive, the bill depends on your plan, and depending on the plan, both often arrive through a specialty pharmacy after a prior authorization rather than over a pharmacy counter. Brixadi’s manufacturer offers a copay assistance program, and the eligibility rules and application steps are in Brixadi Copay Assistance Programs. Ask whether Sublocade’s manufacturer has a program that applies to you as well.
Price is a fair reason to choose one injection over the other once you know what your plan will cover. It is not a bad idea to ask before the first injection rather than after.
Can a long-acting injection work as a built-in taper off of Suboxone?
This is an idea I have been turning over since 2019, and I want to label it plainly as my own clinical reasoning, not an established protocol. Tapering off of sublingual buprenorphine is hard at the bottom, because the films and tablets do not come in pieces small enough for the last steps. A depot that is allowed to wear off has no bottom step, because the level just keeps falling on its own.
After the final injection, the blood level of buprenorphine falls by roughly the same fraction with each passing stretch of time, so the drops are large at first and smaller and smaller as the level gets low.
That is the same shape as the percentage-based, hyperbolic descent I use for sublingual buprenorphine tapers and for benzodiazepine and antidepressant tapers, where each reduction is a fraction of what remains rather than a fixed amount. A wearing-off depot draws that curve on its own, which is why it can behave like a taper.
In fact, the labels give a sense of the tail. Once the blood level has stopped climbing from one dose to the next, which the labels call steady state, a patient stopping Sublocade may have detectable buprenorphine for twelve months or longer, while the Brixadi label puts it at about one month after weekly dosing and about four months after monthly dosing. I have described the Sublocade version of this approach in The Sublocade Taper for Getting Off Suboxone.
Which one is better for tapering, Brixadi or Sublocade?
Nobody knows yet, and I include myself. While Sublocade offers the longest and slowest tail, which is the gentlest landing, it is also the least reversible one, because once a monthly depot is in, the next change waits for the next injection, and after the last one the level keeps falling for months on its own. Brixadi weekly offers finer control, four strengths and a new decision every week, with a tail measured in weeks instead of a year.
So, the open question is whether finer control beats a longer tail, or the other way around, and I suspect the answer will differ from one patient to the next. The right pace is set between you and your prescriber, watching how you feel, and slowed whenever it needs to be slowed.
If the taper is too fast, the doctor must help by slowing it. If it is too slow, patient and doctor may agree to go a bit faster, as tolerated. That negotiation is the taper, whichever product carries it.
What should you ask before choosing an injection?
A patient who wants an injection should ask four things: which product the office actually stocks, whether the office is certified under that product’s REMS program, what the plan will pay, and what the doctor’s own patients have reported.
Dr. Leeds does not give or arrange either injection. He can advise on them in a consultation, including choosing between Brixadi and Sublocade, the timing of a first dose so that precipitated withdrawal, the sudden withdrawal that buprenorphine sets off when it is taken too soon after an opioid, is avoided, and how to come off of a depot when the time comes.
For the films and tablets, Dr. Leeds treats new patients by telemedicine throughout Florida, with induction, the first days on the medication, done at home with phone support and a low-dose start when fentanyl is involved. Patients who would like to talk through buprenorphine treatment, or the injection question, can request a consultation through the contact form.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
