Brixadi injection: what to expect

Brixadi is buprenorphine in an extended-release form, made in a weekly version and a monthly version.

It is a Schedule III controlled medication and is available only through a restricted safety program (REMS); only healthcare providers prepare and give it.

Adults with moderate to severe opioid use disorder who have started treatment with a dose of buprenorphine under the tongue, or who already take buprenorphine.

A healthcare provider gives the injection under the skin of the buttock, thigh, abdomen or upper arm. It is never self-injected.

• With the weekly version, the same spot is not used again for at least 8 weeks.
• For people new to Brixadi, the upper arm is used only after 4 doses in a row.

Weekly doses are given every 7 days. Monthly doses are given every 28 days, and can be given up to 1 week before or after that day.

A person new to buprenorphine takes a 4 mg test dose under the tongue once withdrawal signs appear. If it is tolerated, the first weekly injection follows. The monthly version has not been studied for people new to treatment, so they begin with weekly doses.

• A person already taking buprenorphine under the tongue can switch directly to weekly or monthly Brixadi, at a dose matched to their daily dose.
• Insurance plans often require prior authorization before the first injection. Our front desk can check your insurance before your first visit.
• Injections are given at in-person visits in our West Ashley office.

Treatment typically begins with an in-person assessment, followed by weekly in-person or virtual visits before moving to a monthly schedule. Each plan is tailored to the patient and their situation.

If problems come up, visits become more frequent again until things are steady.

• A withdrawal check at every visit, using the Subjective Opiate Withdrawal Scale (SOWS).
• A urine drug test at every visit: a point-of-care test in our West Ashley office or a test at a local lab near you, with confirmatory lab testing when a result needs it.
• A urinalysis when needed. Some people have trouble urinating while taking buprenorphine, so we check for urinary retention or a urinary tract infection when symptoms point to it.
• Screening for depression and anxiety at every visit.
• Monthly counseling, alongside your medication visits.
• Each injection is given by a healthcare provider in our West Ashley office; it is never self-injected.
• A review of how you are doing, side effects and your goals.

• Tell your provider about every medicine you take, especially benzodiazepines or other sedatives, which can slow breathing dangerously.
• Keep an overdose reversal medicine such as naloxone on hand; the label asks providers to strongly consider prescribing or recommending one.
• At a stable prescribed dose, buprenorphine does not cause a high, and its overdose risk is much lower than illicit opioids. It can still be dangerous with alcohol, benzodiazepines or other sedatives, and it must be locked away from children.