Brixadi (buprenorphine) is a prescription drug that’s used to treat opioid use disorder (OUD). Brixadi comes as a liquid solution in a prefilled syringe. You’ll receive Brixadi as an injection under your skin at your doctor’s office.

Brixadi is prescribed for adults to treat moderate to severe OUD. It belongs to a group of drugs called partial opioid agonists.

Brixadi is prescribed in combination with counseling and psychotherapy.

To learn more about Brixadi’s uses, see the “What is Brixadi used for?” section below.

Brixadi basics

Brixadi contains the active ingredient buprenorphine. (An active ingredient is what makes a drug work.)

Brixadi is a brand-name medication that’s given as an injection. It’s not available in a generic version. But buprenorphine is available in other forms, such as oral tablets.

Find answers below to some commonly asked questions about Brixadi.

How does Brixadi compare with Sublocade?

Both Brixadi and Sublocade are used to treat moderate to severe opioid use disorder (OUD). They contain the same active ingredient,* buprenorphine, and are both partial opioid agonists.

Both drugs are injected under the skin by a healthcare professional.

Your doctor may prescribe Brixadi to be injected once per week or once per month. It can be injected under the skin of your buttock, thigh, abdomen, or upper arm.

Sublocade is injected once per month. It’s only injected under the skin of your abdomen.

If you have other questions about how Brixadi and Sublocade compare, talk with your doctor. They can help you find the best treatment for you.

* An active ingredient is what makes a drug work.

Is Brixadi safe for older adults?

It’s likely that Brixadi is safe for older adults. Studies of Brixadi didn’t include many adults ages 65 years and older. But generic buprenorphine has been shown to be safe in older adults.

As an older adult, you may be more sensitive to some of Brixadi’s side effects, such as its effects on breathing.

If you have questions about whether it’s safe for you to receive Brixadi, talk with your doctor.

Is Brixadi used for opioid overdose?

No, Brixadi is not used for opioid overdose. Narcan (naloxone) is the preferred treatment for opioid overdose. Your doctor will likely recommend that you have Narcan available during your treatment with Brixadi.

Narcan is a nasal spray that can be used in an emergency to treat an opioid overdose. If you have Narcan, let your family and companions know where they can find it in an emergency. And let them know that if they give you Narcan to treat an opioid overdose, you’ll still need medical care. They should call 911 or take you to the nearest emergency room after giving you Narcan.

Other drugs are available that can treat your condition. The following drugs are similar to Brixadi:

If you’d like to explore an alternative to Brixadi, talk with your doctor. They can tell you about other medications that might work well for you.

Brixadi is prescribed for adults with moderate to severe opioid use disorder (OUD). With OUD, people continue to use opioids despite negative consequences. Opioids include prescription drugs, such as oxycodone, and illegal drugs, such as heroin.

Brixadi is a partial opioid agonist. It attaches to opioid receptors throughout the nervous system and blocks stronger opioids from attaching. It helps to reduce opioid cravings without causing a “high.” With time, Brixadi can help decrease your body’s dependence on opioids.

Brixadi is usually prescribed as part of a treatment program for OUD with counseling and psychotherapy.

If you’re wondering whether Brixadi might be a good choice for you, talk with your doctor.

Like most drugs, Brixadi may cause mild or serious side effects. The lists below describe some of the more common side effects that Brixadi may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Brixadi. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a list of some of the mild side effects that Brixadi can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Brixadi’s prescribing information.

Mild side effects of Brixadi that have been reported include:

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

* To learn more about this side effect, see the “Allergic reaction” section below.

Serious side effects

Serious side effects from Brixadi can occur, but they aren’t common. If you have serious side effects from Brixadi, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Brixadi that have been reported include:

* For more information, see the “What should be considered before receiving Brixadi?” section below.
† To learn more about this side effect, see the “Allergic reaction” section below.

Allergic reaction

Some people may have an allergic reaction to Brixadi.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, usually in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Brixadi. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Your doctor will recommend the dosage of Brixadi that’s right for you. Below are commonly used dosages, but the dosage you receive will be determined by your doctor.

Form and strengths

Brixadi is an extended-release* medication. It comes as a liquid solution in single-dose, prefilled syringes. It’s given as an injection under your skin.

Brixadi’s available strengths depend on whether you receive it once per week or once per month. Strengths are listed in milligrams (mg) of drug per milliliter (mL) of liquid solution.

If given weekly, Brixadi is available in the following strengths:

  • 8 mg/0.16 mL
  • 16 mg/0.32 mL
  • 24 mg/0.48 mL
  • 32 mg/0.64 mL

If given monthly, Brixadi is available in these strengths:

  • 64 mg/0.18 mL
  • 96 mg/0.27 mL
  • 128 mg/0.36 mL

* “Extended release” means the drug is slowly released into your body over a long period of time.

Recommended dosages

Your doctor will recommend the dosage of Brixadi that’s right for you. Below are commonly used dosages, but the dosage you receive will be determined by your doctor.

Treatment for opioid use disorder

Brixadi is prescribed for treatment of opioid use disorder (OUD). It’s an extended-release medication that’s slowly released into your body over a long period of time. It may be given as an injection every 7 days (weekly) or as an injection every 28 days (monthly).

Before starting treatment with Brixadi, you’ll first need to take generic buprenorphine as a sublingual tablet (SLT).* Your initial treatment with Brixadi depends on whether you’re currently taking buprenorphine SLT:

  • If you’re currently taking buprenorphine SLT. If you’ve been taking a stable dose of buprenorphine SLT, your doctor can transition you to treatment with Brixadi directly. Your doctor may recommend the weekly or monthly injection.
  • If you’re not currently taking buprenorphine SLT. If you haven’t been taking buprenorphine SLT, your doctor will have you take a test dose to check whether you have withdrawal symptoms. If you don’t experience any withdrawal symptoms, your doctor may recommend weekly injections of Brixadi. If you do have withdrawal symptoms, your doctor may recommend that you first start treatment with buprenorphine. Buprenorphine SLT works faster and doesn’t last as long. This allows your doctor to adjust treatment as needed to best manage any withdrawal symptoms.

When you start treatment with Brixadi, your doctor will decide whether a weekly or monthly schedule is right for you.

Depending on your prior buprenorphine SLT dosage, your starting dosage of Brixadi may range from 8–32 mg per week or 64–128 mg per month. Your doctor will adjust your dosage as needed to manage your symptoms. The maximum dosage of Brixadi is 32 mg per week or 128 mg per month.

To learn more about Brixadi’s dosage, see this article.

* A sublingual tablet is an oral tablet that dissolves under your tongue.

How Brixadi is administered

Your doctor will explain how Brixadi will be given to you. They’ll also explain how much you’ll be given and how often.

Brixadi is available as a liquid solution that’s given as an injection under your skin. You’ll receive these injections at your doctor’s office or a clinic.

Brixadi can be injected under the skin of the buttock, thigh, abdomen, and upper arm. If you receive Brixadi injections each week, the injection site will be rotated to a different area each week so that you don’t receive the injection in the same area twice in a row.

If you receive Brixadi injections once per month, the injection site doesn’t need to be rotated.

If you have questions about what to expect during your Brixadi injections, talk with your doctor.

Questions about receiving Brixadi

Below are some common questions about treatment with Brixadi.

  • Is there a best time of day to take Brixadi? No. You can receive your injection at a time that’s convenient for you.
  • What if I miss a dose of Brixadi? If you miss an appointment to receive an injection of Brixadi, call your doctor’s office as soon as possible to reschedule. Weekly doses can be given up to 2 days before or after your scheduled dose. Monthly doses can be given up to 1 week before or after your scheduled dose.
  • Will I need to use Brixadi long term? Maybe. You and your doctor will work together to determine how long you’ll receive Brixadi.

Below is important information you should consider before receiving Brixadi.

Interactions

Taking a drug with certain medications, vaccines, foods, and other things can affect how the drug works. These effects are called interactions.

Brixadi can interact with several other medications.

Before receiving Brixadi, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

Drug interactions

Below is a list of medications that can interact with Brixadi. This list doesn’t contain all drugs that may interact with Brixadi. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drug group or drug nameDrug examples
benzodiazepines• diazepam (Valium)
• alprazolam (Xanax)
insomnia drugs• zolpidem (Ambien)
• eszopiclone (Lunesta)
opioids• hydrocodone (Hysingla ER)
• oxycodone (OxyContin)
• tramadol (ConZip)
• fentanyl (Fentora)
drugs that slow down the CYP3A4 enzyme* • ketoconazole
• erythromycin (Eryc, Ery-Tab)
drugs that speed up the CYP3A4 enzyme*• rifampin (Rifadin)
• phenytoin (Dilantin)
certain HIV drugs• doravirine (Pifeltro)
• efavirenz
• atazanavir (Reyataz)
certain antidepressants• amitriptyline
• sertraline (Zoloft)
• duloxetine (Cymbalta)
• mirtazapine (Remeron)
monoamine oxidase inhibitors (MAOIs)• phenelzine (Nardil)
• linezolid (Zyvox)
muscle relaxants• cyclobenzaprine (Amrix)
• methocarbamol (Robaxin)
diuretics (fluid pills)• hydrochlorothiazide (Microzide)
• furosemide (Lasix)
certain drugs for Parkinson’s disease• benztropine
• trihexyphenidyl
certain antihistamines• diphenhydramine (Benadryl)
• chlorphenamine

* Cytochrome P450 3A4 (CYP3A4) is an enzyme in the liver that helps to break down certain drugs, including Brixadi.

Interaction with alcohol

It’s not safe to consume alcohol while receiving Brixadi. Both alcohol and Brixadi are central nervous system (CNS) depressants and can slow brain activity. CNS refers to the brain and spinal cord.

Drinking alcohol while receiving Brixadi can increase the risk of falls. It can also cause people to feel extremely sleepy or clumsy. In rare cases, combining Brixadi with other CNS depressants, such as alcohol, has led to coma and death.

If you drink alcohol and have questions about its safety during Brixadi treatment, talk with your doctor or pharmacist.

Other interactions

Brixadi can interact with other substances such as:

  • Vitamins or supplements: Brixadi interacts with St. John’s wort. Your doctor may recommend that you avoid taking this supplement during your Brixadi treatment.
  • Foods: Brixadi can interact with grapefruit and grapefruit juice. Your doctor may recommend that you do not consume grapefruit products during your Brixadi treatment.

Before starting Brixadi treatment, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you take. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

Pregnancy

It’s not known whether treatment with Brixadi is safe during pregnancy. Brixadi hasn’t been studied in adults who are pregnant.

However, it is known that a fetus exposed to certain substances while in the womb can become dependent* on those substances. The newborn may experience withdrawal symptoms when those substances are no longer present. This condition is known as neonatal abstinence syndrome (NAS).

When exposed to partial opioid agonists, such as Brixadi, or opioids in the womb, a fetus may develop opioid dependence. A newborn who has become dependent on opioids will experience a type of NAS called neonatal opioid withdrawal syndrome (NOWS).

While serious, NOWS is treatable. Withdrawal symptoms of NOWS include:

There are risks to receiving Brixadi while pregnant, but there are also risks to having untreated opioid use disorder while pregnant. If you’re pregnant, talk with your doctor about the possible risks of Brixadi. Also, tell your healthcare team about any medications or other substances you’ve taken during your pregnancy. This can help them to prepare for your medical needs and those of the newborn.

* With dependence, the body needs the drug to function as usual.

Breastfeeding

It’s likely safe to breastfeed your child while receiving Brixadi. Studies have shown that buprenorphine, the active ingredient in Brixadi, passes into breast milk in very small amounts when taken as a tablet that dissolves under the tongue. Children who were breastfed in these studies did not experience any harmful effects. However, your doctor may suggest monitoring your child for sleepiness, breathing problems, or difficulty feeding.

If you’re considering breastfeeding while receiving Brixadi, talk with your doctor to learn more.

Boxed warning

Brixadi has a boxed warning about the risk of serious harm or death if injected into a vein. A boxed warning is the most serious warning from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

Brixadi is given as an injection under the skin. Brixadi should not be injected into a vein. If Brixadi is injected into a vein, it may cause damage to nearby tissue. It can also cause blood clots to form. A blood clot can stop blood flow in the blood vessel. Blood clots can also travel to other parts of the body, such as the lungs and brain. In rare cases, it can lead to death.

Due to these risks, Brixadi is only administered by a healthcare professional. And the drug is only available through a risk evaluation and mitigation strategy (REMS) program. The FDA requires REMS programs for certain drugs to help make sure they’re administered safely.

Other warnings

Brixadi can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether Brixadi is a good treatment option for you.

Talk with your doctor about your health history before you take Brixadi. Be sure to tell them if any of the following factors apply to you:

Whether you have health insurance or not, cost may be a factor when you’re considering Brixadi. What you’ll pay for Brixadi may depend on several things, such as your treatment plan and the pharmacy you use.

Here are a few things to consider regarding cost:

  • Cost information and savings coupons: You can visit Optum Perks* to get price estimates of what you’d pay for Brixadi when using coupons from the site.
  • Copay savings program: Talk with your doctor or pharmacist if you have questions about how to pay for your prescription. You may be eligible for a copay assistance program from the drug’s manufacturer.

You can also check out this article to learn more about saving money on prescriptions.

* Optum Perks is a sister site of Healthline. Optum Perks coupons cannot be used with insurance copays or benefits.

Brixadi is a partial opioid agonist. Long-term treatment with Brixadi can cause dependence. With dependence, your body needs the drug to function as usual.

If you abruptly stop treatment with Brixadi, you can experience withdrawal symptoms. These are symptoms that can occur once your body has become dependent on Brixadi.

Symptoms of Brixadi withdrawal are typically milder than symptoms of opioid withdrawal. Brixadi withdrawal symptoms also take longer to appear. Brixadi withdrawal symptoms can include:

If you and your doctor decide to stop or lower your dosage of Brixadi, your doctor will closely monitor you for withdrawal symptoms for several months. If you experience withdrawal symptoms, they can prescribe buprenorphine to help relieve your symptoms.

If you have questions or concerns about withdrawal symptoms or your risk of dependence with Brixadi, talk with your doctor.

If you have questions about your Brixadi treatment, talk with your doctor or pharmacist. Questions you may want to ask include:

  • How will my pain be treated if I need surgery or have an injury while receiving Brixadi?
  • How long can I expect to receive Brixadi?
  • Can I transition to monthly Brixadi injections after being on weekly Brixadi injections for a while?

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.