Brixadi (buprenorphine) is a brand-name drug prescribed for opioid use disorder (OUD) in adults. Brixadi comes as a solution for subcutaneous injection that’s given weekly or monthly by a healthcare professional.
Brixadi is approved by the Food and Drug Administration (FDA) to treat moderate to severe OUD in adults. Brixadi belongs to a drug class called partial opioid agonists. Brixadi isn’t available in a generic version.
Keep reading for specific information about the dosage of Brixadi, including its strengths and how the medication is given. For a comprehensive look at Brixadi, see this article.
Note: This article describes typical dosages for Brixadi provided by the drug’s manufacturer. However, your doctor will prescribe the Brixadi dosage that’s right for you.
The information below describes Brixadi’s typical dosages and other details about the drug.
Brixadi form
Brixadi comes as a solution in a single-dose prefilled syringe that’s given as an extended-release subcutaneous injection. (Extended release means the drug releases slowly into your body over a period of time.) Your doctor or another healthcare professional will administer your injections at their office or clinic.
Brixadi strengths
Brixadi injections are given weekly or monthly. Brixadi is available in the following strengths:
- Brixadi weekly:
- 8 milligrams (mg) in 0.16 milliliters (mL) of solution
- 16 mg/0.32 mL
- 24 mg/0.48 mL
- 32 mg/0.64 mL
- Brixadi monthly:
- 64 mg/0.18 mL
- 96 mg/0.27 mL
- 128 mg/0.36 mL
Typical dosages
The following information describes dosages that are commonly prescribed or recommended. However, your doctor will determine the best dosage to fit your needs.
Dosage for opioid use disorder
Doctors may prescribe Brixadi to treat opioid use disorder (OUD). Brixadi is prescribed as part of a treatment plan that includes support and counseling.
If your doctor prescribes Brixadi for OUD, you’ll receive your Brixadi injections either once per week (every 7 days) or once per month (every 28 days). Your specific dosage will depend on whether you’re already taking buprenorphine (the active drug in Brixadi).
Not currently taking buprenorphine
If you’re not currently taking buprenorphine for OUD, your doctor will give you a test dose. Specifically, they’ll give you the sublingual tablet form of generic buprenorphine. This is an oral form of the drug that dissolves under your tongue. A test dose is given to make sure you won’t have a withdrawal reaction* from stopping opioids.
After your test dose, you’ll receive weekly Brixadi injections. Your doctor will likely start by prescribing one 16-mg injection of Brixadi. Within 3 days, you’ll receive another injection of 8 mg. Your doctor may decide to give you a second injection of 8 mg at least 24 hours after the first one.
After your first week of Brixadi treatment, you’ll receive just one injection per week. Your doctor will determine your maintenance dosage based on the amount you received during the first week:
- Your maintenance dosage will be 24 mg per week if you received two injections (16 mg and 8 mg) the first week.
- Your maintenance dosage will be 32 mg per week if you received three injections (16 mg, 8 mg, and 8 mg) the first week.
Your doctor may adjust your weekly Brixadi dosage depending on how your body responds to the medication. Specifically, your doctor will monitor whether your dosage reduces your urge to take opioids or decreases your symptoms of opioid withdrawal.
The maximum recommended dosage of Brixadi is 32 mg once per week.
* A withdrawal reaction is a set of symptoms that can occur when you stop taking a drug your body has become dependent on. To learn more, see the “Brixadi and withdrawal and dependence” section below.
Currently taking buprenorphine
If you’re currently taking buprenorphine for OUD, your doctor may prescribe Brixadi instead. They’ll determine whether to prescribe weekly or monthly Brixadi injections based on your current buprenorphine dosage. For details, see the table below:
| Current daily dosage of buprenorphine sublingual tablet | Brixadi weekly dosage | Brixadi monthly dosage |
| 6 mg or less | 8 mg | not recommended |
| 8–10 mg | 16 mg | 64 mg |
| 12–16 mg | 24 mg | 96 mg |
| 18–24 mg | 32 mg | 128 mg |
Weekly versus monthly Brixadi injections
Your doctor may consider monthly Brixadi injections depending on your response to the medication. Specifically, they may consider monthly Brixadi if you’ve been taking a stable dose of sublingual buprenorphine. The table below shows the recommended Brixadi dosages for weekly versus monthly injections:
| Brixadi weekly dosage | Brixadi monthly dosage |
| 16 mg | 64 mg |
| 24 mg | 96 mg |
| 32 mg | 128 mg |
For more information about your specific Brixadi dosage, talk with your doctor.
Long-term treatment
Brixadi is meant to be a long-term treatment. If you and your doctor determine that Brixadi is safe and effective for you, you’ll likely receive it long term.
Before you start Brixadi treatment, talk with your doctor about what to expect.
The Brixadi dosage your doctor prescribes will depend on several factors. These include:
- your age
- how your body responds to Brixadi
- other medications you take
- side effects you may have with Brixadi
- your liver function
Other medical conditions you have can also affect your Brixadi dosage.
Dosage adjustments
Your doctor may need to adjust your dosage if you take certain medications. Examples include inhibitors or inducers of a certain liver enzyme.* These drugs can affect the level of Brixadi in your body. To find out what drugs may interact with Brixadi, see the “Interactions” section in this article.
Your doctor may also need to adjust your Brixadi dosage if you have liver damage or if you’re age 65 years or older.
Be sure to tell your doctor about all medications you take and any health conditions you may have. Your doctor will prescribe the dosage that’s right for you.
* A liver enzyme is a type of protein in the liver that breaks down medications.
Brixadi comes as a solution that’s given as an extended-release* subcutaneous injection (under the skin).†
Your doctor will inject Brixadi under the skin of your upper arm, abdomen, buttock, or thigh. However, the injection location depends on whether you’re currently taking buprenorphine.‡
If you aren’t taking buprenorphine before starting Brixadi, your doctor may inject Brixadi only in your abdomen, buttock, or thigh area. This is because Brixadi’s clinical trials show the drug isn’t absorbed as well when it’s injected into the upper arm.
But if you’re currently taking buprenorphine, your doctor may inject Brixadi in your upper arm. You may also receive upper arm injections if you’ve already received four weekly injections in other areas. (Brixadi is prescribed as a weekly or monthly injection. For details, see the “Brixadi dosage” section above.)
If you receive weekly Brixadi injections, your doctor will choose a different injection site each week. This will help reduce your risk of injection-related side effects, such as bleeding or pain at the injection site.
If you have questions about how Brixadi is given, talk with your doctor or pharmacist.
Note: After Brixadi is injected, the solution forms a gel-like substance known as a depot. You may or may not feel this as a bump under your skin. Do not try to remove it.
* Extended release means the drug releases slowly into your body over time after it’s injected.
† Brixadi has a boxed warning about the risk of serious harm if injected into a vein. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see “Boxed warning” at the top of this article.
‡ Buprenorphine is a generic version of the active drug in Brixadi. To learn more, see the “Brixadi dosage” section above.
ACCESSIBLE DRUG LABELSSome pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.
If you miss your appointment for your Brixadi dose, call your doctor’s office as soon as possible to reschedule. They’ll adjust your dosing schedule as needed.
Typically, you can receive your weekly injection 2 days before or 2 days after your scheduled appointment. And you can receive your monthly injection 1 week before or 1 week after your scheduled appointment.
If you need help remembering your appointments, try setting an alarm or downloading a reminder app on your phone.
Brixadi has risks of misuse and addiction because it’s a partial opioid agonist. Drugs in this class act in a similar way to opioids, which carry a strong risk of misuse. With misuse, a drug is taken or used in a way other than how it’s prescribed. With addiction, a drug is taken even though it’s causing harm.
Because of how partial opioid agonists work, the risk of misuse may be lower than with an opioid. Still, Brixadi misuse may lead to severe breathing problems, overdose, coma, and even death in rare cases. Receiving the drug more frequently or at higher doses than prescribed increases the risk. Receiving Brixadi with other drugs or alcohol also increases the risk. (To learn about Brixadi’s recommended dosages, see the “Brixadi dosage” section above.)
Before prescribing Brixadi, your doctor will determine whether it’s safe for you. Be sure to tell your doctor about all of the medications you may take. You should also tell your doctor if you consume alcohol.
Talk with your doctor if you have questions about Brixadi and misuse.
It’s important that you do not receive more Brixadi than your doctor prescribes. For some medications, taking more than the recommended amount may lead to harmful effects or overdose.
Because of the risk of overdose with Brixadi, your doctor may recommend that you have naloxone (Narcan, Kloxxado, others) with you during Brixadi treatment. This drug can help treat an opioid overdose that may occur if you take other opioids with Brixadi. If you have questions about this, talk with your doctor or pharmacist.
Effects of an overdose
Overdose effects of Brixadi can include:
- extreme tiredness or sedation
- low blood pressure
- difficulty breathing
- pinpoint pupils
If you receive more than the recommended amount of Brixadi
Call your doctor right away if you believe you’ve received too much Brixadi. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.
Treatment with Brixadi can cause dependence. With dependence, your body becomes used to a drug and needs it to function. This means you may have withdrawal symptoms if you suddenly stop treatment with Brixadi after receiving it regularly for some time. Withdrawal symptoms are side effects that happen after a drug is stopped and your body has become dependent on it.
Symptoms of withdrawal after abruptly stopping Brixadi treatment include:
- feeling anxious or agitated
- sleep difficulties
- muscle aches
- nausea, vomiting, and diarrhea
- excessive sweating
These symptoms can be very uncomfortable, but they’re not typically life threatening.
Do not stop Brixadi treatment unless your doctor specifically tells you to do so. If a decision is made to stop Brixadi treatment, your doctor will slowly lower your dose over time. This is known as a dose taper. It can help reduce your risk of withdrawal symptoms. If you have questions about this or your treatment, talk with your doctor.
Below are some frequently asked questions about Brixadi.
Is the dosage of Brixadi similar to the dosage of Vivitrol?
No, the dosage of Brixadi isn’t similar to the dosage of Vivitrol (naltrexone). Vivitrol is given as an intramuscular injection once a month. Brixadi is given as a subcutaneous injection, either weekly or monthly. In addition, the dose in milligrams (mg) for each drug differs because they have different active ingredients.
Both Brixadi and Vivitrol may be prescribed to treat opioid use disorder (OUD). Vivitrol may also be prescribed to treat alcohol use disorder. Your doctor will prescribe the drug and the dosage that’s right for you.
To learn more about how these drugs compare, talk with your doctor.
How long does it take for Brixadi to start working?
Brixadi starts to work after your first dose. Because of how the drug works, you likely won’t feel it working in your body.
Keep in mind that Brixadi is prescribed as part of an OUD treatment plan that includes support and counseling. This means your doctor and counselor will work with you to determine whether the drug is effective for your condition. Your doctor will monitor your response to Brixadi treatment. They’ll base this on whether your dosage reduces your urge to take opioids or decreases your symptoms of opioid withdrawal.
Talk with your doctor if you have questions about what to expect with Brixadi treatment.
The dosages in this article are typical dosages provided by the drug’s manufacturer. If your doctor recommends Brixadi for you, they’ll prescribe the dosage that’s right for you. If you have questions about the dosage of Brixadi that’s best for you, talk with your doctor.
Besides learning about dosage, you may want other information about Brixadi. These articles might be helpful:
- More about Brixadi. For information about other aspects of Brixadi, refer to this article.
- Details about your condition. For information related to opioid use disorder, see this list of articles.
Disclaimer: Medical News Today 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.