What is Sublocade? All about the Sublocade injection
This is for informational purposes only. Do not use any information in this blog to guide your treatment. This was originally written as a reference for my patients. You must follow the instructions of your provider.
What is Sublocade?
For those who know what Suboxone is, the easiest way to think about it is that Sublocade is a once-a-month shot of Suboxone. In actuality, Sublocade is a once-a-month shot of Buprenorphine where Buprenorphine is the active medication in Suboxone. More specifically, it is an extended-release formulation of Buprenorphine that was approved by the FDA on November 30, 2017. Sublocade comes in 100 mg and 300 mg doses.
How do you take Sublocade?
Sublocade is injected into the fat underneath your skin at your belly; this is done every 4 weeks or once a month. This injection must be done by a certified healthcare provider. If someone was to get a hold of Sublocade and tried to inject it into their veins, this would cause a serious risk of death as the medication becomes a solid mass and could cause clotting including in the lungs. This is not a concern when Sublocade is correctly injected subcutaneously (into the fat underneath your skin). After injected, the medication is slowly released into your system at sustained levels throughout the month
Sublocade underneath the skin
Sublocade being released into your body
Starting Sublocade
You do not have to stop taking Suboxone (Buprenorphine-Naloxone) for any period of time before starting Sublocade. That is, if you are taking Suboxone now, you can start Sublocade. Per the manufacturer, in order to start Sublocade you only need to have been taking Suboxone underneath your tongue for at least a week. The standard approach is for a patient to have been taking at least one or more Suboxone 8/2 mg films or tabs for at least a week where the first injection is with the Sublocade 300 mg dose for the first month. For the second injection for the second month of being on Sublocade, the 300 mg dose is used again. After that, the Sublocade 100 mg dose is used for the third injection and for the remainder of treatment with Sublocade. In some cases, the provider may start with the Sublocade 300 mg injection and stay at this dose for the second, third, and following injections. If a patient is taking Suboxone 4/1 mg a day (or half of an 8/2 mg film or tab), the provider may start with the 100 mg Sublocade dose.
How does Sublocade work?
Sublocade is similar to Suboxone in that Sublocade is used to treat opioid use disorder also referred to as opioid addiction or opioid dependence. The medication works by attaching to opioid receptors. In this way, it prevents cravings, prevents opioid withdrawal symptoms, and also decreases the ability of other opiates or opioids to attach to your opioid receptors. This type of treatment has been shown to prevent relapses.
Using Sublocade to come off of Suboxone
Sublocade is not FDA-approved or indicated for this reason though there are many stories of people using Sublocade in order to stop taking Suboxone. People take advantage of the fact that Sublocade is such a long-acting medication as it takes such a long time to come out of your system. Though it differs from person to person, there are a number of people reporting having very mild to no withdrawal symptoms after stopping Sublocade. In fact, Sublocade may stay in your system for 6 months, 12 months, and possibly even longer after your last injection where Buprenorphine may continue to show on drug tests for this period of time. For those who are stopping Sublocade or any form of treatment, it is necessary to have a relapse prevention plan and support systems in place.
What are the Advantages of Sublocade over Suboxone?
as already described, Sublocade is released into your system all month with no daily ups and downs
there is no need to remember to take the medication every day, this may be easier for many
no more bad taste with Sublocade. Many people do not like the taste of Buprenorphine-based products that have to be put underneath your tongue such as Suboxone, Buprenorphine-Naloxone, Buprenorphine SL, and Zubsolv
opiates and opioids are bad for your teeth. Many consider Buprenorphine-based products like Suboxone that sit in your mouth to be especially bad for your teeth. As Sublocade is an opioid, it too is considered to be bad for your teeth, but perhaps not as bad as Suboxone as it is not sitting in your mouth every day
What are the disadvantages, side effects, and potential risks of Sublocade?
As with all medications and treatments, there are a number of important potential side effects and risks, these include but are not necessarily limited to:
the injection is painful
reaction leaving a large bump at the injection site that may last for longer than months
injection site reaction including pain, itching, redness, and/ or bruising
as Sublocade is an opioid, it causes physical dependence in the same way that Suboxone does. If you stop Sublocade you may have opioid withdrawal symptoms similar to when other opiates or opioids are stopped
headache
nausea, vomiting
decrease blood pressure
constipation
respiratory depression
itching
drowsiness
dizziness
increased sweating
fatigue
increased liver enzymes
may make you tired
injection site bleeding
problems with coordination
irregular heartbeat that can lead to death
soft tissue atrophy/ deterioration
moderate to severe liver damage
difficulty treating pain
opioid withdrawal
insomnia
anxiety
weakness
numbness
flu-like symptoms
upset stomach
allergic reaction
overdose
Sublocade 100 mg injection and Sublocade 300mg injection
Does Sublocade work?
Yes. Remember, Sublocade is a once-a-month injection of Buprenorphine, the same medicine as Subutex; this is the active medicine in Suboxone. Studies have shown Sublocade’s ability to block the subjective effects of opioids. After your first injection, the medication starts working, Sublocade levels peak within 24 hours before decreasing to a maintenance level after several days that is maintained throughout the month where you should not have the ups and downs that some patients complain about with Suboxone taken underneath your tongue.
While Sublocade works after the first injection, there are some people who feel that during the first month, it does not work as well as Suboxone underneath the tongue. Although this can happen, it is not expected. This is good to know in case you have this experience. Although not considered a usual approach due to concerns for increased risks, after the very first Sublocade injection, a provider may prescribe Suboxone to be continued at the same time. Insurance will often continue to pay for the Suboxone prescription in this situation. However, as this is not a usual approach, some insurances will not pay for Suboxone directly after a Sublocade injection (for at least 4 weeks, the amount of time Sublocade is expected to work). To be clear, if you feel that Sublocade is not right for you, after a month, you can choose to go back to Suboxone regardless. Depending on a number of factors, there is a possibility that you may or may not need a higher Suboxone dose.
I want to start Sublocade treatment with a Sublocade doctor
If you have questions or want to start treatment with Sublocade, call 219-850-4490 or schedule an appointment online. You can get started with treatment now. Many insurances including Indiana Medicaid do cover Sublocade. We can work with your insurance to have the Sublocade injection delivered to our office where the injection will be performed. If you are not local or live too far from our office, you may use the official Sublocade website to look for a provider near you.
More information about Sublocade:
Brand name: Sublocade
Generic name: Buprenorphine
Dosage: Once-a-month injection of 100 or 300 mg of Buprenorphine
Administration: injected only by a certified healthcare provider
Indication: treatment of moderate to severe opioid use disorder, opioid addiction
Miscellaneous: Sublocade is a controlled substance and an opioid. Treatment with Sublocade should include counseling
This is for informational purposes only. Do not use any information in this blog to guide your treatment. This was originally written as a reference for my patients. You must follow the instructions of your provider.
