Brixadi and Sublocade are both long-acting buprenorphine shots for opioid use disorder (OUD), and the biggest difference between them is schedule. Brixadi comes in weekly or monthly doses, while Sublocade is given once a month. Both are part of medication for addiction treatment (MAT), and both are given by a healthcare provider, never taken at home.
Brixadi and Sublocade use the same medicine, buprenorphine, in a slow-release shot. Brixadi offers weekly or monthly dosing, a smaller needle, and room-temperature storage, while Sublocade is monthly only. The right fit depends on your history with buprenorphine, how often you can get to a clinic, and what your prescriber recommends.
Both shots are extended-release forms of buprenorphine, a partial opioid agonist.
Buprenorphine attaches to the same brain receptors as other opioids but activates them only partway, which helps ease cravings and withdrawal without the full effect of drugs like heroin or fentanyl. Both shots go just under the skin, where the medication forms a small depot that releases buprenorphine slowly as it breaks down.
The U.S. Food and Drug Administration (FDA) approved Sublocade in November 2017 and Brixadi in May 2023. Each is approved for adults with moderate to severe OUD and works best as part of a full opioid use disorder treatment plan that includes counseling.
Both are also tightly controlled. Under a federal safety program called a Risk Evaluation and Mitigation Strategy (REMS), the shot goes straight from a certified pharmacy or clinic to your provider, so you can’t take it home or give it to yourself.
| Feature | Brixadi | Sublocade |
| Active Medication | Buprenorphine, extended-release | Buprenorphine, extended-release |
| FDA Approval | May 2023 | November 2017 |
| How Often | Weekly or monthly | Monthly |
| Dose Options | Weekly: 8, 16, 24, or 32 mg; monthly: 64, 96, or 128 mg | 300 mg for the first two doses, then usually 100 mg monthly |
| Injection Sites | Buttock, thigh, abdomen, or upper arm | Abdomen, thigh, buttock, or back of the upper arm |
| Injection Volume | 0.16 to 0.64 mL | 0.5 or 1.5 mL |
| Needle Size | 23-gauge (thinner) | 19-gauge (wider) |
| Storage | Room temperature | Refrigerated, with up to 12 weeks allowed at room temperature |
| Who Gives It | A healthcare provider in a certified setting | A healthcare provider in a certified setting |
Details in the table come from each drug’s current prescribing label.
Schedule is where the two shots differ most.
Weekly Brixadi comes in four strengths, which makes it easier to fine-tune your dose early in treatment. Monthly Brixadi comes in three strengths and works well once things feel stable and you’d rather visit the clinic less often. Either way, Brixadi lets you and your provider change the schedule as your needs shift.
Sublocade has a simpler pattern: two 300 mg shots to start, then a monthly maintenance shot, usually 100 mg. Some people stay at 300 mg if 100 mg doesn’t control cravings well enough.
Monthly Sublocade shots need to be at least 26 days apart, while monthly Brixadi is given about every 28 days.
You no longer need a week or more of daily buprenorphine before either shot. Both can start after one test dose of transmucosal buprenorphine, the kind that dissolves under your tongue or inside your cheek.
The test dose confirms your body tolerates buprenorphine.
Starting too soon after other opioids can cause precipitated withdrawal, a sudden and uncomfortable wave of symptoms. Your provider will check how far along you are in withdrawal, watch how you respond to the test dose, and only then give the first shot.
| Your Situation | Brixadi | Sublocade |
| Not Currently Taking Buprenorphine | A 4 mg test dose, then a 16 mg weekly shot, plus an 8 mg shot within 3 days | A single dose of buprenorphine (often 4 mg), 1 hour of observation, then a 300 mg shot |
| Already on Daily Buprenorphine | A weekly or monthly dose matched to your daily dose | A 300 mg shot if you take 8 to 24 mg a day |
| Timing of the Second Dose | Weekly shots continue every 7 days | As early as 1 week after the first, or up to 1 month |
| Monthly Dosing Right Away | Not studied for new starters, so you begin weekly | Monthly from the start |
If you’re new to buprenorphine and want Brixadi treatment, plan on weekly shots at first. New Brixadi patients also wait until after four weekly doses before using the upper arm as an injection site.
Not sure what kind of help you need? Our team can walk you through your options, including insurance and Medicaid.
Talk With Our TeamIn February 2025, the FDA approved two meaningful changes to the Sublocade label. Both narrowed the gap between Sublocade and Brixadi, so older comparisons you find online may be out of date.
Before the update, Sublocade required at least seven days of daily buprenorphine before the first shot. Now a provider can give the shot after a single dose of transmucosal buprenorphine and one hour of observation to make sure you tolerate it.
Brixadi already worked this way, so the two shots now start on a similar timeline.
Before the update, Sublocade was approved for the abdomen only. The updated label adds three more sites, which gets closer to Brixadi’s four:
More site options can make long-term treatment more comfortable, since providers rotate where each shot goes. The current Sublocade label also allows the second 300 mg shot as early as one week after the first.
Fast starts matter. Many people reach out for help during a hard moment, like after an overdose scare or while trying to get off fentanyl. A week of waiting can feel impossibly long, and a same-day path to a long-acting shot removes one more reason to put off care.
Your choice can now rest on schedule, comfort, and fit instead of which shot starts faster.
Most people feel a quick pinch and some soreness. The needle and amount of liquid differ between the two shots:
With Sublocade injections, you may notice a small lump under the skin for several weeks. The lump is the depot slowly releasing medication, and it shrinks over time.
Don’t rub or massage the spot.
Brixadi forms a gel under the skin that releases buprenorphine as it breaks down. With weekly Brixadi, your provider rotates sites and avoids reusing the same spot for at least eight weeks, which helps keep each area comfortable over months of treatment.
The most common side effects overlap. According to the Brixadi prescribing information, common reactions include:
The Sublocade prescribing information lists these as its most common reactions:
Both shots carry the same serious warning: injecting either one into a vein can cause dangerous blood clots.
Mixing buprenorphine with alcohol, benzodiazepines, or other sedatives raises the risk of slowed breathing. Tell your provider about every medication you take, including sleep aids, anxiety medications, and anything you buy over the counter, so they can spot risky combinations early.
There’s no set end date for treatment.
You and your provider decide together how long to stay on buprenorphine, and many people stay on it for a long time because it supports stability. If you do decide to stop, a long-acting shot tapers itself to some degree, since medication leaves your body gradually.
Withdrawal symptoms, if they show up, tend to come on more slowly than they would after stopping a daily film. Gradual doesn’t mean symptom-free, though, so read our Sublocade withdrawal timeline and make a plan with your provider before your last shot.
Life gets in the way sometimes.
Brixadi builds in some flexibility, since a weekly dose can be given up to two days early or late and a monthly dose up to one week early or late. If you miss a Sublocade shot, the label says to get the next one as soon as you can, then continue at least 26 days apart.
Either way, call your clinic as soon as you know you’ll miss an appointment. A short delay usually leaves some buprenorphine in your system, but your provider should still know.
Many people start on a daily film or tablet and later move to a shot. If that’s you, your current daily dose helps your provider choose your starting dose:
Still deciding whether a shot beats a daily film? Our guide to Sublocade vs. Suboxone walks through how a monthly injection compares with daily medication, including convenience, steady medication levels, and what the switch involves.
Ready to start treatment? Porch Light Health offers in-person clinics and telehealth across Colorado and New Mexico.
Find a Clinic Near YouNo single shot is right for everyone. As far as we know, no large trial has compared Brixadi and Sublocade directly, so the choice usually comes down to practical fit.
Your provider will look at your health history, other medications, pregnancy plans, and daily routine before recommending one.
You can always revisit the choice as your needs change.
Porch Light Health accepts Medicaid and Medicare and works with commercial insurers, including Anthem Blue Cross Blue Shield, UnitedHealthcare, Humana, Cigna, and Kaiser Permanente. Coverage for each shot depends on your plan, and some plans require approval before treatment starts.
If cost is a worry, ask about our sliding-fee program.
Porch Light Health offers both Brixadi and Sublocade at select clinics in Colorado. We’ll help you figure out which option fits, with no judgment. Call 866-839-8868 or reach out online to get started.
Is Brixadi stronger than Sublocade?
Not in a way you can compare by milligrams. The two shots use different formulas, so 100 mg of Sublocade and 96 mg of Brixadi aren’t equivalent amounts. Your provider matches the dose to your needs.
Can I switch from Sublocade to Brixadi, or the other way around?
Switching is possible, but it’s a clinical decision. Your provider will plan the timing around your last shot and how you’re feeling.
Do I need to be in withdrawal before my first shot?
You need to be far enough from your last opioid use that buprenorphine won’t trigger precipitated withdrawal. Your provider will check your symptoms and give a test dose before the first shot.
Can I take Brixadi or Sublocade home?
No. Federal safety rules require a healthcare provider to give both shots in a certified setting.
Can I drink alcohol while on a buprenorphine shot?
Alcohol and buprenorphine together can slow your breathing. Talk openly with your provider about alcohol use so they can help you stay safe.
Will a buprenorphine shot show up on a drug test?
Buprenorphine shows up on tests designed to look for it. Many standard opioid panels don’t screen for it, but results depend on the test. Let the testing site know you’re in treatment.
Does Porch Light Health offer telehealth for these shots?
The shots themselves are given in person. Some follow-up care and counseling may be available through telehealth, so ask our team what fits your plan.
How long will I need to stay on a shot?
There’s no set timeline. Many people stay on buprenorphine long term, and you and your provider will check in regularly about what’s working.
Choosing between Brixadi and Sublocade is easier with someone in your corner. Our team can walk you through both options, check your coverage, and help you start care. Call 866-839-8868 or contact us online today.
Medical disclaimer: This article is for general education and isn’t a substitute for professional medical advice. Talk with a qualified healthcare provider before starting, changing, or stopping any medication.
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