Long acting injectable buprenorphine (LAIB) are long acting buprenorphine depot preparations that are injected subcutaneously and provide patients with a sustained release of buprenorphine for the duration of the depot preparation. Currently, two LAIB products are available for the Australian market. They differ in their formulations, administration and pharmacology. The two products available are Buvidal and Sublocade. Buvidal formulations allow for weekly or monthly dosing frequency. Sublocade formulations allow for monthly dosing only.
Buvidal dose should be determined according to patient's Suboxone dose and subsequent doses can be titrated post clinical review. Buvidal may be initiated directly if required and usually a 24 mg Buvidal Weekly dose is started and the dose is titrated from this starting point until clinical effect is achieved.
Sublocade dosage is usually commenced post initiating treatment with Suboxone and a dose of Suboxone greater than 8mg daily. The recommended induction is: 300 mg monthly injections x 2 doses (8 weeks) and then 100 mg monthly doses (if the patient is stable on initial 2 x 300 mg doses) or 300 mg monthly doses if require additional buprenorphine effects.
If there are any issues, concerns or uncertainty about dosing it is always worthwhile to contact a more experienced prescriber or seek specialist assistance to ensure the right dosage of medication is being prescribed and given in an appropriate manner.
Weekly or monthly administration of LAIB takes away the need for daily dosing and takeaways, and reduces the frequency of supervised dosing to weekly or monthly intervals. This serves to reduce travel, stigma and out of pocket expenses for patients. Eliminating takeaway doses also reduces the scope for medication diversion. It is a medication with great potential but it is not for every patient and appropriate patient selection and follow up is important to ensure patients do not get destabilised on a new treatment.
Author: Dr Thileepan Naren MBBS FACRRM FRACGP
Thileepan is an Addiction Medicine Advanced Trainee and experienced general practitioner with a demonstrated history of working with disadvantaged and marginalized groups.