LAIB Sublocade

LAIB Sublocade
Sublocade is a long acting injectable buprenorphine (LAIB) manufactured by Invidior that uses the "Atrigel" system to provide for a sustained and prolonged delivery of buprenorphine into the systemic circulation after subcutaneous injection. Sublocade contains the following excipients: N-methyl-2-pyrrolidone (NMP), poly(DL-lactide-co-glycolide) (PLGA/polyglactin).

Dosing of LAIB

Sublocade provides for two doses: 100mg or 300 mg.

Initiate treatment with of sublingual buprenorphine at least 8 mg for atleast 7 days, then transfer to Sublocade. The recommended induction regimen is 300 mg monthly injections for two doses (over eight weeks) and then 100 mg monthly doses (if patient 'stable' on initial 2 x 300 mg doses) or 300 mg monthly doses if require additional buprenorphine effects are required. Patients may be initiated with 100mg Sublocade (after completing a seven-day course of sublingual buprenorphine) if there are safety concerns or concerns about drug interactions.

Buvidal is the preferred option for patients on low dose sublingual buprenorphine defined as 6mg or less.

Sublocade is dosed every 4 weeks (26–42 day schedule).

Sublocade is administered as a subcutaneous injection into the abdomen and the site is rotated as per manufacturers guidelines. The abdomen is divided into quadrants and Sublocade administration is rotated between each quadrant.

Clinical pharmacology:
Sublocade takes 24 hours to reach peak plasma concentration. It has a bioavailability of 100% and a half life of 43 to 60 days. Steady‐state equilibrium is achieved by the fourth to sixth dose.

Storage requirements:
Sublocade requires cold storage requirements (2–8oC). It may be stored at room temperature (below 25oC) for up to either 7 or 28 days before use and mane be removed from cold storage for at least 15 minutes prior to subcutaneous injection.

Contra-indications

The following are listed as contra-indications for Sublocade.

Child-Pugh C liver disease
Respiratory insufficiency
Hypersensitivity to either buprenorphine or excipients
Subjects less than 18 years of age Acute intoxication with alcohol or other CNS depressants Pregnancy and lactation

Sublocade is a commonly used LAIB formulation that provides an importance part of assisting patients with opioid use disorder remain within the opioid substitution program.

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.