Benjamin Zohar, NCACIP

Brixadi vs. Suboxone: Doses, Conversion, Withdrawal & Key Differences

Benjamin Zohar, NCACIP -

Quick answer: Brixadi and Suboxone both use buprenorphine to treat opioid use disorder, but they deliver it differently. Brixadi is a healthcare-administered extended-release injection available in weekly and monthly formulations. Suboxone is a buprenorphine/naloxone film generally taken once daily under the tongue or inside the cheek. Patients already taking Suboxone may be switched directly to corresponding Brixadi doses under current FDA labeling.

Last updated: September 26, 2026.

Medically reviewed by: Brandon McNally, RN

Safety note: Both Brixadi and Suboxone contain buprenorphine. Buprenorphine can precipitate withdrawal when initiated while sufficient fentanyl, heroin, methadone or another full opioid agonist remains active. Combining buprenorphine with alcohol, benzodiazepines, gabapentinoids, opioids or other central nervous system depressants can increase the risk of severe sedation and respiratory depression.

Key Takeaways

  • Brixadi contains buprenorphine only. Suboxone contains buprenorphine plus naloxone.
  • Brixadi is available weekly and monthly. Suboxone film is generally administered once daily.
  • Brixadi has seven strengths: 8, 16, 24 and 32 mg weekly; 64, 96 and 128 mg monthly.
  • Suboxone film has four strengths: 2/0.5, 4/1, 8/2 and 12/3 mg buprenorphine/naloxone.
  • The FDA label provides suggested Brixadi doses when switching from daily transmucosal buprenorphine. These are switching recommendations, not simple milligram-for-milligram equivalencies.
  • Patients not already receiving buprenorphine begin with a transmucosal buprenorphine test dose before Brixadi Weekly. Brixadi Monthly is not the initial formulation for new entrants who are not already taking buprenorphine.
  • Brixadi is distributed through a REMS program. Patients do not take Brixadi home for self-injection.
  • Neither medication is universally better. The practical tradeoff is long-acting adherence and reduced take-home medication versus daily dosing flexibility.

Table of Contents

Brixadi vs. Suboxone at a Glance

Brixadi provides extended-release buprenorphine from an injection, while Suboxone provides buprenorphine and naloxone through a film generally taken every day.

Feature Brixadi Suboxone
Active medication Buprenorphine Buprenorphine + naloxone
Form Extended-release subcutaneous injection Sublingual or buccal film
Frequency Weekly or monthly Generally daily
Administration Healthcare professional Usually self-administered
Naloxone No Yes
Take-home supply No Yes
Dose flexibility Weekly or monthly adjustments depending on formulation Daily dose can be adjusted more rapidly
REMS restricted distribution Yes No comparable depot REMS
Controlled substance Schedule III Schedule III

What Is the Main Difference Between Brixadi and Suboxone?

The main difference is how buprenorphine is delivered over time. Brixadi forms an extended-release depot under the skin, while Suboxone is absorbed through the oral mucosa from an individual film dose.

Brixadi is available as either a weekly or monthly formulation. Once administered, the injection continues releasing buprenorphine without requiring the patient to take medication every morning.

Suboxone is generally taken once daily. This creates more day-to-day treatment responsibility but also allows the prescriber to adjust dosing considerably faster.

For the full Brixadi dosing and administration guide, see Brixadi Injection Dosing Chart, Side Effects, Doses & Sublocade Comparison.

Are Brixadi and Suboxone the Same Medication?

No. They share buprenorphine, but they are different drug products.

Brixadi contains only buprenorphine in an extended-release injectable formulation.

Suboxone contains:

  • buprenorphine, a partial opioid agonist; and
  • naloxone, an opioid antagonist.

Buprenorphine is responsible for most of the therapeutic opioid-use-disorder effect in Suboxone when the film is used as directed.

Does Brixadi Contain Naloxone?

No. Brixadi contains buprenorphine without naloxone. Suboxone combines buprenorphine with naloxone.

Naloxone is included in Suboxone primarily to discourage certain forms of misuse. Brixadi does not require the same formulation because patients do not receive the injection for self-administration.

The absence of naloxone does not mean Brixadi is “stronger” than Suboxone. The products use different formulations, absorption routes and dosing schedules.

Is Brixadi Better Than Suboxone?

Neither medication is universally better. Brixadi reduces the need for daily medication, while Suboxone provides greater short-term dose flexibility.

Brixadi may be useful when:

  • daily adherence is difficult;
  • a patient prefers weekly or monthly treatment;
  • take-home medication is repeatedly lost or stolen;
  • diversion is a concern;
  • more stable buprenorphine exposure is desirable.

Suboxone may be useful when:

  • treatment is being initiated or actively adjusted;
  • rapid dose changes are clinically helpful;
  • the patient prefers daily control over treatment;
  • access to injectable buprenorphine is limited;
  • pharmacy or insurance access favors transmucosal treatment.

A treatment decision should consider clinical response, adherence, other medications, liver health, access, insurance coverage and patient preference.

What Doses of Brixadi and Suboxone Are Available?

Brixadi is available in seven injection strengths, while Suboxone film is available in four buprenorphine/naloxone strengths.

Brixadi Weekly

  • 8 mg
  • 16 mg
  • 24 mg
  • 32 mg

Brixadi Monthly

  • 64 mg
  • 96 mg
  • 128 mg

Suboxone Film

  • 2 mg buprenorphine / 0.5 mg naloxone
  • 4 mg / 1 mg
  • 8 mg / 2 mg
  • 12 mg / 3 mg

The current Suboxone prescribing information describes a maintenance range that is generally individualized between 4 mg/1 mg and 24 mg/6 mg per day according to clinical response.

For signs that a daily buprenorphine dose may require clinical reassessment, see Signs Your Suboxone Dose Is Too Low (Cravings, Withdrawal & What to Do).

What Brixadi Dose Is Equivalent to Suboxone?

There is no simple milligram-for-milligram equivalence, but the FDA-approved Brixadi label provides suggested corresponding doses when switching from daily transmucosal buprenorphine products such as Suboxone.

Daily transmucosal buprenorphine dose Suggested Brixadi Weekly Suggested Brixadi Monthly
6 mg or less 8 mg weekly No corresponding monthly starting dose listed
8–10 mg 16 mg weekly 64 mg monthly
12–16 mg 24 mg weekly 96 mg monthly
18–24 mg 32 mg weekly 128 mg monthly

Clinical Pearl: This FDA table is a switching guide, not proof that the printed milligram amounts are pharmacologically identical. A 16 mg daily Suboxone regimen is not simply “equal” to a 96 mg injection in the ordinary arithmetic sense. The formulations release buprenorphine very differently.

The current Brixadi prescribing information should be used when clinicians are evaluating the labeled conversion pathway.

Can You Switch Directly From Suboxone to Brixadi?

Yes. Patients who are already being treated with a transmucosal buprenorphine-containing product can be switched directly to either Brixadi Weekly or Brixadi Monthly under the FDA-approved labeling.

The selected Brixadi dose depends in part on the patient's current daily buprenorphine exposure.

The prescriber may also consider:

  • withdrawal and craving control;
  • current Suboxone dose;
  • adherence;
  • sedation;
  • ongoing opioid exposure;
  • other medications;
  • hepatic function;
  • insurance and clinic access.

For comparison with another injectable buprenorphine product, see Sublocade vs. Suboxone: Injection vs. Film, Doses, Withdrawal & Key Differences.

Can You Start Brixadi Without Already Taking Suboxone?

Yes, but a patient who is not already receiving buprenorphine begins through the Brixadi Weekly pathway after tolerating a transmucosal buprenorphine test dose.

According to the current FDA label, a patient who is not already receiving buprenorphine receives a 4 mg transmucosal buprenorphine test dose when objective signs of mild to moderate withdrawal are present.

If the test dose is tolerated without precipitated withdrawal, the labeled sequence begins with Brixadi Weekly. The FDA label describes a first 16 mg weekly injection followed by additional weekly-formulation dosing during the first week to establish the appropriate weekly regimen.

Brixadi Monthly is not intended as the first buprenorphine treatment for a new entrant who is not already receiving buprenorphine.

This distinction is important because “Brixadi can be started after one buprenorphine dose” does not mean every new patient can immediately receive the monthly formulation.

Do You Still Take Suboxone After a Brixadi Injection?

Suboxone should not be automatically continued as a daily medication after Brixadi is started unless the treating clinician specifically directs otherwise.

Brixadi is already releasing buprenorphine continuously from the injection depot.

If cravings, withdrawal symptoms or other concerns occur after an injection, the clinician should evaluate the cause rather than the patient independently adding Suboxone.

Clinical reassessment may include:

  • the Brixadi formulation and dose;
  • time since the injection;
  • current withdrawal symptoms;
  • ongoing opioid exposure;
  • drug interactions;
  • treatment adherence;
  • other medical or psychiatric factors.

Which Lasts Longer: Brixadi or Suboxone?

Brixadi lasts substantially longer after each administration because it is an extended-release injection.

The current Brixadi prescribing information reports an apparent terminal buprenorphine half-life of approximately:

  • 3–5 days for Brixadi Weekly; and
  • 19–26 days for Brixadi Monthly.

For Suboxone film, the buprenorphine component has a mean elimination half-life of approximately 24–42 hours.

These figures should not be interpreted as exact drug-test detection windows. Detectability varies according to dose, duration of treatment, metabolism and the test being used.

For more information on buprenorphine detection, see How Long Does Suboxone Stay in Your System?.

Brixadi vs. Suboxone Withdrawal: What Is Different?

Both medications can produce physical dependence because both contain buprenorphine, but withdrawal after discontinuation may follow very different timelines.

Suboxone concentrations decline comparatively quickly after the final daily dose. Withdrawal can therefore begin on a shorter timeline if treatment is stopped abruptly.

Brixadi releases buprenorphine gradually from the depot. After steady state, the FDA label notes that buprenorphine may remain detectable in plasma for approximately one month after Brixadi Weekly and approximately four months after Brixadi Monthly.

Because of this prolonged release, withdrawal after stopping Brixadi can be delayed.

The Brixadi label recommends monitoring patients for signs and symptoms of withdrawal for several months after discontinuation.

Patients should not create their own buprenorphine taper or transition schedule.

Brixadi vs. Suboxone Side Effects

Many systemic side effects overlap because both medications contain buprenorphine, but Brixadi adds injection-site effects while Suboxone can cause oral-film-specific adverse reactions.

Possible Brixadi side effects

  • injection-site pain;
  • injection-site redness or itching;
  • headache;
  • constipation;
  • nausea;
  • insomnia;
  • sedation;
  • liver-related abnormalities;
  • respiratory depression, particularly with other CNS depressants.

Possible Suboxone side effects

  • headache;
  • nausea or vomiting;
  • constipation;
  • sweating;
  • insomnia;
  • oral numbness;
  • tongue discomfort;
  • oral mucosal irritation;
  • sedation and respiratory depression when combined with other depressants.

Anyone experiencing severe sedation, significant breathing difficulty, jaundice, severe withdrawal or a worsening injection-site reaction should receive medical evaluation.

What Does REMS Mean for Brixadi?

REMS stands for Risk Evaluation and Mitigation Strategy. Brixadi is available only through a restricted distribution program because intravenous self-administration of the depot formulation can cause serious harm or death.

The Brixadi REMS program requires participating healthcare settings and pharmacies to follow certification and distribution requirements so that Brixadi is provided directly to healthcare professionals for administration.

This means:

  • patients do not pick Brixadi up and self-inject it;
  • the medication is administered by a healthcare professional;
  • certified distribution procedures are used;
  • the injection remains within a controlled healthcare chain of custody.

Suboxone does not use this depot-injection REMS model because the film is dispensed for transmucosal use.

Which Has Less Opportunity for Diversion: Brixadi or Suboxone?

Brixadi creates considerably fewer opportunities for take-home medication diversion because the patient does not possess a supply of injections.

Suboxone is typically dispensed for home use. That creates potential issues such as:

  • lost medication;
  • theft;
  • sharing or selling medication;
  • unintentional pediatric exposure;
  • missed daily doses.

Brixadi instead remains in the healthcare distribution system and is administered by a professional.

That does not mean Suboxone is an inappropriate treatment. Take-home dosing can also provide convenience, autonomy and rapid dose flexibility for many patients.

Was Brixadi Compared With Suboxone in a Clinical Trial?

Brixadi was studied against sublingual buprenorphine/naloxone, but the active comparator in the pivotal Phase 3 study should not be described as a direct trial of the branded Suboxone film.

The 24-week randomized, double-blind, active-controlled study compared Brixadi injections with sublingual buprenorphine/naloxone tablets.

In the FDA-defined responder analysis:

  • 16.9% of patients in the Brixadi group met the responder definition;
  • 14.0% in the sublingual buprenorphine/naloxone group met the definition;
  • the difference met the study's prespecified noninferiority criterion.

The FDA label also reports a statistically significant difference favoring Brixadi across the cumulative distribution of negative opioid assessments; however, among patients with very high proportions of opioid-negative assessments, the difference between groups was small.

Evidence note: This trial supports Brixadi's efficacy compared with sublingual buprenorphine/naloxone treatment. It should not be simplified into a claim that Brixadi has been proven “better than Suboxone” for every patient.

Brixadi vs. Suboxone: Myth vs. Fact

Myth Fact
Brixadi is simply injectable Suboxone. Brixadi contains buprenorphine only. Suboxone contains buprenorphine plus naloxone.
A 96 mg Brixadi injection is exactly equivalent to 16 mg of Suboxone every day. The FDA provides suggested switching doses, but the formulations are not simple milligram-for-milligram equivalents.
Any new patient can immediately start Brixadi Monthly. Patients not already receiving buprenorphine begin through the Brixadi Weekly pathway after tolerating transmucosal buprenorphine.
You automatically keep taking Suboxone every day after Brixadi. Brixadi itself continuously releases buprenorphine. Additional transmucosal treatment should only be used under clinician direction.
Brixadi cannot cause withdrawal because it lasts so long. Physical dependence can persist, and withdrawal may occur later as depot buprenorphine concentrations decline.
Brixadi is automatically better because patients do not dose every day. Long-acting treatment reduces daily dosing burden, while Suboxone provides greater short-term dose flexibility. The appropriate choice is individualized.

When to Seek Medical Help

Call emergency services for slowed or stopped breathing, inability to wake, blue or gray lips, seizures, severe confusion or loss of consciousness. Give an opioid overdose reversal medication such as naloxone when opioid overdose is suspected if it is available.

Contact the treating clinician promptly for severe sedation, worsening withdrawal, rapidly increasing cravings, jaundice, dark urine or a Brixadi injection site that becomes increasingly painful, hot, draining, ulcerated or markedly swollen.

For broader treatment-navigation information, see How Long Island Families Can Find Safe, Licensed Addiction Treatment.

Frequently Asked Questions About Brixadi vs. Suboxone

Is Brixadi the same as Suboxone?

No. Both contain buprenorphine, but Brixadi is an extended-release injection containing buprenorphine alone. Suboxone is a transmucosal film containing buprenorphine and naloxone.

What Brixadi dose corresponds to 16 mg of Suboxone?

The FDA Brixadi label places daily transmucosal buprenorphine doses of 12–16 mg in the suggested switching range for Brixadi 24 mg Weekly or 96 mg Monthly. This is a labeled switching recommendation, not a direct milligram-for-milligram equivalence.

What Brixadi dose corresponds to 24 mg of Suboxone?

For daily transmucosal buprenorphine doses of 18–24 mg, the Brixadi label lists 32 mg Weekly or 128 mg Monthly as suggested corresponding doses when switching. The treating clinician still determines whether the transition is appropriate.

Can you go directly from Suboxone to Brixadi?

Yes. Patients already treated with a transmucosal buprenorphine-containing product may transition directly to Brixadi Weekly or Brixadi Monthly according to the current prescribing information.

Can you start Brixadi without being on Suboxone first?

A patient not already receiving buprenorphine can begin after tolerating a 4 mg transmucosal buprenorphine test dose. New entrants begin with Brixadi Weekly rather than Brixadi Monthly.

Does Brixadi have naloxone?

No. Brixadi contains buprenorphine only. Suboxone contains both buprenorphine and naloxone.

Which lasts longer, Brixadi or Suboxone?

Brixadi lasts longer after each administration. Brixadi Weekly has an apparent terminal half-life of approximately 3–5 days and Brixadi Monthly approximately 19–26 days, compared with approximately 24–42 hours for the buprenorphine component of Suboxone film.

Can Brixadi be self-injected at home?

No. Brixadi is subject to restricted REMS distribution and is administered by a healthcare professional. Patients do not receive the injection for self-administration.

Can you switch back from Brixadi to Suboxone?

A clinician may transition a patient back to transmucosal buprenorphine, but timing should be individualized because Brixadi continues releasing buprenorphine after the last injection.

Does Brixadi cause less withdrawal than Suboxone?

Not necessarily. Brixadi concentrations decline more slowly, so withdrawal can be delayed rather than absent. Both medications contain buprenorphine and can produce physical dependence.

Source Verification

Dose strengths, switching ranges, initiation requirements, pharmacokinetic information, REMS requirements and clinical-trial findings in this article were checked against current FDA-approved prescribing information for Brixadi and Suboxone. The comparison distinguishes FDA switching recommendations from exact pharmacologic equivalence and distinguishes the Phase 3 sublingual buprenorphine/naloxone comparator from the branded Suboxone film.

References

  1. U.S. Food and Drug Administration. BRIXADI (buprenorphine extended-release) injection: Prescribing Information .
  2. U.S. Food and Drug Administration. SUBOXONE (buprenorphine and naloxone) sublingual film: Prescribing Information .
  3. BRIXADI REMS. Official BRIXADI Risk Evaluation and Mitigation Strategy .
  4. U.S. Food and Drug Administration. Information About Medications for Opioid Use Disorder .
  5. Substance Abuse and Mental Health Services Administration. Buprenorphine Treatment Information .
  6. ClinicalTrials.gov. NCT02651584: Phase 3 Study of Extended-Release Buprenorphine Versus Sublingual Buprenorphine/Naloxone .

Last updated: September 26, 2026.

About the Author

Benjamin Zohar, NCACIP is a Nationally Certified Advanced Clinical Intervention Professional and ISSUP network moderator specializing in addiction intervention, treatment navigation and emerging substance-use risks. His educational work published through ISSUP on counterfeit medications, fentanyl exposure and concentrated 7-hydroxymitragynine has been cited or referenced by GoodRx, The Washington Post, WIRED and Newsweek.

Medical review: Brandon McNally, RN

Medical disclaimer: This article is intended for educational and public-health purposes. It does not provide individualized medical advice, diagnosis or a tapering schedule. Do not start, stop or alter a prescription medication without consulting a qualified healthcare professional. Call emergency services for seizures, difficulty breathing, loss of consciousness, severe confusion or other life-threatening symptoms.

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