Buprenorphine is now available as a depot injection for the maintenance treatment of opioid dependence. Two products are registered in Australia, Buvidal® and Sublocade®. However, only Buvidal® is currently accessible on the Pharmaceutical Benefits Scheme (PBS) having received a Section 100 Opioid Dependence listing on the 1st September 2019.
Buvidal® is a modified-release buprenorphine injection for weekly (±2 days) or monthly (±1 week) administration. Upon contact with body fluids, the solution forms a highly viscous gel from which the active ingredient is released in a slow and consistent manner. Buvidal® should be injected slowly into the subcutaneous tissue, taking care to avoid inadvertent intravascular or intradermal injection. Patients may transition directly to Buvidal® from sublingual buprenorphine formulations. However, as the bioavailability of the depot is up to nine times higher than sublingual formulations, appropriate dosage adjustment is required.
A double-blind, double-dummy randomised clinical trial demonstrates non-inferiority of weekly and monthly depot buprenorphine compared to daily sublingual buprenorphine-naloxone. Further analysis establishes the superiority of depot buprenorphine with 35% of urine samples from these patients testing negative for illicit opioids compared to 28% of samples from patients receiving sublingual buprenorphine-naloxone. The safety profile of depot buprenorphine was comparable to that of sublingual buprenorphine-naloxone with the exception of some mild to moderate injection site reactions.
Anticipated benefits of depot buprenorphine injections include:
- Improved adherence;
- Greater convenience;
- Reduced stigma associated with supervised dosing;
- Reduced risk of diversion; and
- Reduced risk of inadvertent medication exposure (e.g. to children from takeaway doses).
- Buvidal® Monthly (buprenorphine) Australian approved product information. Sydney: Camurus. Approved February 2019.
- Buvidal® Weekly (buprenorphine) Australian approved product information. Sydney: Camurus. Approved February 2019.
- Lintzeris N, Dunlop A, Masters D. Brief Clinical guidelines for use of depot buprenorphine (Buvidal® and Sublocade®) in the treatment of opioid dependence. NSW Ministry of Health: St Leonards; 2019.
- Lofwall MR, Walsh SL, Nunes EV, Bailey GL, Sigmon SC, Kampman KM, et al. Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone for treatment of opioid use disorder: a randomized clinical trial. JAMA Intern Med. 2018; 178(6): 764-73.