Initiating Sublocade 100 mg for Opioid Use Disorder

Patient Selection and Preparation

The American College of Physicians recommends that Sublocade (buprenorphine extended-release) 100 mg is indicated for patients with opioid use disorder (OUD) who have already been stabilized on a transmucosal (sublingual or buccal) buprenorphine product, delivering at least 8-24 mg per day for a minimum of 7 days 1
Patients must demonstrate tolerance to buprenorphine before initiating Sublocade to minimize risk of precipitated withdrawal 2
The American Medical Association suggests that patients should be assessed for their risk of relapse, expected level of opioid withdrawal symptoms, and comorbid conditions before determining the appropriate timing for Sublocade initiation 1

The National Institute on Drug Abuse recommends stabilizing the patient on 8-24 mg daily of sublingual or buccal buprenorphine for a minimum of 7 consecutive days before transitioning to Sublocade 100 mg monthly subcutaneous injection 2
Ensure the patient is not experiencing withdrawal symptoms and is comfortable on their oral buprenorphine dose, as suggested by the American College of Physicians 3
After stabilization, transition to Sublocade 100 mg monthly subcutaneous injection, with the first two monthly doses being 300 mg, followed by maintenance doses of 100 mg monthly, as recommended by the American Academy of Addiction Psychiatry 4

Individualize the decision to initiate Sublocade based on the patient's daily buprenorphine dose, indication for treatment (pain vs. dependency), and risk of relapse, as suggested by the American Medical Association 1
Be aware that concomitant use of buprenorphine with QT-prolonging agents is contraindicated, according to the American Heart Association 1
Multiple drug-drug interactions can result in QT-interval prolongation, serotonin syndrome, paralytic ileus, reduced analgesic effect, or precipitation of withdrawal symptoms, as warned by the National Institute on Drug Abuse 2

For patients with inadequate analgesia on buprenorphine maintenance, consider increasing the dosage in divided doses before transitioning to Sublocade, as recommended by the Infectious Diseases Society of America 5
For patients with chronic pain who are transitioning from full opioid agonists, ensure they are in mild withdrawal before initiating any form of buprenorphine to avoid precipitated withdrawal, as suggested by the American College of Physicians 3

Monitor patients closely after the first injection of Sublocade for signs of precipitated withdrawal, especially if the patient was recently using full opioid agonists, as recommended by the American Academy of Addiction Psychiatry 2

Be cautious with patients who may require surgery, as Sublocade's high binding affinity may interfere with perioperative pain management, according to the American Society of Anesthesiologists 1
Do not attempt to remove Sublocade after administration, as the risks include surgical complications, infection, and damage to surrounding tissue, as warned by the American College of Surgeons 4