Switching between different formulations of buprenorphine MATOD therapy

Some patients may transfer from sublingual buprenorphine to modified-release subcutaneous injections. Modified-release buprenorphine injections are available as weekly (Buvidal Weekly) or monthly preparations (Buvidal Monthly or Sublocade); see Preparations of buprenorphine for medication-assisted treatment of opioid dependence (MATOD) for a comparison of preparations.

Starting doses of modified-release subcutaneous buprenorphine preparations when switching between formulations outlines usual starting doses of modified-release subcutaneous buprenorphine when switching between formulations. To switch from one MATOD formulation to another, see the following recommendations:

from sublingual buprenorphine to Buvidal Weekly
from Buvidal Weekly to Buvidal Monthly (or directly from sublingual buprenorphine to Buvidal Monthly)
from sublingual buprenorphine to Sublocade.

Table 1. Starting doses of modified-release subcutaneous buprenorphine preparations when switching between formulations
Dose of daily sublingual buprenorphine	Starting dose of Buvidal Weekly injection [NB1]	Starting dose of Buvidal Monthly injection [NB1]	Starting dose of Sublocade monthly injection [NB1]
2 to 6 mg	8 mg	n/a	n/a
8 to 10 mg	16 mg	64 mg	300 mg monthly for 2 months, then 100 mg monthly (no less than every 26 days) [NB2]
12 to 16 mg	24 mg	96 mg
18 to 24 mg	32 mg	128 mg
26 to 32 mg	n/a	160 mg
Note: n/a = not appropriate; use an alternative preparation NB1: Starting doses in this table are not for standalone use; see text for information on titration. NB2: If switching from Buvidal to Sublocade, seek expert advice. The initial loading doses are not generally needed.