Brixadi (buprenorphine) is an extended-release injection used to treat moderate-to-severe opioid use disorder. It is usually given once weekly or monthly by a health care provider.
Like most medicines, Brixadi can cause side effects. Some are more common than others, and some may ease as your body adjusts to treatment.
Keep reading to learn about possible Brixadi side effects, what you can do to help prevent or manage them, and when to reach out to your health care provider.
This article does not include every possible side effect. Tell your health care provider about any symptoms that concern you or do not improve, even if they are not listed here.
Common Brixadi Side Effects
The most commonly reported side effects with Brixadi include:
- Injection site pain, redness, or itching
- Headache
- Constipation
- Nausea
- Trouble sleeping (insomnia)
- Urinary tract infection
In most cases, these side effects are mild to moderate and improve on their own. Contact your health care provider if any of these feel severe or do not go away. Do not stop treatment on your own.
Serious Side Effects of Brixadi
Less commonly, Brixadi can cause more serious side effects, including:
- Life-threatening breathing problems (respiratory depression)
- Liver problems, including hepatitis
- Opioid withdrawal symptoms
- A serious allergic reaction
If you have symptoms that feel serious or life-threatening, seek medical care right away. Below, we will cover these side effects in more detail, including steps you can take to help prevent or manage them.
Tips for Managing Brixadi Side Effects
1. Injection site reactions
Symptoms at or near the injection site may include:
- Pain
- Itching
- Swelling
- Redness or discoloration
- Bruising
These symptoms are usually temporary and go away on their own. Here are some tips to prevent or manage injection site reactions:
- Review the instructions that come with your medicine or see the guide on the drugmaker's website.
- Be sure to rotate the injection site each day; do not use the same spot over and over.
- Ask your health care provider if it is OK to use a cool compress on the area or if an over-the-counter (OTC) pain reliever or anti-itch medicine may help.
Let your health care provider know if injection site reactions persist or feel severe. This could be a sign of infection and may need treatment. They may want to review proper injection techniques with you or suggest other ways to manage your symptoms.
2. Headache
Headache is a commonly reported side effect of Brixadi.
Symptoms may include mild-to-moderate head pain or pressure.
To help manage headaches:
- Rest in a quiet, dark room if needed.
- Drink enough fluids throughout the day.
- Try relaxation techniques, such as deep breathing.
- Maintain a regular sleep schedule.
- Minimize stress.
- Drink enough fluids and eat regular meals or snacks.
- An OTC pain reliever may help ease headache pain, but check with your health care provider or pharmacist first to make sure it is safe for you.
3. Constipation
Constipation is a common side effect of Brixadi.
Symptoms may include:
- Fewer bowel movements
- Hard stools
- Straining during bowel movements
Tips to help manage constipation:
- Drink plenty of fluids throughout the day.
- Moving your body can help move your bowels. Try to get more exercise, such as walking or swimming.
- Slowly add or increase the amount of high-fiber foods in your diet, such as fruits, vegetables, beans, and whole grains. Most adults should aim for 25-38 grams of fiber each day.
- Ask your health care provider if an OTC stool softener, laxative, or fiber supplement like psyllium may help.
- Try to follow a regular bathroom schedule.
Contact your health care provider if constipation is severe, does not improve, or comes with stomach pain and vomiting.
4. Nausea
Nausea affected many people using Brixadi in clinical studies.
Symptoms of nausea may include an upset stomach, queasiness, or feeling like you may throw up.
Mild nausea may improve as your body adjusts to treatment. The following tips may help relieve this side effect:
- Eat smaller, more frequent meals.
- Snack on bland foods like crackers.
- Avoid greasy, spicy, or strong-smelling foods.
- Take small sips of water throughout the day to stay hydrated.
Tell your health care provider if you have nausea that is severe, does not go away, or leads to vomiting that keeps you from keeping fluids down.
5. Trouble sleeping
Insomnia has been reported with Brixadi.
To help manage it:
- Keep a regular sleep and wake schedule.
- Limit caffeine, especially later in the day.
- Avoid screens close to bedtime.
Talk to your health care provider if sleep problems continue, since some sleep medicines should not be combined with Brixadi. (See our companion article on Brixadi drug interactions for more.)
6. Serious breathing problems (respiratory depression)
Buprenorphine can cause life-threatening breathing problems and even death, particularly when combined with alcohol, benzodiazepines, or other medicines that slow down the central nervous system.
Ask your health care provider about having an opioid overdose reversal medicine on hand, such as naloxone or nalmefene, and make sure people close to you know how to use it.
Get emergency help right away if you or someone around you:
- Feels unusually sleepy or hard to wake up
- Is confused or slurring speech
- Is breathing slower than normal
- Feels faint or dizzy
7. Opioid withdrawal symptoms
Because buprenorphine only partly activates opioid receptors, starting Brixadi (especially before other opioids have fully left your system) can trigger withdrawal symptoms. Withdrawal can also happen if Brixadi is stopped abruptly.
Possible symptoms include:
- Shaking or sweating
- Muscle aches
- Nausea, vomiting, or diarrhea
- Runny nose or watery eyes
- Feeling unusually hot or cold
Because Brixadi releases buprenorphine slowly, withdrawal symptoms can show up weeks or months after you stop the treatment, and you may need to be monitored for several months. Do not stop treatment on your own. Tell your health care provider if you notice withdrawal symptoms so they can adjust your plan.
Reducing Your Risk of Brixadi Side Effects
Here are some tips to help lower your risk of side effects:
- Attend all recommended appointments and lab tests.
- Keep track of any new or changing symptoms and share them with your health care provider.
- Ask about having an opioid overdose reversal medicine on hand, and make sure people close to you know how to use it.
- Tell your health care provider about all medicines, vitamins, and supplements you take.
- Report any new or worsening symptoms to your health care provider right away.
Contact your health care provider about any side effects you have while using Brixadi, even if it is not listed here. Do not stop using Brixadi or change your treatment plan on your own. Your health care provider can help decide whether changes are needed.
