Consumer medicine information

Sublocade

Buprenorphine

BRAND INFORMATION

Brand name

Sublocade

Active ingredient

Buprenorphine

Schedule

S8

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Sublocade.

SUBLOCADE®

SUBLOCADE®


 Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.


WARNING: Important safety information is provided in a boxed warning in the full CMI. Read before using this medicine.

 1. Why am I using SUBLOCADE?

SUBLOCADE contains the active ingredient buprenorphine. SUBLOCADE is used as part of medical, social and psychological treatment program for patients dependent on opioids. For more information, see Section 1. Why am I using SUBLOCADE? in the full CMI.

 2. What should I know before I use SUBLOCADE?

Do not use if you have ever had an allergic reaction to SUBLOCADE or any of the ingredients listed at the end of the CMI.
Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding. Tell your doctor if you have or have had any of the following medical conditions: kidney disease, liver problems, breathing problems, problems with excess alcohol use or history of seizures.
For more information, see Section 2. What should I know before I use SUBLOCADE? in the full CMI.

 3. What if I am taking other medicines?

Some medicines may interfere with SUBLOCADE and affect how it works. A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

 4. How do I use SUBLOCADE?
  • SUBLOCADE must be administered only by your doctor or healthcare professional.
  • The recommended first two doses following induction on a buprenorphine-containing product are 300 mg monthly. The subsequent dosing will be selected by your doctor based on clinical assessment of your condition

More instructions can be found in Section 4. How do I use SUBLOCADE? in the full CMI.

 5. What should I know while using SUBLOCADE?

Things you should do

  • Remind any doctor, dentist, pharmacist or nurse you visit that you are using SUBLOCADE
  • If you are going to have surgery, tell the surgeon or anaesthetist that you are using SUBLOCADE
  • Tell your family or friends that, in the event of emergency, they should inform the treating healthcare provider or Emergency Room staff that you are being treated with SUBLOCADE

Things you should not do

  • Do not rub or massage the injection site and be aware of placement of belts or clothing waistbands
  • Do not attempt to tamper with the medicine once given by your healthcare provider

Driving or using machines

  • SUBLOCADE may cause drowsiness which may be made worse if you drink alcohol or take sedatives or anti-anxiety medications
  • Be careful driving or operating machinery until you know how SUBLOCADE affects you

Drinking alcohol

  • Do not drink alcohol or take medicines that contain alcohol whilst being treated with SUBLOCADE
  • Alcohol and some medicines may increase the sedative effects of SUBLOCADE

Looking after your medicine

  • Store at 2°C - 8°C. Refrigerate. Do not freeze.
  • Once outside the refrigerator this product may be stored in its original packaging at room temperature (below 25°C) for up to 12 weeks prior to injecting.

For more information, see Section 5. What should I know while using SUBLOCADE? in the full CMI.

 6. Are there any side effects?

Some common side effects include difficulty sleeping, anxiety, fatigue, weakness, numbness, flu-like symptoms, upset stomach, constipation and diarrhoea, abnormal liver function and injection site reactions. Cases of difficulty breathing and severe liver problems have been reported with SUBLOCADE.

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.


WARNINGS:

Risk of serious harm or death with intravenous administration

Serious harm or death could result if administered intravenously. SUBLOCADE forms a solid mass upon contact with body fluids and may cause occlusion, local tissue damage, and blood clotting events, including life threatening blood clots in the lungs, if administered intravenously.

Hazardous and harmful use

Although SUBLOCADE is indicated for the treatment of opioid dependence, it still poses risks of hazardous and harmful use which can lead to overdose and death. The doctor will monitor your ongoing risk during treatment with SUBLOCADE.

Life threatening respiratory depression

Serious, life-threatening difficulty breathing may occur with the use of SUBLOCADE. Talk to your doctor about situations which may increase the risk of severe difficulty breathing.

Concomitant use of medicines affecting the central nervous system, including alcohol

Use of SUBLOCADE with anti-anxiety medicines, sedatives, antihistamines, some antidepressants, antipsychotics, cannabis and alcohol may result in profound sedation, severe difficulty breathing, coma and death.

SUBLOCADE®

Active ingredient: Buprenorphine


 Consumer Medicine Information (CMI)

This leaflet provides important information about using SUBLOCADE. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using SUBLOCADE.

Where to find information in this leaflet:

1. Why am I using SUBLOCADE?
2. What should I know before I use SUBLOCADE?
3. What if I am taking other medicines?
4. How do I use SUBLOCADE?
5. What should I know while using SUBLOCADE?
6. Are there any side effects?
7.Product details

1. Why am I using SUBLOCADE?

SUBLOCADE modified release injection contains the active ingredient buprenorphine. SUBLOCADE acts as a substitute for opioids like heroin, morphine, oxycodone or codeine and it helps withdrawal from opioids over a period of time.

SUBLOCADE is used as part of a medical, social and psychological treatment program for patients dependent on opioids.

SUBLOCADE must only be administered by your doctor or other healthcare professional.

2. What should I know before I use SUBLOCADE?

Warnings

Do not use SUBLOCADE if:

  • you are allergic to buprenorphine or any of the ingredients listed at the end of this leaflet.
  • always check the ingredients to make sure you can use this medicine.
  • you have serious problems with your liver, or if your doctor detects the development of a serious liver problem during treatment.
  • you are under the age of 18 years.
  • you have serious breathing problems.
  • you are intoxicated due to CNS depressant medicines (e.g. sedative/hypnotics, narcotic pain killers, anti-anxiety or antipsychotic medicines), alcohol or have delirium tremens (the ‘shakes’ and hallucinations).
  • the package is torn or shows signs of tampering.

Check with your doctor if you:

  • have any other medical conditions such as asthma or other breathing problems, thyroid problems, prostate problems, problems with excess alcohol use, problems with drowsiness, Addison's disease, Kyphoscoliosis (hunchback disease), low blood pressure, urination problems, kidney problems, liver problems, if you have head injuries or have a condition where you have increased pressure within your head, if you have problems related to the biliary tract, if you have a history of seizures or If you have severe mental problems or hallucinations (seeing or hearing things that are not really there).
  • take any medicines for any other condition

Some people have died from respiratory failure (inability to breathe) when using benzodiazepines (medicines used to treat anxiety or sleeping problems), or other depressants such as alcohol or other opioids at the same time as buprenorphine. For further information please discuss with your doctor.

Buprenorphine may cause fatal respiratory failure in children who accidentally ingest it.

SUBLOCADE can cause withdrawal symptoms (dependence). Withdrawal signs and symptoms were not observed in the month following discontinuation of SUBLOCADE. Considering the long-acting characteristic, any withdrawal signs and symptoms that may occur would be expected to be delayed.

If you stop receiving injections of SUBLOCADE, your doctor may want to monitor you for several months for signs and symptoms of withdrawal and treat appropriately due to the long-acting characteristic of this medicine.

Athletes should be aware that this medicine may cause a positive reaction to "anti-doping" tests.

The safety and effectiveness in patients over 65 years of age have not been established.

SUBLOCADE forms a depot following subcutaneous injection. Serious harm or death could result if injected intravenously.

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed.

Use of SUBLOCADE or other opioids by the mother during pregnancy may result in withdrawal symptoms in the baby following birth, this is called Neonatal Abstinence Syndrome. Neonatal Abstinence Syndrome is a condition that includes disturbances to a newborn baby's nervous, gastro-intestinal and breathing systems. Not all babies who are exposed to SUBLOCADE in this way will have withdrawal symptoms. Talk to your doctor if you become pregnant or plan to become pregnant during treatment with SUBLOCADE. Your doctor will help you consider the risks and benefits of continued treatment and plan for monitoring your baby following birth. Due to the long duration of buprenorphine effect, your baby will be monitored for several days at the end of pregnancy for effects on breathing and for withdrawal symptoms.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may interfere with SUBLOCADE and affect how it works.

  • medicines containing alcohol
  • certain medicines for treating HIV/AIDS
  • certain medicines for treating fungal and bacterial infections
  • strong pain killers
  • cough medicines containing opioid-related substances
  • certain antidepressants including monoamine oxidase inhibitors
  • certain medicines used to treat fits or epilepsy (anti-convulsants)
  • sedating antihistamines
  • sedatives
  • alcohol
  • anti-anxiety medicines
  • certain medicines for high blood pressure
  • antipsychotic medicines
  • naltrexone.

Tell your doctor if you are scheduled to have surgery using a general anaesthetic.

Some people have died when using sedatives (benzodiazepines) or other depressants, alcohol or other opioids at the same time as buprenorphine. You should not use benzodiazepines (medicines used to treat anxiety or sleep disorders) whilst you are taking SUBLOCADE unless they are prescribed by your doctor.

Alcohol and certain other medicines (as listed above) may increase the sedative effects of buprenorphine which can make driving and operating machinery hazardous.

Do not drink alcohol or take medicines that contain alcohol whilst you are being treated with SUBLOCADE.

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect SUBLOCADE.

4. How do I use SUBLOCADE?

How much to use

  • SUBLOCADE is injected under the skin in your abdomen by your doctor or other healthcare professional only. Your doctor will tell you when you need your next injection. It is important not to miss your scheduled dose.
  • SUBLOCADE must NOT be injected intravenously, intramuscularly or intradermally.
  • SUBLOCADE is only for adults.
  • The recommended first two doses following an induction on a buprenorphine-containing product is 300 mg monthly. The subsequent dosing will be selected by your doctor based on clinical assessment of your condition. Because SUBLOCADE lasts a long time, it should be given monthly and separated by a minimum of 26 days between doses.
  • Do not change the treatment in any way or stop treatment without the agreement of the doctor who is treating you.

When to use SUBLOCADE

SUBLOCADE will be administered once a month by your doctor or other healthcare professional.

If you forget to use SUBLOCADE

SUBLOCADE should be given monthly. It is important to remember to attend your next appointment to receive your next SUBLOCADE injection.

If you cannot keep your appointment for your next SUBLOCADE injection, call your healthcare professional right away so another appointment can be made as soon as possible.

Do not change the treatment in any way or stop treatment without the agreement of the doctor who is treating you.

Because SUBLOCADE lasts a long time, if you stop receiving injections of SUBLOCADE, you should be monitored for several months for symptoms (not sure you need signs and symptoms for the patient) of withdrawal so you can be treated appropriately.

If you use too much SUBLOCADE

Because SUBLOCADE will be administered to you under medical supervision, it is unlikely that you will be given too much.

If you think that you or anyone else may have received too much SUBLOCADE, you should immediately

  • phone the Poisons Information Centre by calling
    in Australia 13 11 26 or in New Zealand 0800 POISON or 0800 764 766, or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

5. What should I know while using SUBLOCADE?

Things you should do

If you are about to start on any new medicine, remind your doctor, nurse and pharmacist who treat you that you are using or will be starting SUBLOCADE.

If you are going to have surgery, tell the surgeon or anaesthetist that you are using SUBLOCADE.

It may affect other medicines used during surgery.

Keep all of your doctor's appointments so that your progress can be checked.

Call your doctor straight away if you:

  • experience hypersensitivity reactions such as swelling of the face, lips, mouth or throat, or severe difficulty in breathing, or
  • experience severe liver problems such as intense fatigue, no appetite, your skin and eyes look yellow, or you have light coloured bowel motions or dark coloured urine.

Remind any doctor, dentist, nurse or pharmacist you visit that you are using SUBLOCADE.

Things you should not do

  • do not attempt to tamper with the medicine once given by your healthcare provider.
  • do not rub or massage the injection site and be aware of the placement of any belts or clothing waistbands.
  • do not give your medicine to anyone else, even if they have the same condition as you.

Things to be careful of

  • SUBLOCADE may cause your blood pressure to drop suddenly, causing you to feel dizzy if you get up too quickly from sitting or lying down.
  • if you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly.
  • if you stop using SUBLOCADE and if you start using opioids again, your sensitivity to opioids may change which could be dangerous. You should talk to your doctor before you start using opioids again.
  • SUBLOCADE contains a narcotic that can be a target for people who abuse prescription medicines or street drugs.

Treating pain, emergencies and anaesthesis

While on SUBLOCADE situations may arise where you need to be treated for pain or may require anaesthesia. SUBLOCADE can interfere with the action of some pain treatments. In the event of an emergency, it is important you and your family or friends inform your healthcare provider or Emergency Room staff that you are being treated with SUBLOCADE. For 6 months after stopping SUBLOCADE, you should continue to inform your healthcare providers you have been treated with SUBLOCADE because SUBLOCADE effect can last for a long time.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how SUBLOCADE affects you.

SUBLOCADE may cause drowsiness, which may be made worse if you also drink alcohol or take sedatives or anti-anxiety medicines. If you are drowsy, do not drive or operate machinery.

Drinking alcohol

Do not drink alcohol or take medicines that contain alcohol whilst you are being treated with SUBLOCADE.

Tell your doctor if you drink alcohol.

Looking after your medicine

  • Store at 2°C - 8°C. Refrigerate. Do not freeze.
  • Once outside the refrigerator this product may be stored in its original packaging at room temperature (below 25°C) for up to 12 weeks prior to injecting.
  • Once the medicine is administered, the needle guard should be locked into place by pushing it against a hard surface such as a table.
  • All syringe components should be disposed of in a secure sharps disposal container.

Keep it where young children cannot reach it.

When to discard your medicine

SUBLOCADE should be discarded if not refrigerated for longer than 12 consecutive weeks.

Getting rid of any unwanted medicine

Do not use this medicine after the expiry date.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Less serious side effects

Less serious side effects

What to do

Pain-related effects:

  • pain in abdomen, back, arms, legs, joints and muscles, leg cramps, muscle weakness
  • headache, migraine
  • chest pain

Gastrointestinal effects:

  • upset stomach and diarrhoea
  • nausea, vomiting, constipation, poor appetite
  • abnormal liver function

General effects:

  • difficulty sleeping, anxiety
  • fatigue, weakness, numbness
  • sleepiness, dizziness, fainting, vertigo
  • flushing, feeling of warmth
  • rash and itching
  • tooth disorders
  • abnormal vision
  • low sex drive, impotence
  • urinary tract infection

Injection site reactions:

  • redness, pain, itching, nodule just under the skin

Flu-like symptoms:

  • chills, fever, sore throat, coughing, runny nose and sweating

Breathing related

  • difficulty breathing
  • cough, respiratory infection

Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effects

What to do

Liver problems:

  • severe fatigue
  • you have no appetite
  • your skin and eyes look yellow
  • you have light coloured bowel motions or dark coloured urine

Hypersensitivity reactions:

  • swelling of the face, lips, mouth or throat
  • severe difficulty breathing

Severe injection site reactions:

  • signs of infection at the injection site such as pain, redness, swelling, itching and warmth.

Signs of overdose:

  • severe drowsiness, dizziness or difficulty thinking
  • severe drop in blood pressure
  • severe difficulty breathing

Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Tell your doctor or pharmacist if you notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects in Australia to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems or in New Zealand online at nzphvc.otago.ac.nz/reporting.

For adverse event reporting please contact:

Indivior Pty Ltd

+800-270-81901

PatientSafetyRoW@indivior.com

By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What SUBLOCADE contains

Active ingredient

(main ingredient)

Buprenorphine

Other ingredients

(inactive ingredients)

Polyglactin
N-methyl-2-pyrrolidone

Potential allergens

None known

Do not take this medicine if you are allergic to any of these ingredients.

What SUBLOCADE looks like

SUBLOCADE 100 mg/0.5 mL modified release injection solution is supplied in a single use dose in a 1 mL plastic syringe with a plunger stopper, together with a 19 G 16mm pre-packaged safety needle (AUST R 303476).

SUBLOCADE 300 mg/1.5 mL modified release injection solution is supplied in a single use dose in a 2.25 mL plastic syringe with a plunger stopper, together with a 19 G 16mm pre-packaged safety needle (AUST R 303753).

Each assembled syringe with plastic plunger rod is supplied in an aluminium foil-laminate pouch containing an oxygen absorbing desiccant. The pouch is in a labelled paperboard carton along with a sterile safety needle and labelling.

SUBLOCADE 100mg/0.5mL and 300mg/1.5mL are supplied in a single use pack.

Who distributes SUBLOCADE

Indivior Pty Ltd
78 Waterloo Road
Macquarie Park NSW 2113
Australia

Pharmacy Retailing (NZ) Ltd
t/a Healthcare Logistics
58 Richard Pearse Drive
Airport Oaks
Mangere
Auckland 2022

This leaflet was prepared in October 2023.

Published by MIMS December 2023

BRAND INFORMATION

Brand name

Sublocade

Active ingredient

Buprenorphine

Schedule

S8

 

Boxed Warnings

Risk of serious harm or death with intravenous administration. Serious harm or death could result if administered intravenously. Sublocade forms a solid mass upon contact with body fluids and may cause occlusion, local tissue damage and thrombo-embolic events, including life threatening pulmonary emboli, if administered intravenously (see Section 4.4).
Hazardous and harmful use. Although Sublocade is indicated for the treatment of opioid dependence it still poses risks of hazardous and harmful use which can lead to overdose and death. Monitor the patient's ongoing risk of hazardous and harmful use regularly during opioid substitution therapy with Sublocade (see Section 4.4 Special Warnings and Precautions for Use).
Life threatening respiratory depression. Serious, life-threatening or fatal respiratory depression may occur with the use of Sublocade. Be aware of situations which increase the risk of respiratory depression, and monitor patients closely, especially on initiation or following a dose increase (see Section 4.4 Special Warnings and Precautions for Use).
Concomitant use of benzodiazepines and other central nervous system (CNS) depressants, including alcohol. Concomitant use of opioids with benzodiazepines, gabapentinoids, antihistamines, tricyclic antidepressants, antipsychotics, cannabis or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Patients and their caregivers should be made aware of the symptoms of respiratory depression. Patients and their caregivers should also be informed of the potential harms of consuming alcohol while receiving Sublocade.

1 Name of Medicine

Sublocade 100 mg/0.5 mL buprenorphine modified release solution for injection.
Sublocade 300 mg/1.5 mL buprenorphine modified release solution for injection.

2 Qualitative and Quantitative Composition

Buprenorphine is dissolved in Indivior's proprietary buprenorphine gel depot delivery system (Indivior's delivery system) at 18% by weight.
0.5 mL modified release injection solution in a prefilled syringe contains 100 mg buprenorphine (as buprenorphine base).
1.5 mL modified release injection solution in a prefilled syringe contains 300 mg buprenorphine (as buprenorphine base).
Buprenorphine is a white to cream, crystalline powder, very slightly soluble in water (< 1 mg/mL). Chemically, buprenorphine is (2S)-2-[17-(Cyclopropylmethyl)-4,5α-epoxy-3-hydroxy-6-methoxy-6α,14-ethano-14α-morphinan-7α-yl]-3,3-dimethylbutan-2-ol.
Buprenorphine has the molecular formula C29H41NO4 and the molecular weight is 467.6.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Sublocade is a modified release solution for injection.
Sublocade is a clear colourless to yellow to amber sterile solution for subcutaneous injection only. It forms a depot upon administration which is designed to deliver buprenorphine at a controlled rate over a one-month period.

4 Clinical Particulars

4.9 Overdose

Manifestations of acute overdose include miosis, sedation, hypotension, respiratory depression and death. Nausea and vomiting may be observed.
The major symptom requiring intervention is respiratory depression, which could lead to respiratory arrest and death. If the patient vomits, care must be taken to prevent aspiration of the vomitus.
Treatment. In the event of depression of respiratory or cardiac function, primary attention should be given to the re-establishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation following standard intensive care measures. The patient should be transferred to an environment within which full resuscitation facilities are available. Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. High doses of naloxone hydrochloride 10-35 mg/70 kg may be of limited value in the management of buprenorphine overdose.
The long duration of action of buprenorphine should be taken into consideration when determining the length of treatment needed to reverse the effects of an overdose. Naloxone can be cleared more rapidly than buprenorphine, allowing for a return of previously controlled buprenorphine overdose symptoms, so a continuing infusion may be necessary. Ongoing IV infusion rates should be titrated to patient response. If infusion is not possible, repeated dosing with naloxone may be required.
Clinical data are limited with regards to the possible surgical removal of the depot as only two cases of surgical removal were reported in premarketing clinical studies.
For further information on the management of overdose, contact the Poisons Information Centre on 131126 (Australia) or National Poisons Centre on 0800 764 766 (New Zealand).

5 Pharmacological Properties

5.3 Preclinical Safety Data

Genotoxicity. No evidence of clastogenic potential towards rat bone marrow cells by subcutaneous Sublocade was found in an in vivo micronucleus test.
The conclusion from various genotoxicity assays, including Ames tests and chromosome aberration studies is that buprenorphine and N-methyl-2-pyrrolidone (NMP) are not genotoxic.
Carcinogenicity. Studies conducted in animals (rats and mice) show that buprenorphine is not carcinogenic at oral doses of up to 56 and 100 mg/kg/day, respectively, both of which equate to approximately 15-fold human exposure at the maximum recommended clinical dose of 32 mg based on body surface area. N-methyl-2-pyrrolidone (NMP), an excipient in Sublocade, produced an increase in hepatocellular adenomas and carcinomas in male and female mice at around 6 and 8 times, respectively, the maximum daily dose (MDD) of NMP delivered via Sublocade. The clinical significance of these findings is unclear. No tumours were noted at 1 and 1.3 times the MDD. Exposure of rats to NMP for 2 years via inhalation (at around 0.7 x MDD) or via diet (at around 3 x MDD) was shown to be non-carcinogenic. The possible carcinogenicity of NMP from subcutaneous Sublocade has not been tested.

6 Pharmaceutical Particulars

6.7 Physicochemical Properties

Chemical structure. The chemical structure of buprenorphine is:
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSBUPREO.gif CAS number. The CAS number is 52485-79-7.

7 Medicine Schedule (Poisons Standard)

Schedule 8.

Summary Table of Changes

https://stagingapi.mims.com/au/public/v2/images/fulltablegif/SUBLOCST.gif