II. Indications
- Indicated for history severe reaction or Anaphylaxis
- Patient injects at time of Allergic Reaction
III. Precautions
- Immediate medical attention after using injector
- Further Anaphylaxis management may be required
- Replace the autoinjector before it expires (avoid relying on an expired injector)
- May try the expired injector if no alternative
- Keep the Epinephrine away from prolonged heat exposure (denatures, weakens effect)
IV. Medications: Epinephrine Autoinjectors
- EpiPen and EpiPen Jr
- Costs may exceed $400
- Twinject
- Adrenaclick
- Generic and may be least expensive option ($100 for 2 pens) once reasonable pricing ensues in late 2016
- Requires removal of 2 cap protectors (instead of 1 with the EpiPen)
- Ana-Guard
- Ana-kit (Epinephrine with Chlorpheniramine)
- Auvi-Q
- Back on market in 2017 after recall in late 2015 (concern regarding consistent dose delivery)
- Talking device that walks patient through use of the injector at time of use
- Device is in shape of smart phone
- Costs as much as $4900 for a 2 pack
- (2013) Presc Lett 20(3): 18
- Symjepi
- Prefilled syringes of 0.3 mg (or 0.15 mg) at $250 for a two pack
- Not an autoinjector
- To use, pull protective cap off needle, insert into mid-outer thigh, press plunger until click, hold in place 2 sec.
- Slide safety guard over needle after use
- (2019) Presc Lett 26(3): 18
- Neffy (Nasal spray)
- FDA approved in U.S. in Augist 2024 for adults and children (weight >= 30 kg or 66 lb)
- Appears to reach similar serum levels of Epinephrine with similar onset as for injectables
- However, absorption may be impacted by prior nasal surgery or Nasal Polyps
- Testing was done in healthy subjects, and efficacy may be reduced in Anaphylaxis
- Injectables are still preferred as first line agents
- Weight >= 30 kg (66 lb): 2 mg nasal Inhaler
- A 1 mg nasal Inhaler is being FDA reviewed for weight 15 to 30 kg (33 to 66 lb) as of 2024
- Technique
- Hold device with thumb on underside plunger and a finger on either side of nozzle
- Insert nozzle completely into 1 nostril and fully depress the plunger to spray
- Each spray delivers 2 mg Epinephrine
- May give a second dose in the same nostril in 5 minutes if needed
- Shelf-Life
- Shelf-Life: 30 months
- Can withstand Temperatures up to 50 C (122 F)
- References
- (2024) Presc Lett 31(10): 56
- LoVecchio (2024) Crit Dec Emerg Med 38(10): 35
- Pharmacy compounded kit (other options are preferred)
- Epinephrine vials, syringe and needle supplies can be purchased for $20
- Requires correctly dosing and administering 0.15 or 0.3 mg IM in case of Anaphylaxis
- If patient prefills syringe, it expires within 2-3 months (dispose and fill new syringe after 2 months)
V. Medications: Related Items
- Veta Smart Case
- Sends smartphone message if kit is left behind, pen is removed, pen expires
- Very expensive security ($130 and then $24 per year)
VI. Dosing
- Pearls
- Consider supplying more than 1 injector
- Place in different locations at home, work, school
- More than one injection may be required
- Prefilled Epinephrine auto-injectors
- Adult dose (weight >66 pounds or 30 kg): 0.30 mg
- Child dose (weight <66 pounds or 30 kg): 0.15 mg
VII. Technique: EpiPen (or similar device)
- Device will penetrate clothing
- Bare skin is not required for the injection
- Preparation
- Remove the cap from the carrying device (caps are yellow for adult version, and green for child's version)
- Remove the injector from the case and grasp in one fist with orange tip pointing downward
- Pull out the blue safety release pin from the top of the device with the free hand
- Technique
- Aim the orange tip toward the outer thigh
- Swing the arm up in abduction and then down striking the device firmly at 90 degrees at the outer thigh
- Expect to hear a click as the needle deploys and penetrates the skin
- Hold the device firmly against the thigh for at least 10 seconds so that all medication is deposited
- Post-Injection
- Remove the device and massage the injection area for 10 seconds
- The needle will be safely enclosed within the orange tip to prevent Needle Sticks
- However device needs to be disposed of as biohazardous waste
- Proceed to obtain immediate medical attention
VIII. Resources
- Meridian Medical Technologies (EpiPen)
IX. References
- (2016) Presc Lett 23(9)
- Arnold (2011) Am Fam Physician 84(10): 1111-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| epipen (on 8/17/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| EPIPEN 0.3 MG AUTO-INJECTOR | Generic | $141.43 each |
| EPIPEN 2-PAK 0.3 MG AUTO-INJCT | Generic | $141.43 each |
| EPIPEN JR 0.15 MG AUTO-INJECTR | Generic | $142.02 each |
| EPIPEN JR 2-PAK 0.15 MG INJCTR | Generic | $142.02 each |
| auvi-q (on 12/20/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| AUVI-Q 0.1 MG AUTO-INJECTOR | $301.77 each | |
| AUVI-Q 0.3 MG AUTO-INJECTOR | $297.40 each | |
| symjepi (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SYMJEPI 0.3 MG/0.3 ML SYRINGE | $120.05 each | |