Viatris, the marketing authorisation holder of EpiPen® auto-injectors, is committed to supporting patients with anaphylaxis and understands the need for patients to be fully aware of why they must always carry two EpiPen® and what to do in an emergency.
You'll find a range of materials on this page to help you support your patients.
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Department of Health guidelines state that schools can hold 'spare' AAIs.1
Schools are advised to hold an appropriate quantity of a single brand of AAI device to avoid confusion in administration and training. Where all pupils are prescribed the same device, the school should obtain the same brand for the spare AAI. If two or more brands are currently held by the school, the school may wish to purchase the brand most commonly prescribed to its pupils. However, the decision as to how many devices and brands to purchase will depend on local circumstances and is left to the discretion of the school.
Find answers to some of the most common questions about EpiPen®. If you can't find what you're looking for, please contact UKenquiry@viatris.com and we'll get back to you as soon as possible.
The answers for EpiPen® also apply to EpiPen® Jr unless otherwise stated.
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Q.What is the difference between EpiPen® and EpiPen® Jr?
A.They both contain adrenaline, but in different concentrations. EpiPen® contains 0.3mg adrenaline and EpiPen® Jr contains 0.15mg adrenaline. Selection of the appropriate dosage concentration for the patient is determined by the prescribing physician according to the patient’s body weight.
EpiPen® auto-injector 0.3mg is recommended for adults and children weighing >25kg.2
EpiPen® Jr. auto-injector 0.15mg is recommended for children weighing between 7.5 – 25kg.3
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Q.What is the active ingredient and dose of EpiPen®?
A.The active ingredient in EpiPen® is adrenaline. Each EpiPen® contains 2ml adrenaline solution.
The dose of EpiPen® is 0.3mg and the dose of EpiPen® Jr is 0.15mg.
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Q.How does EpiPen® work during a severe allergic reaction?
A.During anaphylaxis, airways constrict and blood vessels dilate and become more permeable, which can lead to loss of fluid volume from within the vessels and hypotension. Adrenaline acts on different parts of the body to constrict blood vessels and relax bronchial muscle, helping to reduce bronchospasm, wheezing and dyspnoea. Adrenaline also alleviates pruritus, urticaria and angioedema and may be effective in relieving gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxant effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder.
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Q.How many doses can be given?
A.An initial EpiPen® should be administered as soon as symptoms of anaphylaxis are recognised, and an ambulance called.
In the absence of clinical improvement or if deterioration occurs after the initial treatment, a second injection with an additional EpiPen® auto-injector may be administered 5 minutes after the first injection.
Any more than 2 doses of adrenaline should only be administered under direct medical supervision. The EpiPen® auto-injector is a prefilled disposable automatic injection device which is designed to deliver a single dose.
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Q.What should a patient do after administering EpiPen®?
A.EpiPen® is not intended as a substitute for immediate medical care. In conjunction with the administration of EpiPen®, the patient (or someone with the patient) should call 999 immediately. There is a clear rationale for the patient to stay lying down, with legs elevated where possible, in order to assist blood flow back to the heart and to vital organs. If patients are struggling to breathe, they may need to sit up but this should be for as short a time as possible.4
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Q.When can a patient receive a second EpiPen®?
A.EpiPen® should be administered as soon as symptoms of anaphylaxis are recognised. In the absence of clinical improvement or if deterioration occurs after the first EpiPen®, a second injection with an additional EpiPen® may be administered 5 minutes after the first injection. More than two sequential doses of adrenaline should only be administered under direct medical supervision.
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Q.Which patients should use adrenaline with caution?
A.Adrenaline should be used with caution in patients who have cardiac arrhythmias, coronary artery or organic heart disease, hypertension, or in patients who are on drugs that may sensitise the heart to arrhythmias, e.g., digitalis, diuretics, quinidine, or other anti-arrhythmics. In such patients, adrenaline may precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias.
It should be recognised that the presence of these conditions is not a contraindication to adrenaline administration in an acute, life-threatening situation.
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Q.What if the solution becomes discoloured?
A.Patients should be instructed to periodically visually inspect the adrenaline solution for the presence of particles and discolouration. If the solution contains particles, develops a pinkish colour or becomes darker than slightly yellow, the patient should immediately contact their HCP for a replacement.
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Q.Can EpiPen® be used through clothing?
A.EpiPen® and EpiPen® Jr can be used through clothing if necessary. The needle size of both the EpiPen® and the EpiPen® Jr is 22 gauge. The extended needle length after activation is approximately 15 mm for the EpiPen® and approximately 13 mm for the EpiPen® Jr.2,3
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Q.How should EpiPen® be stored?
A.Adrenaline is sensitive to light. Keep the auto-injector in the outer carton. Do not store above 25°C. Do not refrigerate or freeze.
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Q.Does EpiPen® contain latex?
A.EpiPen® does not contain latex.
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Q.Does EpiPen® contain lactose, sucrose, gluten or tartrazine?
A.EpiPen® does not contain lactose, sucrose, gluten or tartrazine.
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Q.Does EpiPen® contain sulfite?
A. EpiPen® and EpiPen Jr® contain 0.5 mg sodium metabisulfite per dose.
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Q.Can EpiPen® be used in sulfite-allergic patients?
A. EpiPen® contains sodium metabisulfite, a sulfite that may in other products cause allergic-type reactions including anaphylactic symptoms or life-threatening or less severe asthmatic episodes in certain susceptible persons. The alternatives to using adrenaline in a life-threatening situation may not be satisfactory. The presence of a sulfite in this product should not deter administration of the drug for treatment of serious allergic or other emergency situations.
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Q.Can EpiPen® be given to patients with a sulfa allergy?
A.Yes. Although EpiPen® contains sodium metabisulphite, a patient with a sulfa allergy is allergic to drugs that contain the sulphonamide group, but not to drugs containing sulphur, sulfite, or sulphates. The allergy is specific to the sulphonamide group and does not predispose a patient to allergy with any other compounds containing sulphur.
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Q.What is the procedure in the case of accidental injection?
A.Since adrenaline is a strong vasoconstrictor, accidental injection into the hands or feet may result in loss of blood flow to the affected area and so should be avoided. If accidental injection does occur in these areas, the patient should go immediately to the nearest urgent care facility.
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Q.How do you dispose of expired/used EpiPen®?
A.Expired EpiPen® must be disposed of in a sharps bin.
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Q.Can EpiPen® be used in pregnancy?
A.Adrenaline should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus.
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Q.How many EpiPen® should I prescribe?
A.Guidelines recommended that 2 adrenaline auto-injectors are prescribed, which patients should carry at all times.5,6
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Q.What doses do patients require?
A.Acute anaphylaxis for self-administration should be treated by intramuscular injection7
- -For adult and child body weight 25kg and above – 0.3mg.
- -For child body weight 7.5 kg- 25kg – 0.15mg.
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Q.What is the shelf-life of EpiPen®?
A.EpiPen® has a shelf life of 24 months2 and EpiPen® Jr has a shelf life of 19 months.3
1. Department of Health. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads
/attachment_data/file/645476/Adrenaline_auto_injectors_in_schools.pdf. Last accessed: May 2023
2. EpiPen® (adrenaline) Auto- Injector 0.3mg Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc
/product/4289/smpc. Last accessed: May 2023
3. EpiPen® Jr (adrenaline) Auto- Injector 0.15mg Summary of Product Characteristics. Available at: https://www.medicines.org.uk/
emc/product/4290/smpc. Last accessed: May 2023
4. GOV.UK. Available at https://www.gov.uk/government/publications/public-assessment-report-recommendations-to-support-the-effective-and-safe-use-of-adrenaline-auto-injectors/public-assessment-report-of-the-commission-on-human-medicines-adrenaline-auto-injector-expert-working-group-recommendations-to-support-the-effectiv. Last Accessed: May 2023
5. MHRA Guidelines. Available at https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review. Last Accessed: May 2023
6. NICE Anaphylaxis Guidelines. Available at https://www.nice.org.uk/guidance/cg134/evidence/anaphylaxis-full-guideline-pdf-184946941. Last Accessed: May 2023
7. Muraro A, et al. EAACI guidelines: Anaphylaxis. 2022;77: 357-377
EPI-2021-0591 May 2023
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