FAQs


The following Frequently Asked Questions serve as a reminder of key facts about EpiPen® (adrenaline) auto-injectors and also aim to cover any topics which patients may raise which are not discussed elsewhere on the website. 1

What is the active ingredient and dose in EpiPen®?
How does EpiPen® work during a severe allergic reaction?
What should a patient do after receiving an injection?
How many doses can be given?
When can a patient receive a second injection?
Which patients should use adrenaline with caution?
What if the solution becomes discoloured?
What type of needle does an EpiPen® have?
How should EpiPen® be stored?
What happens if EpiPen® has been stored incorrectly?
Does EpiPen® contain latex?
Does EpiPen® contain lactose, sucrose, gluten or tartrazine?
Does EpiPen® contain sulphite?
Can EpiPen® be used in sulphite-allergic patients?
Can EpiPen® (be given to patients with a sulpha allergy?
What is the procedure in the case of accidental injection?
How do you dispose of expired units?
How do you dispose of used units?
Can EpiPen® be used in pregnancy?
Is it safe for patients to remove the blue cap on EpiPen® prior to use?

Q. What is the active ingredient and dose in EpiPen®?
A. Each EpiPen® delivers a single dose of 0.3 mg adrenaline injection, and EpiPen® Jr delivers a single dose of 0.15 mg adrenaline. Each vial contains 2 mL adrenaline solution, but the volume administered is in 0.3 mL as approximately 1.7 mL remains in the auto-injector after activation and cannot be used.
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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 low blood pressure (hypotension). Adrenaline acts on different parts of the body to constrict blood vessels and relax bronchial muscle, helping to reduce alleviate bronchospasm, wheezing and dyspnoea. Adrenaline also alleviates pruritus (itching), urticaria (rash), and angioedema (swelling) 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. What should a patient do after receiving an injection?
A. EpiPen® is not intended as a substitute for immediate medical care. In conjunction with the administration of adrenaline, the patient should be counselled to call 999 immediately after using their EpiPen® and state anaphylaxis.
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Q. How many doses can be given?
A. More than two sequential doses of adrenaline should only be administered under direct medical supervision.
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Q. When can a patient receive a second injection?
A. With severe persistent anaphylaxis, repeat injections with an additional EpiPen® may be necessary, 5 to 15 minutes after the first. 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 physician for a replacement, since these changes indicate that the effectiveness of adrenaline may be decreased.
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Q. What type of needle does an EpiPen® have?
A. Both EpiPen® and EpiPen®Jr should be injected intramuscularly into the outside of the thigh, 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 16.5 mm for the EpiPen® and 12.7 mm for the EpiPen®Jr
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Q. How should EpiPen® be stored?
Adrenaline is sensitive to light. Keep the auto-injector in the outer carton.
Do not store above 25 ºC.
Do not refrigerate or freeze

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Q. What happens if EpiPen® has been stored incorrectly?
A. If the EpiPen® has been exposed to extreme low or high temperatures, the patient is at risk of the firing mechanism malfunctioning and the possible degradation of the solution.
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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 any of these substances.
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Q. Does EpiPen® contain sulphite?
A. Each 0.3 mL of EpiPen® contains 0.5 mg sodium metabisulphite.
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Q. Can EpiPen® be used in sulphite-allergic patients?
A. EpiPen® contains sodium metabisulphite, a sulphite that may in other products cause allergic-type reactions, including anaphylactic symptoms or life-threatening or less severe asthmatic episodes in certain susceptible persons.
In a patient with documented sulphite sensitivity, the alternatives to using adrenaline in a life-threatening situation may not be satisfactory. Therefore, the presence of a sulphite in this product should not deter administration of the drug for treatment of serious allergic or other emergency situations when sulphite-free alternatives are not available.
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Q. Can EpiPen® be given to patients with a sulpha allergy?
A. Yes. Although EpiPen® contains sodium metabisulphite, a patient with a sulpha allergy is allergic to drugs that contain the sulphonamide group, but not to drugs containing sulphur, sulphites, 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 casualty department for treatment.
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Q. How do you dispose of expired units?
A. Expired EpiPen®‘s must be disposed of properly in a sharps bin.
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Q. How do you dispose of used units?
A. Document the dosage of EpiPen® given and dispose of in a sharps container.
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Q. Can EpiPen® be used in pregnancy?
A. EpiPen® is a Pregnancy Category C drug. Adrenaline should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus.
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Q. Is it safe for patients to remove the blue cap on EpiPen® prior to use?
A. The blue cap serves as a safety pin, which prevents the internal spring from activating, causing the ampoule to be penetrated and the needle to protrude. The blue pin should only be removed immediately prior to use. Providing the EpiPen® has not been activated, the blue cap can be re-inserted. It is important to note that recapping is not recommended.
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References:

  1. EpiPen Summary of Product Characteristics, MEDA Pharmaceutical Ltd, August 2012.