EpiPen® auto-injectors are automatic injection devices containing adrenaline for allergic emergencies.

The active ingredient and instructions for use are the same for EpiPen® and EpiPen® Jr so the information here is applicable for EpiPen® or EpiPen® Jr and the term EpiPen® is used throughout to refer to both interchangeably.

EpiPen® and EpiPen® Jr are indicated in the emergency treatment of severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs and other allergens as well as idiopathic or exercise induced anaphylaxis.1,2

EpiPen® is an adrenaline auto-injector (AAI) used for self-administration of adrenaline for the emergency treatment of anaphylaxis.1,2

Below is a summary of the key features and benefits of EpiPen®:1,2

  • EpiPen® delivers the correct dose of adrenaline quickly
  • EpiPen® has needle protection which deploys immediately after administration
  • EpiPen® has familiar jab administration and only a 3 second injection hold time during administration in an emergency1,2
EpiPen® Auto-Injector Adrenaline concentration Body weight
EpiPen® 1 0.3mg (0.3ml, 1:1000) >25kg (3 st. 13 lbs.)
EpiPen® Jr 2 0.15mg (0.3ml, 1:2000) 7.5 – 25kg (1 st. 3lbs. – 3 st. 13lbs.)

Features

Viewing window

The EpiPen® must be replaced in line with the expiry date. In addition, check the EpiPen® regularly to make sure the solution is clear and colourless. If the solution becomes discoloured or contains particles it should be replaced.

Needle cover

This keeps the needle covered before and after use.

Flip top case

Designed for single-handed opening. The EpiPen® should be kept in its case when not in use.

How to use - instructions for patients
  1. Grasp EpiPen® auto-injector in dominant hand, with thumb closest to blue safety cap
  2. With the other hand pull off blue safety cap
  3. Hold the EpiPen® auto-injector at a distance of approximately 10 cm away from the outer thigh. The orange tip should point towards the outer thigh
  4. Jab firmly into the outer thigh, so that the EpiPen® auto-injector is at a right-angle (at a 90 degree angle) to the outer thigh
  5. Hold firmly in place for 3 seconds. The injection is now complete and the window of the auto-injector is obscured. The EpiPen® auto-injector should be removed (the orange needle cover will extend to cover needle) and safely discarded
  6. Call 999

When to use

Anaphylaxis is unpredictable and while a person may have a mild reaction one time, a serious or even life-threatening reaction can occur the next time. In addition, allergic reactions can begin with mild symptoms and then progress to a full anaphylactic episode.

A person who is having an allergic reaction should use their EpiPen® immediately if they experience ANY of the following serious symptoms of anaphylaxis following contact with their allergen:

  • Feeling light-headed or faint
  • Breathing difficulties, such as fast, shallow breathing
  • Wheezing
  • A fast heartbeat
  • Clammy skin
  • Confusion and anxiety
  • Collapsing or losing consciousness

Other allergy symptoms may include hives, feeling or being sick, angioedema or stomach pain.

Patients experiencing the following mild to moderate symptoms of anaphylaxis should take an anti-histamine and have their EpiPen® ready in case of worsening symptoms:

  • Red, raised, itchy rash
  • Swelling of face, lips or eyelids
  • Abdominal pain, nausea and/or vomiting
  • Tingling mouth

It is vital that patients carry 2 EpiPen® at all times. A second EpiPen® should be administered after 5 minutes if symptoms persist.1,2

Who should have an EpiPen®?

Absolute indications:3

  • Patients with previous anaphylaxis with food, latex, aeroallergens such as animals or other unavoidable triggers
  • Patients with co-existent, unstable or moderate to severe persistent asthma and a food allergy
  • Patients with exercise induced anaphylaxis
  • Patients with Idiopathic anaphylaxis
  • Venom allergy in adults with previous systemic reactions and children with more than cutaneous or mucosal systemic reactions
  • Patients with underlying mast cell disorders or baseline serum tryptase concentrations with any previous systemic allergic reactions to insect stings

The following indications should also be considered:3

  • Patients with previous mild-to-moderate allergic reaction to peanut and/or tree nut
  • Patients with previous mild-to-moderate allergic reaction to traces of food
  • Teenagers or young adults with food allergy
  • Patients who are remote from medical help and previous mild-to-moderate allergic reaction to food, venom, latex or aeroallergens

35% of patients may require more than one adrenaline dose.4

As many as 20% of patients will go on to develop a biphasic anaphylactic response many hours later.5

Safety information1,2

If used correctly, significant injury with EpiPen® is unlikely. Patients should not remove the blue safety cap until they are ready to inject. They should always ensure that they point the end with the orange tip towards the thigh and never put their thumbs or fingers over the orange tip. Directions for use are in the package insert.

EpiPen® should only be injected into the anterolateral aspect of the thigh, NOT ANY OTHER PART OF THE THIGH OR BUTTOCK. The outer thigh is the safest site for Intramuscular (IM) injection as there is minimal risk of injection into major blood vessels or nerves in this area. Intravascular injection (which is possible on the front of the thigh) could lead to acute cardiovascular compromise. Injection into a major nerve (which could occur on the posterior thigh or buttock) can cause significant damage; also, injection into the buttock may not be effective for a severe allergic reaction. Accidental injection into the hand, particularly the digits, can cause serious injury and possibly gangrene. This injury needs to be urgently assessed and treated in an emergency room.

Potential side effects include an increase in heart rate, a stronger or irregular heartbeat, sweating, nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness, headache, apprehension, nervousness, or anxiety. However, these side effects usually subside quickly, especially if the patient rests.

EpiPen® should be used with caution in patients with high blood pressure and thyroid conditions (as side effects can last longer) and in pregnancy. Blood sugar may increase in patients with diabetes and symptoms can temporarily get worse in patients with Parkinson’s disease.

Overdose of adrenaline is unlikely with EpiPen®. However, symptoms of overdose are elevated arterial pressure, pulmonary oedema and cardiac arrhythmias. If necessary, pressor effects may be counteracted by rapidly acting vasodilators or alpha-adrenergic blocking drugs.

It is important to remember that in practice there are no known contraindications to IM adrenaline use in a life-threatening allergic reaction.

If you have any concerns/questions about the safety aspects of EpiPen®, please contact the Viatris Medical Information Department on +44 (0)1707 853000 (option 1) or email: info.uk@viatris.com

References

  1. 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
  2. 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
  3. Muraro A, et al. EAACI guidelines: Anaphylaxis. 2022;77: 357-377
  4. Korenblat P et al. A Retrospective Study of Epinephrine Administration for Anaphylaxis: How Many Doses Are Needed? Allergy Asthma Proc. 1999;20(6):383-386
  5. Kemp, S.F et al. 2008. Epinephrine: the drug of choice for anaphylaxis--a statement of the World Allergy Organization. World Allergy Organization Journal, 1(S2), p.S18.