EpiPen^® is an adrenaline auto-injector (AAI) used for self-administration of adrenaline for the emergency treatment of severe allergic reactions (anaphylaxis).

• Delivers the correct dose of adrenaline quickly.
• Has needle protection which deploys immediately after administration.
• Familiar jab administration and 3 second hold time during injection, making it quick to administer in an emergency.

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 an itchy, raised rash (hives), feeling or being sick, swelling (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

• Stomach ache
• 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.⁴

• Patients with previous anaphylaxis with food, latex, aeroallergens such as animals or other unavoidable triggers.¹
• Patients with co-existent, unstable or moderate to severe persistent asthma and a food allergy.¹
• Patients with exercise induced anaphylaxis.¹
• Patients with Idiopathic anaphylaxis.¹
• Venom allergy in adults with previous systemic reactions and children with more than cutaneous or mucosal systemic reactions.¹
• Patients with underlying mast cell disorders or baseline serum tryptase concentrations with any previous systemic allergic reactions to insect stings.¹

• Patients with previous mild-to-moderate allergic reaction to peanut and/or tree nut.¹
• Patients with previous mild-to-moderate allergic reaction to traces of food.¹
• Teenagers or young adults with food allergy.¹
• Patients who are remote from medical help and previous mild-to-moderate allergic reaction to food, venom, latex or aeroallergens.¹

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If used correctly, significant injury with EpiPen^® is unlikely. Patients should not remove the blue safety cap until they are ready to inject, 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.^4,5

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.^4,5

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.^4,5

EpiPen^® should be used with caution in patients with high blood pressure and thyroid conditions (as side effects can last longer) and in pregnancy; furthermore, sensitisation of the heart to catecholamines may occur in patients with uncontrolled hyperthyroidism or those using cocaine.⁶ Blood sugar may increase in patients with diabetes and symptoms can temporarily get worse in patients with Parkinson’s disease.^4,5

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.^4,5

It is important to remember that in practice there are no known contraindications to IM adrenaline use in a life-threatening allergic reaction.⁴

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

• Muraro, A et al., 2014. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy, 69(8), pp.1026-1045.
• Drug Safety Update Volume 11 Issue 1, August 2017: A3.
• 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.
• EpiPen^® (adrenaline) Auto-Injector 0.3mg SPC. Available at https://www.medicines.org.uk/emc/product/4289/smpcLast accessed: September 2020.
• EpiPen^® Jr (adrenaline) Auto-Injector 0.15mg SPC. Available at https://www.medicines.org.uk/emc/product/4290/smpc Last accessed: September 2020.
• Resuscitation Council (UK) Guidelines. January 2008. Available at: https://www.resus.org.uk/anaphylaxis/emergency-treatment-of-anaphylactic-reactions/ Last accessed May 2020.
• Korenblat P et al. Allergy Asthma Proc. 1999;20(6):383-386.