Patient
Support

Mylan, the sole distributor 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.

EpiPen® Trainer

How to use the EpiPen® Trainer Pen and order a training kit.

Patient Resources

Downloadable resources for patients to help them understand their EpiPen®

How to use EpiPen®

Demonstration video and simple instructions for patients so they know how to use their EpiPen® if needed.

Free expiry alert service

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Patients can sign up for our expiry alert service so they will be reminded when their EpiPen® is about to expire.

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Advice for schools

Department of Health guidelines state that schools can hold 'spare' AAIs.

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.

Frequently asked questions

Find answers to some of the most common questions about EpiPen®. If you can't find what you're looking for, please contact us and we'll get back to you as soon as possible.

The answers for EpiPen® also apply to EpiPen® Jr unless otherwise stated.

  • Q.What is the difference between EpiPen® and EpiPen® Jr?

    A.They both contain adrenaline, but in different amounts. EpiPen® contains 0.3mg, and EpiPen® Jr contains 0.15mg. Selection of the appropriate dosage strength for the patient is determined by the prescribing physician according to patient body weight.

    EpiPen® auto injector 0.3mg is recommended for adults and children weighing >25kg.1

    EpiPen® Jr. auto injector 0.15mg is recommended for children weighing between 7.5 – 25kg.5

  • Q.What is the active ingredient and dose in EpiPen®?

    A.Each EpiPen® 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.

    EpiPen® delivers 0.3mg adrenaline and EpiPen® Jr delivers 0.15mg adrenaline.

  • 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 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.

  • Q.How many doses can be given?

    A.During an anaphylactic reaction, EpiPen® should be given immediately and an ambulance called, if there is no improvement in symptoms in 5 minutes, a second EpiPen® should be given. Any more than 2 doses of adrenaline should only be administered under direct medical supervision.

  • 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 (or someone with the patient) should call 999 immediately. The patient should stay lying down or seated and have someone stay with them until they have been assessed by a paramedic. Unconscious patients should be placed in the recovery position.

  • 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.

    If there is no improvement in symptoms 5 minutes after using the first EpiPen®, a second EpiPen® should be given.

  • 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.

  • 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.

  • 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 mm for the EpiPen® and 13 mm for the EpiPen® Jr.

  • 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.

  • 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.

  • Q.Does EpiPen® contain latex?

    A.EpiPen® does not contain latex.

  • Q.Does EpiPen® contain lactose, sucrose, gluten or tartrazine?

    A.EpiPen® does not contain any of these substances.

  • Q.Does EpiPen® contain sulfite?

    A.Each 0.3 mL of EpiPen® contains 0.5 mg sodium metabisulfite.

  • 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.

    In a patient with documented sulfite sensitivity, the alternatives to using adrenaline in a life-threatening situation may not be satisfactory. Therefore, the presence of a sulfite in this product should not deter administration of the drug for treatment of serious allergic or other emergency situations when sulfite-free alternatives are not available.

  • 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.

  • 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.

  • Q.How do you dispose of expired units?

    A.Expired EpiPen® must be disposed of in a sharps bin.

  • Q.How do you dispose of used units?

    A.Document the dosage of EpiPen® given and dispose of in a sharps container.

  • 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.

  • 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.

  • Q.How many EpiPen® should I prescribe?

    A.Guidelines recommended that 2 adrenaline auto-injectors are prescribed, which patients should carry at all times.2,3

  • Q.What doses do patients require?

    A.Acute anaphylaxis for self-administration should be treated by intramuscular injection4

    • -For adult and child body weight 25kgs and above – 0.3mg.1
    • -For child body weight 7.5 kg- 25kg – 0.15mg.5
  • Q.What is the shelf-life of EpiPen®?

    A.EpiPen® has a shelf life of 24 months1 and EpiPen® Jr, 19 months.5

  • Q.What is the cheapest AAI?

    A.The 24 month shelf life of EpiPen® and the 19 month shelf life of EpiPen® Jr, ensures the cost of EpiPen® per month remains  competitive1,5 cost per pen per month is calculated by dividing the NHS list price, by the shelf life from manufacture.

REFERENCES:

1. EpiPen® (adrenaline) Auto-Injector 0.3mg SPC. Available at https://www.medicines.org.uk/emc/product/4289/smpcLast accessed: September 2020.


2. MHRA, Adrenaline auto-injectors: updated advice after European review (Aug 2017)
Available at: www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review. Last accessed May 2020.


3. NICE Anaphylaxis Guidelines- https://www.nice.org.uk/guidance/cg134/evidence/anaphylaxis-full-guideline-pdf-184946941.


4. Muraro et al, 2014. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy 2014; 69:1026-45.


5. EpiPen® Jr (adrenaline) Auto-Injector 0.15mg SPC. Available at https://www.medicines.org.uk/emc/product/4290/smpc Last accessed: September 2020

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