epinephrine autoinjector (Epipen, Symjepi)

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[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]

Indications

Dosage

(administration)

  • inject into outer thigh, hold for 10 seconds, massage
  • no need to remove clothing
  • SEEK MEDICAL ATTENTION AFTER USING
  • up to 20% of patients get a 2nd dose to treat anaphylaxis[4]

epinephrine: 0.15 mg/dose, 0.3 mg/dose

Storage

  • keep in container, epinephrine is degraded by light & heat
  • glove box in car NOT recommended
  • do NOT refrigerate (auto-injector may malfunction)
    • Epipens still work after freezing for 24 hours[17]
  • replace if solution turns brown or precipitates

Black cap houses needle, do NOT try to take it off[2]

Pharmacokinetics

  • effects start to wear off after 10-20 minutes

Adverse effects

Notes

  • cost of 2-pack > $600[7][8]
  • generic to be released at cost of 2-pack = $300[8]
  • 1st generic Epipen FDA-approved Aug 16, 2018[15]
  • recall of select lots of EpiPen, including lots distributed in the U.S. (2017)[12]
  • dose available 50 months after expiration would still provide a beneficial pharmacologic response[13]
  • FDA extends epiration date of 0.3 mg doses (Mylan)[16]

More general terms

Additional terms

Components

References

  1. ↑ Prescriber's Letter 11(3):13 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200303&pb=PRL (subscription needed) http://www.prescribersletter.com
  2. ↑ 2.0 2.1 Prescriber's Letter 14(1): 2007 Medication Errors due to Medication Delivery Devices Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230113&pb=PRL (subscription needed) http://www.prescribersletter.com
  3. ↑ Prescriber's Letter 16(9): 2009 COMMENTARY: Epinephrine Auto-Injectors and Needle Length: Can They Deliver an Intramuscular Dose? GUIDELINES: Diagnosis and Management of Anaphylaxis (AAAAI/ACAAI/JCAAI, 2005 Update) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250904&pb=PRL (subscription needed) http://www.prescribersletter.com
  4. ↑ 4.0 4.1 Prescriber's Letter 17(6): 2010 COMMENTARY: Self-injected Epinephrine in the Outpatient Treatment of Anaphylaxis GUIDELINES: American Academy of Allergy, Asthma and Immunology: The Diagnosis and Management of Anaphylaxis Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260602&pb=PRL
  5. ↑ 5.0 5.1 Brown JC, Tuuri RE, Akhter S et al Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in Children. Pediatrics. Oct 2015 http://www.annemergmed.com/article/S0196-0644%2815%2900588-0/pdf
  6. ↑ 6.0 6.1 FDA Safety Alert. Oct 29, 2015 Auvi-Q (epinephrine injection, USP): Recall - Potential Inaccurate Dosage Delivery. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm470010.htm
  7. ↑ 7.0 7.1 Orciari Herman A, Sofair A, Chavey WE EpiPen Costs Lowered for Some Physician's First Watch, Aug 26, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    Mylan News Release. Aug. 25, 2016 Mylan Taking Immediate Action to Further Enhance Access to EpiPen (Epinephrine Injection, USP) Auto-Injector. http://newsroom.mylan.com/2016-08-25-Mylan-Taking-Immediate-Action-to-Further-Enhance-Access-to-EpiPen-Epinephrine-Injection-USP-Auto-Injector
  8. ↑ 8.0 8.1 8.2 Mylan News Release. Aug. 29, 2016 Mylan to Launch First Generic to EpiPen Auto-Injector at a List Price of $300 per Two-Pack Carton, a More than 50% Discount to the Brand Product. http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product
  9. ↑ KALEO ANNOUNCES 2017 U.S. RETURN OF AUVI-Q (EPINEPHRINE INJECTION, USP) AUTO-INJECTOR FOR LIFE-THREATENING ALLERGIC REACTIONS. PR Newswire, RICHMOND, VA. October 26, 2016 http://www.multivu.com/players/English/7940951-auvi-q-epinephrine-auto-injector-comeback/
    KALEO ANNOUNCES U.S. AVAILABILITY AND PRICING TO PATIENTS OF AUVI-Q (Epinephrine Injection, USP) AUTO-INJECTOR, FOR LIFE- THREATENING ALLERGIC REACTIONS. PR Newswire, RICHMOND, VA. January 19, 2017
  10. ↑ Coukell A, Shih C, Reese E Beyond EpiPen: Prices of Lifesaving Epinephrine Products Soar Competition has failed to drive down prices, leaving policymakers demanding answers. The Pew Charitable Trusts Research & Analysis Sept 22, 2016 http://www.pewtrusts.org/en/research-and-analysis/analysis/2016/09/22/beyond-epipen-prices-of-lifesaving-epinephrine-products-soar
  11. ↑ EpiPen Maker Mylan Hit With Class-Action Lawsuit PR Newswire, Houston Tx. October 26, 2016 http://www.prnewswire.com/news-releases/epipen-maker-mylan-hit-with-class-action-lawsuit-300351794.html
  12. ↑ 12.0 12.1 12.2 FDA Safety Alert. March 31, 2017 EpiPen and and EpiPen Jr Auto-Injector: Recall - Failure to Activate Device. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm550165.htm
  13. ↑ 13.0 13.1 Cantrell FL, Cantrell P, Wen A, Gerona R Epinephrine Concentrations in EpiPens After the Expiration Date. Ann Intern Med. 2017. May 9. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28492859 <Internet> http://annals.org/aim/article/2625390/epinephrine-concentrations-epipens-after-expiration-date
  14. ↑ Brooks M FDA Approves New Epinephrine Prefilled Syringe Medscape - Jun 16, 2017. http://www.medscape.com/viewarticle/881731
  15. ↑ 15.0 15.1 FDA News Release. Aug 16, 2018 FDA approves first generic version of EpiPen. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm617173.htm
  16. ↑ 16.0 16.1 Brooks M FDA Extends Some EpiPen Expiration Dates to Fight Shortages. Medscape - Aug 21, 2018. https://www.medscape.com/viewarticle/901002
  17. ↑ 17.0 17.1 Boyles S EpiPens Still Work After Freezing. Devices still fired after being frozen for 24 hours in study. MedPage Today. November 20, 2018 https://www.medpagetoday.com/meetingcoverage/acaai/76458
  18. ↑ Weir A et al. Epinephrine auto-injectors for anaphylaxis: a review of the clinical effectiveness, cost-effectiveness, and guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Apr 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33074635 Bookshelf ID: NBK563019
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