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Epinephrine Home Injectable Devices

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Epinephrine Home Injectable Devices, Epinephrine Autoinjector, Nasal Epinephrine, EpiPen, EpiPen Jr, Twinject, Adrenaclick, Ana-Guard, Ana-kit, Auvi-Q, Symjepi, Neffy

  • See Also
  1. Anaphylaxis
  • Indications
  1. Indicated for history severe reaction or Anaphylaxis
  2. Patient injects at time of Allergic Reaction
  • Precautions
  1. Immediate medical attention after using injector
  2. Further Anaphylaxis management may be required
  3. Replace the autoinjector before it expires (avoid relying on an expired injector)
    1. May try the expired injector if no alternative
    2. Keep the Epinephrine away from prolonged heat exposure (denatures, weakens effect)
  • Medications
  • Epinephrine Autoinjectors
  1. EpiPen and EpiPen Jr
    1. Costs may exceed $400
  2. Twinject
  3. Adrenaclick
    1. Generic and may be least expensive option ($100 for 2 pens) once reasonable pricing ensues in late 2016
    2. Requires removal of 2 cap protectors (instead of 1 with the EpiPen)
  4. Ana-Guard
  5. Ana-kit (Epinephrine with Chlorpheniramine)
  6. Auvi-Q
    1. Back on market in 2017 after recall in late 2015 (concern regarding consistent dose delivery)
      1. http://www.fda.gov/Safety/Recalls/ucm469980.htm
    2. Talking device that walks patient through use of the injector at time of use
    3. Device is in shape of smart phone
    4. Costs as much as $4900 for a 2 pack
    5. (2013) Presc Lett 20(3): 18
  7. Symjepi
    1. Prefilled syringes of 0.3 mg (or 0.15 mg) at $250 for a two pack
    2. Not an autoinjector
    3. To use, pull protective cap off needle, insert into mid-outer thigh, press plunger until click, hold in place 2 sec.
      1. Slide safety guard over needle after use
    4. (2019) Presc Lett 26(3): 18
  8. Neffy (Nasal spray)
    1. FDA approved in U.S. in Augist 2024 for adults and children (weight >= 30 kg or 66 lb)
    2. Appears to reach similar serum levels of Epinephrine with similar onset as for injectables
      1. However, absorption may be impacted by prior nasal surgery or Nasal Polyps
      2. Testing was done in healthy subjects, and efficacy may be reduced in Anaphylaxis
      3. Injectables are still preferred as first line agents
    3. Weight >= 30 kg (66 lb): 2 mg nasal Inhaler
      1. A 1 mg nasal Inhaler is being FDA reviewed for weight 15 to 30 kg (33 to 66 lb) as of 2024
    4. Technique
      1. Hold device with thumb on underside plunger and a finger on either side of nozzle
      2. Insert nozzle completely into 1 nostril and fully depress the plunger to spray
      3. Each spray delivers 2 mg Epinephrine
      4. May give a second dose in the same nostril in 5 minutes if needed
    5. Shelf-Life
      1. Shelf-Life: 30 months
      2. Can withstand Temperatures up to 50 C (122 F)
    6. References
      1. (2024) Presc Lett 31(10): 56
      2. LoVecchio (2024) Crit Dec Emerg Med 38(10): 35
  9. Pharmacy compounded kit (other options are preferred)
    1. Epinephrine vials, syringe and needle supplies can be purchased for $20
    2. Requires correctly dosing and administering 0.15 or 0.3 mg IM in case of Anaphylaxis
    3. If patient prefills syringe, it expires within 2-3 months (dispose and fill new syringe after 2 months)
  • Medications
  • Related Items
  1. Veta Smart Case
    1. Sends smartphone message if kit is left behind, pen is removed, pen expires
    2. Very expensive security ($130 and then $24 per year)
  • Dosing
  1. Pearls
    1. Consider supplying more than 1 injector
    2. Place in different locations at home, work, school
    3. More than one injection may be required
  2. Prefilled Epinephrine auto-injectors
    1. Adult dose (weight >66 pounds or 30 kg): 0.30 mg
    2. Child dose (weight <66 pounds or 30 kg): 0.15 mg
  • Technique
  • EpiPen (or similar device)
  1. Device will penetrate clothing
    1. Bare skin is not required for the injection
  2. Preparation
    1. Remove the cap from the carrying device (caps are yellow for adult version, and green for child's version)
    2. Remove the injector from the case and grasp in one fist with orange tip pointing downward
    3. Pull out the blue safety release pin from the top of the device with the free hand
  3. Technique
    1. Aim the orange tip toward the outer thigh
    2. Swing the arm up in abduction and then down striking the device firmly at 90 degrees at the outer thigh
    3. Expect to hear a click as the needle deploys and penetrates the skin
    4. Hold the device firmly against the thigh for at least 10 seconds so that all medication is deposited
  4. Post-Injection
    1. Remove the device and massage the injection area for 10 seconds
    2. The needle will be safely enclosed within the orange tip to prevent Needle Sticks
      1. However device needs to be disposed of as biohazardous waste
    3. Proceed to obtain immediate medical attention
  • Resources
  1. Meridian Medical Technologies (EpiPen)
    1. http://www.epipen.com/how-to-use-epipen/
  • References
  1. (2016) Presc Lett 23(9)
  2. Arnold (2011) Am Fam Physician 84(10): 1111-8 [PubMed]