EpiPen® (Epinephrine Auto Injector)

What is epinephrine?

Epinephrine is derived from an amino acid called tyrosine. It is grouped as a catecholamines which are hormones made by the adrenal gland. Norepinephrine and dopamine are also referred to as catecholamines as they are both synthesized by tyrosine.

What is an EpiPen?

It treats serious allergic reactions to foods, insect stings/bites, drugs and other substances.

How does an EpiPen work?

When an EpiPen is administered, it blocks the entire body releasing allergic chemicals which stop the progression of allergic response. As a result, it increases blood pressure by constricting blood vessels and decreases swelling. The lungs also begin to open up as the muscles around the airways begin to relax.

An EpiPen is fast-acting but is not long-lasting.

Usage & Storage

Each EpiPen provides a single-use injection of epinephrine.

An EpiPen should be accessible at all times.

It’s important to receive instructions from your pharmacist on how to administer this medication to be well prepared in the event you need to use it.

Friends and family should also be educated on how to properly administer an EpiPen in the event you cannot inject the medication yourself.

For children and infants, be sure to hold the leg in place when the EpiPen is administered to prevent any sudden injuries.

After using your EpiPen you should still seek medical attention immediately and notify a healthcare professional that you have given yourself an injection. This is important so that you avoid getting a double dose of epinephrine.

Avoid injecting this medication into areas other than the thigh. Do not inject into the hands, feet or buttocks and inform a healthcare professional if you have.

The medication should be clear and should not contain particles or appear discolored. Do not use an EpiPen if it appears cloudy or pink/brown in color and proceed to obtain a new supply.

How to store an EpiPen

• Keep your EpiPen at room temperature
• It is important to store your EpiPen® Auto-Injector in order to keep this medication effective and ready to use if you experience a severe allergic reaction.
• Keep away from direct sunlight.
• Keep away from extreme heat, refrigerate or freeze..
• Do not store your ® Auto-Injector in a car during extremely hot temperatures as it can compromise the medication.
• Do not drop.
• Keep the blue safety cap on to prevent accidental injection until ready for use.
• Keep the EpiPen in its carrier tube to protect from any damage and remember it is not waterproof.
• Do not keep any other objects including the paper instructions to prevent from easy access when the EpiPen auto-injector is needed during a severe allergic emergency.
• Consult your pharmacist about how to properly dispose of used or compromised medication.

Disposing your EpiPen

Dispose of unwanted, unused or expired EpiPen’s using an FDA-cleared sharps disposal container. Do not dispose of through household trash.

You may use a household container if it is:

• made of heavy-duty plastic
• leak resistant
• can be closed, puncture resistant
• properly labeled of hazardous waste inside

Follow community guidelines when its time to dispose of your sharps disposal container. Follow your state or local laws about how to properly dispose of used medication, needles or syringes. Speak to your pharmacist or read the following information on the FDA website: http://www.fda.gov/safesharpsdisposal

Side Effects

Common side effects from administering epinephrine include:

• anxiety
• apprehensiveness
• restlessness
• tremor
• weakness
• dizziness
• sweating
• palpitations
• pallo
• nausea and vomiting
• headache
• respiratory difficulties

Cardiovascular Reactions

• Patients with underlying cardiac disease or those receiving certain drugs have been reported in having arrhythmias including fatal ventricular fibrillation.
• Rapid increase in blood pressure have lead to cerebral hemorrhage mostly with elderly patients with cardiovascular disease
• Angina may occur in those with coronary artery disease
• Rare cases of stress cardiomyopathy have been reported in those treated with epinephrine.

Reactions From Improper Technique and/or Accidental Injection

• An accidental injection into the fingers, hands or feet may result in the loss of blood flow to the affected area
• Accidental injections may cause adverse reactions such as increased heart rate or local site reactions (site pallor, hypoesthesia and coldness) that may result in bleeding, bruising, discoloration, skeletal injury or erythema.
• Gas gangrene has resulted from injection into the buttock
• Uncooperative children moving/kicking during injection has resulted in lacerations, bent needles or embedded needles.

Soft tissue & Skin Infections

Rare cases of serious skin & soft tissue infections have been reported after injection into the thigh include: myonecrosis caused by Clostridia (gas gangrene) and necrotizing fasciitis.

Symptoms are more likely to occur in people with hypertension or hyperthyroidism.

Contact your doctor for medical advice about side effects and risks. If you choose to report side effects to FDA, contact 1-800-FDA-1088 or at www.fda.gov/medwatch.

Despite the side effects, it’s important to understand that your doctor has prescribed this medication as the benefits far outweigh the risks. Most people do not experience serious side effects.

Consult your doctor if you have any serious side effects such as signs of infection at the injection site or irregular heartbeat.

Seek medical attention immediately if you experience serious side effects such as chest pain, vision changes, seizures, fainting or confusion.

The following is not a complete list of side effects. Consult your doctor or pharmacist if you notice any side effects not listed above.

Warnings & Precaution

The use of an EpiPen is an emergency treatment that should not replace seeking medication attention or going to the hospital. Patients should still seek medical care after administration. Two sequential doses should not be administered unless under direct medical supervision.

Occasionally inspect the EpiPen® solution through the viewing window to ensure it appear clear.

Replace EpiPen® Auto-Injector if it appears:

• discolored, brown or pink
• contains solid particles
• shows any signs of leakage or damage

Injection-Related Complications

EpiPens should only be injected into the anterolateral aspect of the thigh.

Do not Inject Intravenously

A large dose of epinephrine may lead to cerebral hemorrhage due to a sharp increase in blood pressure. If this happens this is counteracted with a vasodilator.

Do not inject into the buttock

During anaphylaxis, injecting into the buttock may not provide effective treatment. Patients are recommended to go to an emergency room for further treatment of their severe allergic reaction.

Do not inject into fingers, hands or feet

If an accidental injection into the hands, fingers or feet occurs, patients should seek medical attention at the closest emergency room since it may result in loss of blood flow to the affected area. Inform a healthcare professional on the area that was accidentally injected.

Allergic Reactions due to Sulfites

Despite the existence of sulfites in this drug and the patients sensitivity to sulfites, this should not deter patients from administration of this drug.

Alternatives to epinephrine my not suffice during a life-threatening situation. Epinephrine is the preferred treatment for severe allergic reactions even though it contains sodium metabisulfite, a sulfite that in other products may cause may cause severe allergic reactions.

Disease Interactions

Some patients may be risk of complications or adverse reactions from using epinephrine. It should be known that although they have existing conditions, this should be a contraindication to using epinephrine. Consult your doctor if you have any existing conditions if further instructions are needed.

Patients with Heart Disease

Patients with heart disease, including cardiac arrhythmias, organic heart or coronary artery disease, or hypertension should proceed with caution when administering epinephrine. Epinephrine may aggravate or precipitate angina pectoris as well as produce ventricular arrhythmias in people taking drugs that may sensitize the heart to arrhythmias.

Other Diseases

EpiPens should be injected with caution for patients with diabetes, hyperthyroidism, elderly individuals and women who are pregnant. Patients with Parkinson’s may experience a temporary worsening of symptoms.

Administration

Patients who have a history of severe allergic reactions (anaphylaxis) such as
insect stings/bites, drugs, allergens, idiopathic or exercise-induced anaphylaxis should be carefully instructed when their EpiPen should be used.

Patients should dispose of the blue safety release immediately after injection as it may pose as a choking hazard for children or pets.

A helpful diagram is printed on a label on each EpiPen detailing steps on how to use your EpiPen.

Specific-Patient Use

There have not been adequate case studies on the effects of epinephrine in pregnant women. During pregnancy, anaphylaxis can be catastrophic and lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and more commonly in the fetus. Anaphylaxis occurs approximately 3 cases for every 100,000 deliveries.

The management of anaphylaxis is similar in pregnant women as it would be in the general population. Epinephrine is the first choice for treatment for both pregnant and un-pregnant patients. Patients should still seek immediate hospital care or medical attention after administration.