Cardiovascular Medicine Book

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Epinephrine Autoinjector

Aka: Epinephrine Autoinjector, Epinephrine Home Injectable Devices, EpiPen, EpiPen Jr, Twinject, Adrenaclick, Ana-Guard, Ana-kit, Auvi-Q
  1. Indications
    1. Indicated for history severe reaction or Anaphylaxis
    2. Patient injects at time of Allergic Reaction
  2. Precautions
    1. Immediate medical attention after using injector
    2. Further Anaphylaxis management may be required
  3. 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 (however device needs to be disposed of as biohazardous waste)
      3. Proceed to obtain immediate medical attention
  4. 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
  5. Preparations: 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. 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. Cost when back on the market in 2017, will cost as much as $500, and in some cases $4500
      5. (2013) Presc Lett 20(3): 18
    7. 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)
  6. Preparations: 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)
  7. Resources
    1. Meridian Medical Technologies (EpiPen)
      1. http://www.epipen.com/how-to-use-epipen/
  8. References
    1. (2016) Presc Lett 23(9)
    2. Arnold (2011) Am Fam Physician 84(10): 1111-8 [PubMed]
Medication Costs
epipen (on 4/19/2017 at Medicaid.Gov Pharmacy Drug pricing)
EPIPEN 2-PAK 0.3 MG AUTO-INJCT Generic $142.56 each
EPIPEN JR 2-PAK 0.15 MG INJCTR Generic $142.20 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Epipen (C0591454)

Concepts Hormone (T125) , Organic Chemical (T109) , Pharmacologic Substance (T121)
English Epipen, epipen, epipens, EpiPen 2-Pak
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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