Epinephrine

About Epinephrine

Epinephrine lessens the widening and leakiness of blood vessels that can drop blood pressure in anaphylaxis, relaxes the airways, and eases itching, hives and swelling. Auto-injectors and neffy are labeled for the emergency treatment of type I allergic reactions, including anaphylaxis from stings, foods, medicines, other allergens or no known cause. EpiPen (0.3 mg) is for people weighing 30 kg or more and EpiPen Jr (0.15 mg) for 15 to 30 kg; Auvi-Q comes in the same two doses plus 0.1 mg for children of 7.5 to under 15 kg. neffy is a nasal spray: 2 mg for 30 kg or more and 1 mg for 15 to under 30 kg.

It does not replace medical care: get emergency help after every use, since its effect may wear off after 10 to 20 minutes. A second dose may be needed if symptoms persist or worsen; more than two in a row are given only under direct medical supervision. EpiPen’s label has no boxed warning and no contraindications. Injection is never into a vein, the buttock, fingers, hands or feet: an accidental injection into a hand or foot can cut off blood flow and needs emergency care, and rare serious infections have followed injections. Common effects are anxiety, restlessness, shakiness, weakness, dizziness, sweating, a pounding heart, pale skin, nausea, vomiting, headache and breathing difficulty. People with heart disease, an overactive thyroid, diabetes or Parkinson’s disease may react more strongly, and the sulfite in EpiPen and neffy should not stop anyone from using them in an emergency.

Nasal polyps or a past nasal injury or surgery can change how much neffy is absorbed, and its label suggests considering an injected product for those patients; its common effects are nasal discomfort, headache, a runny nose, dizziness, nausea, vomiting and throat irritation. The devices work differently (Auvi-Q speaks its instructions aloud), so anyone who may give a dose should practice with the trainer that comes with EpiPen and Auvi-Q. Each device gives one dose; EpiPen’s label tells patients to carry two at all times, and neffy’s says to have two available. Epinephrine is also the first-line treatment for anaphylaxis during pregnancy.

Taking Epinephrine

How to take it

For a severe allergic reaction, inject into the middle of the outer thigh, through clothing if needed, keeping fingers off the needle end; hold EpiPen firmly in place for 3 seconds and Auvi-Q for 2. neffy is one spray into one nostril. Then get emergency medical care. If symptoms do not improve or get worse, a second dose can be given with a new device (for Auvi-Q and neffy, from 5 minutes after the first; neffy in the same nostril).

If you miss a dose

There is no schedule: it is used only in an emergency. Each device gives one dose, so ask for a replacement after using one.

Storage

At room temperature, 68 to 77°F (20 to 25°C), never refrigerated or left in a car; keep injectors protected from light. Auvi-Q and neffy must not be frozen, though a neffy that froze and thawed can still be used, and neffy tolerates excursions up to 122°F (50°C). Replace any injector whose liquid looks discolored or cloudy or has particles, and any device past its expiration date.

Interactions to know about

Tricyclic antidepressants, MAO inhibitors, levothyroxine and some antihistamines can strengthen its effects; beta blockers and alpha blockers can weaken them; ergot medicines can reverse its effect on blood pressure; and digoxin and diuretics raise the risk of an irregular heartbeat.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Epinephrine differs from pharmacy to pharmacy

An auto-injector is a device as well as a medicine and costs pharmacies far more than an ordinary generic. EpiPen, Auvi-Q and neffy are priced as brands and each comes in a pack of two, so quotes are per pack; the generics come from few companies, a pharmacy may stock one product and not another, and devices are replaced when they expire even if unused.

Only products rated equivalent can be swapped at the counter: a prescription for EpiPen or EpiPen Jr can be filled with Teva’s generic where state law allows, but Auvi-Q, neffy and the Adrenaclick generic need a prescription written for them, and a switch also means learning a different device.

Ways to pay less for Epinephrine without insurance

• If the prescription is for EpiPen or EpiPen Jr, ask whether the pharmacy stocks Teva’s generic, which is rated equivalent.
• For Auvi-Q or neffy, which have no generic, ask the maker whether its savings or patient assistance program applies to someone paying cash; many copay cards require commercial insurance.
• Compare more than one pharmacy for the same product and pack.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Epinephrine

1. 1.Which device is my prescription for, and can it be filled with a generic here?
2. 2.Can you show me how to use my device with its trainer?
3. 3.When do these devices expire, and how should I store them in hot or cold weather?
4. 4.Do any of my heart, blood pressure, thyroid or antidepressant medicines change how epinephrine works?

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