Anaphylactic – Anaphylaxis aareness epipen training – How To Use an EpiPen
Knowing how to use an EpiPen is important. Doctors are seeing more and more children with allergies, especially food allergies. Due to the unpredictable nature of allergic reactions, epinephrine auto-injectors (EpiPens) are prescribed. EpiPens deliver medicine quickly and effectively. No child has ever had serious problems from a standard dose of epinephrine when using an EpiPen.
Times when you need to use an EpiPen can be stressful. To calmly react to an allergic reaction, know when and how to use an EpiPen, understand symptoms of allergic reactions and have an action plan in place.
What is EpiPen?
EpiPen is an injection containing epinephrine, a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.
EpiPen is used to treat severe allergic reactions (anaphylaxis)to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis.
Epinephrine auto-injectors such as EpiPen and EpiPen Jr. may be kept on hand for self-injection by a person with a history of an severe allergic reaction.
EpiPen may also be used for purposes not listed in this medication guide.
EpiPen is used to treat severe allergic reactions (anaphylaxis).
Seek emergency medical attention even after you use EpiPen to treat a severe allergic reaction. The effects of EpiPen may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.
Before using EpiPen a second time, tell your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
Before using EpiPen
To make sure EpiPen is safe for you, tell your doctor if you have:
- heart disease or high blood pressure;
- a heart rhythm disorder;
- coronary artery disease;
- Parkinson’s disease;
- diabetes; or
- a thyroid or adrenal gland disorder.
It is not known whether EpiPen will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether epinephrine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received a dose of EpiPen.
How should I use EpiPen?
Use EpiPen exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.
EpiPen is injected into the muscle of your outer thigh. In an emergency, this injection can be given through your clothing.
Your medicine may also come with a “trainer pen.” The trainer pen contains no medicine and no needle. It is only for non-emergency use to practice giving yourself an EpiPen injection. Do not use a trainer pen to treat an allergic reaction.
The auto-injector device is a disposable single-use system that comes with patient instructions for safe and effective use. Do not self inject this medicine if you do not understand these instructions.
Do not remove the safety cap until you are ready to use the auto-injector. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed.
To use an EpiPen auto-injector:
- Form a fist around the auto-injector with the black tip pointing down. Pull off the safety cap.
- Place the black tip against the fleshy portion of your outer thigh. You may give the injection directly through your clothing. Do not put your thumb over the end of the unit.
- With a quick motion, push the auto-injector firmly against your thigh. This will release the spring-loaded needle that injects the dose of EpiPen. Hold the auto-injector in place for a few seconds after activation.
- Remove the auto-injector from your thigh. Carefully re-insert the used device needle-first into the carrying tube. Re-cap the tube and take it with you to the emergency room so that anyone who treats you will know how much EpiPen you have received.
Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction. The effects of epinephrine may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.
Use an auto-injector only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.
Do not use the EpiPen if it has changed colors or has any particles in it, or if the expiration date on the label has passed. Call your doctor for a new prescription.
Store EpiPen at room temperature away from moisture, heat, and light. Do not refrigerate this medication, and do not store it in a car.
What happens if I miss a dose?
Since EpiPen is normally used only as needed in an emergency, you are not likely to be on a dosing schedule. Do not use repeat doses of EpiPen without a doctor’s advice.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid?
Do not inject EpiPen into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh.
Accidentally injecting EpiPen into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness. If this occurs, seek emergency medical attention.
EpiPen side effects
Before using EpiPen a second time, call your doctor if your first injection caused a side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
Call your doctor at once if you notice pain, swelling, warmth, redness, or other signs of infection around the area where you gave an injection.
Common EpiPen side effects may include:
- nausea and vomiting;
- pale skin;
- feeling short of breath;
- weakness or tremors;
- headache; or
- feeling nervous or anxious.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
What other drugs will affect EpiPen?
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with EpiPen, especially:
- a diuretic or “water pill”;
- levothyroxine, Synthroid;
- an antidepressant–amitriptyline, doxepin, imipramine, nortriptyline, and others;
- a beta-blocker–atenolol, carvedilol, labetalol, metoprolol, nadolol, propranolol, sotalol, and others;
- cold or allergy medicine that contains an antihistamine;
- ergot medicine–ergotamine, dihydroergotamine, ergonovine, methylergonovine (Methergine);
- heart rhythm medication such as quinidine (Quin-G); or
- an MAO inhibitor–isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine.
This list is not complete. Other drugs may interact with EpiPen, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
For the Consumer
Applies to epinephrine: injection injectable, injection solution
In addition to its needed effects, some unwanted effects may be caused by epinephrine (the active ingredient contained in EpiPen). In the event that any of these side effects do occur, they may require medical attention.
Major Side Effects
You should check with your doctor immediately if any of these side effects occur when taking epinephrine:
Incidence not known:
- Abnormal or decreased touch sensation
- arm, back, or jaw pain
- bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- blurred vision
- chest pain or discomfort
- chest tightness or heaviness
- fast, irregular, pounding, or racing heartbeat or pulse
- fear or nervousness
- nausea or vomiting
- paleness of the skin
- pounding in the ears
- shakiness in the legs, arms, hands, or feet
- slow or fast heartbeat
- trembling or shaking of the hands or feet
- troubled breathing
- unusual tiredness or weakness
If any of the following symptoms of overdose occur while taking epinephrine, get emergency help immediately:
Symptoms of overdose:
- coldness of the skin
- decreased urine output
- lightheadedness, dizziness, or fainting
- muscle twitching
- pounding, slow heartbeat
- rapid weight gain
- rapid, deep breathing
- stomach cramps
- swelling of the face, ankles, or hands
For Healthcare Professionals
Applies to epinephrine: compounding powder, inhalation aerosol, inhalation solution, injectable kit, injectable solution, intravenous solution, subcutaneous suspension
Due to the lack of randomized, controlled clinical trials for the treatment of anaphylaxis, the true incidence of adverse reactions associated with the systemic use of this drug is difficult to determine. The most commonly reported adverse reactions include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.[Ref]
Frequency not reported: Tachycardia, supraventricular tachycardia, ventricular arrhythmias, myocardial ischemia, myocardial infarction, limb/peripheral ischemia, palpitations, angina, arrhythmias, hypertension, vasoconstriction, ventricular ectopy, ventricular fibrillation, cold extremities, electrocardiogram changes, stress cardiomyopathy[Ref]
Frequency not reported: Headache, paresthesia, tremor, stroke, central nervous system bleeding, dizziness, cerebral hemorrhage, memory impaired, lightheadedness, psychomotor agitation, tingling, Parkinsonism aggravated, syncope, convulsions, subarachnoid hemorrhage, hemiplegia[Ref]
Frequency not reported: Nervousness, excitability, anxiety, apprehension, restlessness, disorientation, panic, hallucinations, psychosis, fear, sleeplessness/insomnia, tenseness, confusion, irritability[Ref]
Frequency not reported: Extravasation, injection site pallor, coldness at injection site, hypoesthesia at injection site, injury at injection site, local ischemic necrosis[Ref]
Frequency not reported: Diaphoresis, pallor, piloerection, skin blanching, skin necrosis with extravasation, necrotizing fasciitis, flushing/redness of skin and face, hyperhidrosis[Ref]
Frequency not reported: Hypoglycemia, hyperglycemia, insulin resistance, hypokalemia, lactic acidosis, insulin secretion inhibited, metabolic acidosis, anorexia[Ref]
Frequency not reported: Pulmonary edema, rales, respiratory difficulty, dyspnea, bronchospasm, hypoxia of mucosa[Ref]
Frequency not reported: Renal insufficiency[Ref]
Hypersensitivity side effects have been extremely unusual. Contact dermatitis has been associated with ocularly applied epinephrine (the active ingredient contained in EpiPen) These reactions have typically presented with lid edema and a thick yellow discharge.
Frequency not reported: Nausea, vomiting, bowel necrosis, hypersalivation[Ref]
Frequency not reported: Urinary retention, difficult micturition[Ref]
Frequency not reported: Thrombocytosis[Ref]
Frequency not reported: Myonecrosis[Ref]
Frequency not reported: Chest pain, weakness, gas gangrene, asthenia[Ref]
Frequency not reported: Corneal endothelial damage[Ref]
Frequency not reported: Growth hormone secretion stimulated[Ref]
1. “Product Information. Epinephrine (EPINEPHrine).” Physicians Total Care, Tulsa, OK.
2. “Product Information. Auvi-Q (EPINEPHrine).” sanofi-aventis, Bridgewater, NJ.
3. “Product Information. EpiPen (EPINEPHrine).” Dey Laboratories, Napa, CA.
4. Cerner Multum, Inc. “Australian Product Information.” O 0
5. “Product Information. Adrenalin (EPINEPHrine).” A-S Medication Solutions, Chicago, IL.
6. “Product Information. Adrenaclick Two-Pack (EPINEPHrine).” Amedra Pharmaceuticals LLC, Middlesex, NJ.
7. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0
Not all side effects for EpiPen may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
Selection of the appropriate dosage strength (EpiPen 0.3 mg or EpiPen Jr 0.15 mg) is determined according to patient body weight.
- Patients greater than or equal to 30 kg (approximately 66 pounds or more): EpiPen 0.3 mg
- Patients 15 to 30 kg (33 pounds to 66 pounds): EpiPen Jr 0.15 mg
Inject EpiPen or EpiPen Jr intramuscularly or subcutaneously into the anterolateral aspect of the thigh, through clothing if necessary. Instruct caregivers of young children who are prescribed an EpiPen or EpiPen Jr and who may be uncooperative and kick or move during an injection to hold the leg firmly in place and limit movement prior to and during an injection [see Warnings and Precautions (5.2)].
Each EpiPen or EpiPen Jr contains a single dose of epinephrine for single-use injection. Since the doses of epinephrine delivered from EpiPen or EpiPen Jr are fixed, consider using other forms of injectable epinephrine if doses lower than 0.15 mg are deemed necessary.
The prescriber should carefully assess each patient to determine the most appropriate dose of epinephrine, recognizing the life-threatening nature of the reactions for which this drug is indicated. With severe persistent anaphylaxis, repeat injections with an additional EpiPen or EpiPen Jr may be necessary. More than two sequential doses of epinephrine should only be administered under direct medical supervision [see Warnings and Precautions (5.1)].
The epinephrine solution in the clear window of the EpiPen Auto-Injector should be inspected visually for particulate matter and discoloration. Epinephrine is light sensitive and should be stored in the carrier tube provided to protect it from light [see How Supplied/Storage and Handling (16.2)].