Get to Know the EpiPen

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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An extreme life-threatening allergic reaction, anaphylaxis, from a bee sting or food allergy requires quick attention to save lives. Epinephrine auto-injectors (the EpiPen being the most common) are the best treatment for anaphylaxis. Severe allergic reactions from food allergies are more common than ever, so we need to make the EpiPen cheap, accessible, and less scary for regular folks.

Here are key points we all need to know about epinephrine auto-injectors (the EpiPen):

1. In most states, a prescription is needed for a child or adult to receive epinephrine injections. Some states have changed this so a child can receive an epinephrine injection even without a prescription on file.

2. The renewed focus on the EpiPen should help teach people how and when to use them and dispel fears many have about adverse effects.

3. Adverse effects of epinephrine are minor and pass quickly, contrary to what most of us believe. Tremor, dizziness, palpitations, anxiety, restlessness, and headache may occur but dissipate quickly.

4. All patients who have experienced anaphylaxis should have access to epinephrine for self-treatment as it is the best treatment available.

5. Ask your primary care doctor or pediatrician which auto-injector is best for you but here are your choices:

EpiPen: 0.3 mg per dose

EpiPen Jr: 0.15 mg per dose

Twinject: 0.3 mg per dose (provides two 0.3 mg doses in one device)

Twinject: 0.15 mg per dose (provides two 0.15 mg doses in one device)

Adrenaclick: 0.3 mg per dose

Adrenaclick: 0.15 mg per dose

6. Carry the auto-injector at all times. This seems obvious, but most severe reactions occur when people are out of their normal routines (during exercise, while dining out, attending celebrations and banquets, or traveling).

7. When to use it: If you are an adult, use your EpiPen if you are having trouble breathing, feel tightness in the throat, feel lightheaded or think you might pass out

8. How to use it: Epinephrine should ideally be injected into the mid-outer part of the thigh, into the underlying muscle. Intramuscular injection is preferable to subcutaneous injection (under the skin), as it results in more rapid systemic absorption

9. A second dose may be needed 5 to 15 minutes after the first.

Dr O.

Epinephrine pens, EpiPen, Twinject, and Adrenaclick are sold in kits of 2 pens. The cost may vary between the two packages sizes, and it is occasionally less expensive to purchase 2 single pens than the 2-pen package. Prices range from about $60 – $150 for single pens, and from about $120 – $300 for 2-pen kits. EpiPen, EpiPen Jr, Twinject, and Adrenaclick are covered by many insurance plans as Tier 2 drugs, meaning a moderate co-pay, while epinephrine pens are often covered as Tier 1 drugs with the lowest co-pay.

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