5 Things to Know About Neffy, the First FDA-Approved Epinephrine Nasal Spray

There’s a good chance that you know someone who keeps an epinephrine auto-injector, such as an EpiPen, on hand in case they experience anaphylaxis. Anaphylaxis is a life-threatening Type 1 allergic reaction that can cause your airways to close, among other effects. Epinephrine is the go-to option for the emergency treatment of anaphylaxis.

Up until now, epinephrine for anaphylaxis treatment has only been available in injectable form. But in August 2024, the FDA approved neffy — an epinephrine nasal spray. This new form of epinephrine may be an ideal option for people who are afraid of injections.

Below, we'll cover five things you should know about neffy’s FDA approval — including who it’s approved for and how to use it.

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1. Neffy is approved for people who weigh 66 lbs or more

Neffy is FDA approved for the emergency treatment of Type 1 allergic reactions, including anaphylaxis, in both adults and children who weigh 66 lbs (30 kg) or more. This is different from epinephrine auto-injectors, one of which has a dose available for children weighing as little as 16.5 lbs (7.5 kg).

In the clinical trials that earned neffy FDA approval, it was only compared to the largest dose (0.3 mg) of injectable epinephrine. This dose is intended for people with a body weight of 66 lbs or more.

Neffy’s manufacturer plans to submit an application for FDA approval by mid-fall 2024 for a lower dose for children weighing between 33 lbs (15 kg) and 66 lbs. This means we could see this lower dose available during 2025. If approved, it would be the same weight range as the well-known EpiPen Jr.

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2. The dose of neffy is different from epinephrine auto-injectors because of how the body absorbs it

Neffy comes as a two-pack of nasal sprays. Each nasal spray contains a single dose of 2 mg epinephrine.

This may seem much higher than the 0.3 mg of epinephrine that’s in auto-injectors. But this difference is due to how the body absorbs the medication through the nose. Not all of the medication sprayed into your nose will reach the bloodstream.

In studies, the levels of epinephrine that reach the bloodstream with neffy are similar to what’s seen after you use injectable epinephrine. So the 2 mg of epinephrine that’s in neffy is considered an equivalent dose to a 0.3 mg epinephrine auto-injector.

3. There are steps you should follow when using neffy

Using neffy may be easier than injecting epinephrine for some people. But it’s important to use it correctly. Improper use may cause it to be less effective.

The steps below explain how to use neffy:

1. Remove neffy from its packaging.

2. Hold the nasal spray with your thumb on the bottom of the plunger and a finger on either side of the nozzle.

3. Insert the nozzle of the nasal spray into one nostril. Use your right hand if you’re spraying into your right nostril. Use your left hand for the left nostril. Stop inserting it when your index and middle fingers touch your nostril.

4. Hold the nasal spray so that it points towards the forehead. Avoid aiming it at the outer or inner wall of your nostril.

5. Firmly press the plunger until it snaps up and sprays liquid into the nostril. Avoid sniffing after giving a dose.

6. Remove the nasal spray from your nose.

7. Check for symptoms after the first dose. If symptoms come back or get worse, you can administer a second dose of neffy starting at 5 minutes after the first dose. But the second dose can be administered at any time later if symptoms return. Be sure to use the same nostril. Don’t use more than 2 doses without a healthcare professional or emergency responder telling you to do so.

EXPERT PICKS: WHAT TO READ NEXT

• More about anaphylaxis: It’s crucial to use epinephrine as soon as you notice symptoms of this serious allergic reaction. Read more about how to spot anaphylaxis and the next steps you should take.

• Other epinephrine options: Adrenaclick and EpiPen are two types of epinephrine auto-injectors. Here, our pharmacists detail the similarities and differences between them.

• Can you use an EpiPen after it expires? Experts explain why you should always keep an eye on your EpiPen’s expiration date.

Similar to other forms of epinephrine, you should use neffy at the first sign of anaphylaxis. Symptoms can change from mild to life-threatening very quickly. Using neffy as soon as you can is crucial for it to be as effective as possible.

Anaphylactic reactions should be evaluated and monitored in the ER, even if you’ve administered epinephrine. This is because symptoms can come back and require further treatment from a healthcare professional. Immediately after administering neffy, call 911 or get the individual to the nearest ER for emergency medical help.

Good to know: Neffy doesn’t contain needles. So you can throw the nasal sprays away in your regular trash. You don’t need to dispose of it in a sharps container like you would with an epinephrine auto-injector.

4. Like all forms of epinephrine used to manage anaphylaxis, Neffy has side effects

As a general rule, all forms of epinephrine used to manage anaphylaxis can cause the following side effects:

• Nervousness or anxiety

• Dizziness

• Headache

• Tremors

• Nausea and vomiting

But because neffy is a nasal spray, it may cause some mild nose-related side effects you wouldn’t have with epinephrine auto-injectors. These include nasal discomfort, throat irritation, and runny nose (rhinorrhea). Other potential neffy side effects include:

• Tingling nose

• Feeling over excited

• Fatigue

• Shakiness

• Itchy nose

• Sneezing

• Stomach pain

• Pain in the gums or teeth

• Numbness of the mouth

• Nasal congestion

These side effects are typically mild and should resolve on their own fairly quickly.

On the flip side, injectable epinephrine may cause redness, pain, or swelling where you inject it. Other serious injection-specific warnings that can happen include:

• Accidental injection into a vein, which may result in a brain bleed (cerebral hemorrhage)

• Accidental injection into fingers, hands, or feet, which may result in loss of blood flow to those areas

• Other needle-related injuries, such as a bent or embedded needle

• Rare but serious injection site reactions, including necrotizing fasciitis (“flesh-eating bacteria”) and myonecrosis (a bacterial infection of the muscle)

Since neffy doesn’t contain a needle, these injection-specific warnings aren’t listed in the medication’s labeling.

5. Certain people shouldn’t use neffy

Certain nose conditions can impact how your body absorbs neffy. In some cases, this could make it less effective. If you have a history of nasal polyps or nasal surgery, speak with your prescriber. They may prefer that you use an epinephrine auto-injector.

As with any other epinephrine product, make sure your prescriber knows if you’re allergic to sulfites (different from a sulfa allergy). Neffy contains sodium metabisulfite as an inactive ingredient. But the presence of a sulfite(s) in neffy or other injectable epinephrine products shouldn’t stop you from using them for treatment of serious allergic reactions or other emergency situations.

How to save on neffy

There are ways to save on neffy, which is available as a brand-name medication. GoodRx can help you navigate between GoodRx coupons, copay savings cards, and patient assistance programs to save money on your prescription.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase two neffy nasal sprays (1 carton) at an exclusive cash price of $199.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $25 per prescription for neffy using a savings card from the manufacturer.

• Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for neffy’s patient assistance program, which offers the medication free of charge.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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