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Frequently Asked Questions

HCP Resources

Review these questions healthcare providers frequently have about the EpiPen® (epinephrine) Auto-Injector.

What are the dosing guidelines for the EpiPen® (epinephrine) Auto-Injector?1

EpiPen® dosage should be based on body weight.

The effective dose is usually in the range 0.005-0.01 mg/kg bodyweight.

EpiPen®:

  • The EpiPen® Auto-Injector is intended for intramuscular administration in adults and children who weigh 30 kg or more.
  • The EpiPen® Auto-Injector delivers a single intramuscular dose of 0.3 mg epinephrine in a 0.3 mL volume (0.3 mg/0.3 mL).

EpiPen Jr®:

  • The EpiPen Jr® Auto-Injector is intended for pediatric intramuscular administration in children who weigh between 15 kg and 30 kg.
  • EpiPen Jr® Auto-Injector delivers a single intramuscular dose of 0.15 mg epinephrine in a 0.3 mL volume (0.15 mg/0.3 mL)

Dosing in children (<15 kg):

  • Since the dose of epinephrine delivered from EpiPen Jr® is fixed at 0.15 mg, the physician can consider other forms of injectable epinephrine if doses lower than 0.15 mg are felt to be necessary (e.g., for children weighing less than 15 kg).

Dosing in children (>30 kg):

  • The EpiPen® Auto-Injector 0.3 mg (adult formulation) is recommended.

Dosage adjustments are at the discretion of a healthcare professional.

When should EpiPen® be used?1

EpiPen® should be used at the first sign or symptom of a severe allergic reaction. Clear warning signs do not always occur before a serious reaction.

In patients with a history of a severe cardiovascular collapse, the physician may advise use of EpiPen® upon exposure to a known allergen – before a potentially life-threatening reaction begins.*

* The EpiPen® Auto-Injector is not indicated to prevent death associated with anaphylaxis.

How is EpiPen® administered?1

Remove the EpiPen® Auto-Injector from the carrier tube and follow these 2 simple steps:

A way to remember it or teach it to someone is by using the phrase
Blue to the sky, Orange to the thigh”

Person pulling blue cap off of EpiPen device, “Blue to the sky”
  • Grasp with orange tip pointing downward
  • Remove blue safety cap by pulling straight up – do not bend or twist
Person injecting orange side of EpiPen device into thigh, “Orange to the thigh”
  • Place the orange tip against the middle of the outer thigh
  • Swing and push the auto-injector firmly into the thigh until it “clicks”
  • Hold firmly in place for 3 full seconds (count slowly, “1, 2, 3”)

After giving the dose, seek medical attention immediately or go to the emergency room. Stay close to a healthcare facility or be able to call 911 for the next 48 hours.

Instructions for how and when to use EpiPen® are provided in a variety of resources:

EpiPen® Patient Information (Downloadable PDF)

Patient consumer Instruction Sheet (Downloadable PDF)

EpiPen.ca consumer site (Video demonstration and instructions)

EpiPen® 101 consumer site (Interactive online training)

MyEpiPen Canada consumer app (Video demonstration and instructions)

How many doses of EpiPen® can be administered?1

If you or your child do not feel better or get worse, you can inject another dose of EpiPen® or EpiPen Jr® 5 to 15 minutes after the first injection.

Do not inject more than 2 injections right after each other.

Too much epinephrine can cause dangerously high blood pressure, stroke, or death. Signs of an overdose include:

  • Irregular heart beat
  • Difficulty breathing caused by a build-up of fluid in your lungs

You must seek medical assistance or go to a hospital emergency room immediately after using EpiPen® or EpiPen Jr®.

Even if you have sought medical help, you must stay within close proximity to a hospital or where you can easily call 911 for the next 48 hours.

A severe allergic reaction is a serious, acute, allergic reaction that may cause death. It has a sudden onset and generally lasts less than 24 hours. Because a severe allergic reaction is a generalized reaction, a wide variety of clinical signs and symptoms may be observed.

Physicians may determine that a single dose of epinephrine may not be enough to reverse the symptoms of a severe allergic reaction. As such, your healthcare provider may prescribe more than one EpiPen® to have on hand.

Can EpiPen® be injected through clothing?1

Yes. If necessary, EpiPen® can be injected through clothing.

Why might a second or subsequent doses of EpiPen® be required?1

Anaphylactic reactions typically follow a uniphasic, or single-phase course, however 20% of severe allergic reactions will have a biphasic, or second-phase reaction.

If a reaction continues or the symptoms return, epinephrine can be re-injected every 5-15 minutes until there is a resolution of anaphylaxis or signs of adrenalin excess.

This second reaction usually occurs after no symptoms have shown (an asymptomatic period) for 1 to 8 hours, but may occur up to 38 hours (mean 10 hours) after the initial reaction. Second-phase reactions can occur even following administration of corticosteroids.

About 1/3 of the second reactions are more severe, 1/3 are as severe, and 1/3 are less severe.

Due to these risks, patients should seek medical attention immediately and go to the nearest emergency room right after using EpiPen®. For the next 48 hours, patients must stay close to a hospital or where they can call 911.

Multiple doses of epinephrine are also required for long-lasting or protracted anaphylaxis. This condition is frequently associated with low blood pressure (profound hypotension) and sometimes lasts longer than 24 hours. Protracted anaphylaxis is minimally responsive to aggressive therapy and has a poor prognosis.

Can patients purchase EpiPen® without a prescription?1

In Canada, EpiPen® can be purchased with or without a prescription.

Are there clinic tools and resources for healthcare providers to teach patients about anaphylaxis and the EpiPen® Auto-Injector?

Yes. Pfizer provides a variety of clinic tools and resources to educate patients and caregivers about severe allergies and the EpiPen® Auto-Injector.

The following can be downloaded or ordered free by healthcare providers:

Start by ordering the EpiPen® Training Kit and Organization Kit on the EpiPen.ca consumer site. Use the FREE EpiPen® Training Device included in both the Training Kit and Organization Kit to demonstrate and practice using the EpiPen® Auto-Injector.

The Patient Instruction Sheet counsels patients on how to properly administer the EpiPen® Auto-Injector.

The Pharmacist’s Counselling Action Tool is a comprehensive guide to counselling patients on the EpiPen® Auto-Injector.

The Food Allergy Poster can be displayed in your waiting room or exam room to provide patients with key information regarding food allergies and anaphylaxis.

The Anaphylaxis Education Poster helps educate patients about the symptoms of anaphylaxis and how to use EpiPen®.

All of the above resources can be ordered here >

Are there tools and resources that patients can use to learn how to properly use the EpiPen® Auto-Injector?

Yes. For patients and caregivers, demonstration of the injection technique with the EpiPen® Training Device by a physician or pharmacist is recommended.

Patients, caregivers, and consumers can order their own Training Device to practice with and to instruct friends and family. The EpiPen® Training Device can be ordered free on the EpiPen.ca consumer site.

Instructions for how and when to use EpiPen® are provided in a variety of resources:

EpiPen® Patient Information (Downloadable PDF)

Patient Instruction Sheet (Downloadable PDF)

EpiPen.ca consumer site (Video demonstration and instructions)

EpiPen® 101 consumer site (Interactive online training)

MyEpiPen Canada consumer app (Video demonstration and instructions)

Patients and parents of children at risk of a severe allergic reaction should be encouraged to actively educate others on how and when to use EpiPen®.

Can EpiPen® be used during pregnancy?1

Although there are no adequate and well-controlled studies in pregnant women, epinephrine should be used in pregnancy only if the potential benefit justifies the potential risk to the developing infant.

How long does a new EpiPen® have before it expires?1

Pfizer strives for patients to receive a minimum of 12 months before expiry when they purchase EpiPen® Auto-Injectors.

Pfizer does not sell wholesalers any EpiPen® Auto-Injectors with less than 13 months before expiration. Pharmacists can return a short-dated EpiPen® Auto-Injector to Pfizer for a refund, but only before it is dispensed to a patient. Once dispensed, Pfizer will not provide a refund or exchange.

Encourage patients to verify the expiry date of any new EpiPen® Auto-Injector the pharmacy dispenses before they make the final purchase. If the expiry date is less than 12 months, Pfizer recommends patients to ask the pharmacist to dispense a longer dated device.

What conditions can compromise the efficacy of an EpiPen® Auto-Injector?1

An improperly stored EpiPen® is not recommended for use in the event of a severe allergic reaction.

Conditions that compromise an EpiPen® Auto-Injector include:

  • Not storing at room temperature
  • Refrigeration
  • Kept in a vehicle during extremely hot or cold weather
  • Not protected from light
  • Exposure to temperatures below 15° and above 30°C (59° to 86°F)
  • Submerging in water
  • Rough handling: EpiPen® is a medical device that contains glass and must be handled with care

Patients should periodically check to see that the liquid in their EpiPen® Auto-Injector is clear and not brown — and to replace immediately if it’s discoloured or contains sediment (a precipitate).

Is certification required to administer EpiPen® to someone in need of the medication but who is unable to self inject?1

Emergency administration of EpiPen® for a suspected severe allergic reaction does not require certification.

Illustrated instructions for using EpiPen® are printed on the barrel of every EpiPen® Auto-Injector. The instructions were designed to be quickly understood by someone who has not been previously shown how to use EpiPen®.

Patients and parents of children at risk of a severe allergic reaction are encouraged to actively educate others on how and when to use EpiPen®.

EpiPen® and EpiPen Jr® are designed as emergency supportive therapy only and not as a replacement or substitute for subsequent medical or hospital care. After administration, patients should seek medical attention immediately or go to the nearest emergency room. For the next 48 hours, patients must stay close to a hospital or where they can call 911.

How long should EpiPen® be held against the thigh during injection?1

Hold EpiPen® firmly in place for three full seconds (count slowly, “1, 2, 3”) to help ensure the dose of epinephrine is properly delivered.

Inject even through clothing if necessary.

Do not inject EpiPen® or EpiPen Jr® into hands, feet, or buttock.

What is the EpiPen® Expiration Reminder Service?

The EpiPen® Expiration Reminder Service sends alerts either by e-mail or by text message (or both) one month and one week before the registered EpiPen® expires, and once after it expires.

This gives advance notice to re-order before EpiPen® expires, to help ensure your patients will have an unexpired device, in the event they need it.

Details and registration for the Expiration Reminder Service are found on the EpiPen.ca consumer site.

How can the patient know the injection has delivered the epinephrine?1

There is a viewing window on the barrel of the EpiPen® Auto-Injector which is clear prior to delivery and is obscured or shaded after delivery.

Also, once the dose is administered and the EpiPen® Auto-Injector is released from the injection site, the orange needle cover extends and immediately locks in place. This encases the needle to prevent accidental needle sticks.

Both of these things serve as a visual indicator that the dose of epinephrine has been delivered. Further, after the orange needle cover is extended, the EpiPen® Auto-Injector will not fit back into the carrier tube.

What should be done if the blue safety release is accidentally removed?1

If the EpiPen® Auto-Injector has not been activated (i.e. pressed against the thigh) then the blue safety release can be carefully replaced.

Because removing the blue safety release prepares EpiPen® for activation, it should be gently placed in its needle-safe storage tube with the uncovered safety release end at the top. Be very careful to keep fingers clear of each end. Then secure the blue safety release in place.

Can sulfite-sensitive patients use EpiPen®?1

The EpiPen® Auto-Injector contains sodium metabisulphite and may cause allergic-type reactions, including anaphylactic symptoms or mild to severe asthmatic episodes in certain susceptible persons.

Epinephrine is the drug of choice for serious allergic reactions and the presence of a sulphite in this product should not prevent administration of the drug for treatment of serious allergic or other emergency situations, even if the patient is sulphite-sensitive.

What if EpiPen® is accidentally injected into a hand or foot?1

Accidental injection into a hand or foot may result in loss of blood flow to the affected areas and should always be avoided.

If there is an accidental injection into these areas, go immediately to the nearest emergency room for treatment.

Is an EpiPen® carrier bag or belt available?

Waistpacks for EpiPen® can be ordered on the EpiPen.ca consumer site.

A free waistpack can be ordered using the lot number found on the EpiPen® Auto-Injector or packaging. Or a free waistpack can also be ordered when registering for the Expiration Reminder Service on the EpiPen.ca consumer site.

To order a waistpack from the EpiPen.ca consumer site, follow this link or paste it into your browser: www.epipen.ca/en/waistpack

How is EpiPen® properly stored?1

It's important to properly store EpiPen® to help ensure it's ready to use in the event of a severe allergic reaction.

Full instructions for storing EpiPen® are included in the EpiPen® Patient Leaflet.

  • Always store EpiPen® in the carrier tube with the blue safety release on until you need to use it
  • Keep EpiPen® at room temperature: Do not refrigerate
  • EpiPen® should be stored at 25°C [excursions permitted to temperatures between 15° to 30°C (59°to 86°F)]
  • Do not keep EpiPen® in a vehicle during extremely hot or cold weather
  • Protect EpiPen® from light
  • Submerging EpiPen® in water can compromise the delivery mechanism
  • Periodically check to make sure the liquid in the EpiPen® Auto-Injector is not brown in colour
  • Replace an EpiPen® Auto-Injector if it is discoloured or contains sediment (a precipitate)
  • If EpiPen® has not been stored according to the above storage recommendations, using the auto-injector cannot be recommended
  • The EpiPen® Auto-Injector is a medical device that contains glass and should be handled with care
What if EpiPen® is on back-order?

Please contact Pfizer Customer Service Group at 1-800-387-4974.

Does Pfizer offer an assistance program for EpiPen®?

Pfizer does not have an assistance program for EpiPen®.