EpiPen® resources for healthcare providers

EpiPen® resources for healthcare providers

EpiPen® resources
for healthcare providers

From the first diagnosis to ongoing education, Pfizer offers a wide variety of tools and resources to help you and your patients manage severe anaphylaxis.

Tools and resources for your practice

Tools and resources for your patients

Frequently asked questions

EpiPen® and EpiPen Jr® (epinephrine) Auto-Injectors are indicated for the emergency treatment of anaphylactic reactions in patients who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions.

Click here for complete safety information.

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

Establish EpiPen® dosage in any specific patient on body weight. The effective dose is usually in the range 0.005–0.01 mg/kg body weight.

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.
  • The 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, consider other forms of injectable epinephrine if you feel doses lower than 0.15 mg are necessary (eg, children weighing <15 kg).
Dosing in children (>30 kg):
  • The EpiPen® Auto-Injector 0.3 mg (adult formulation) is recommended.

Dosage adjustments should be made at the discretion of the healthcare provider.

How is EpiPen® administered?1

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

<h5><span>Blue</span> to the sky.</h5> <ul> <li><span>Grasp with orange tip pointing downward</span></li> <li><span><strong>Remove blue safety cap by pulling straight up – do not bend or twist</strong></span></li> </ul>
<p><img alt="Image of the blue safety cap being taken off the EpiPen® device, “Blue to the sky”" data-entity-type="file" data-entity-uuid="9c5dce12-2004-4d67-b574-b9997b05d4d1" src="/sites/default/files/inline-images/answer-jpg-1.png" /></p>
<h5><span>Orange</span> to the thigh.</h5> <ul> <li><span>Place the orange tip against the middle of the outer thigh</span></li> <li><span><strong>Swing and push the auto-injector firmly into the thigh until it “clicks”</strong></span></li> <li><span>Hold firmly in place for three seconds – count slowly, “1, 2, 3”</span></li> </ul>
<p><img alt="Image of the orange side of the EpiPen® device being injected into thigh" data-entity-type="file" data-entity-uuid="5f4d8f94-2a0d-43a8-9f12-847b98959707" src="/sites/default/files/inline-images/answer-jpg-2_0.png" /></p>
<p>Your patients can inject through clothing if necessary. They <strong>cannot</strong> inject EpiPen® or EpiPen&nbsp;Jr® into their hands, feet, or buttocks.</p> <p>If patients are administering the dose themselves, instruct them to seek medical attention immediately by calling 911 or going to the emergency room.</p> <p>In any scenario, encourage patients to stay close to a healthcare facility or be prepared to call 911 for the next 48 hours.</p>
How many doses of EpiPen® can be administered?1

The first dose is used immediately at the first signs and symptoms of a severe allergic reaction.

After administering EpiPen®, patients must go to the nearest emergency room for evaluation and should undergo a period of observation of no less than 4 hours.

Reinject an additional EpiPen® Auto-Injector every 5 to 15 minutes until there is a resolution of anaphylaxis or signs of adrenaline excess if:

  • Symptoms persist while awaiting transport to the hospital
  • Symptoms recur; patients could have a second reaction
  • The reaction continues

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

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.

This second reaction usually occurs after an asymptomatic period of 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, which 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 EpiPen® be injected through clothing?1

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

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, instruct the patient to go to the nearest emergency room immediately for treatment.

How can the patient know the injection has delivered epinephrine?1
  • The viewing window on the barrel of the EpiPen® Auto-Injector, which is clear prior to delivery, will be obscured or shaded after delivery.
  • After EpiPen® is removed from the thigh, the orange needle cover will be extended and locked in place.
  • EpiPen® and its extended orange needle cover will not fit into the carrier tube.
What should be done if the blue safety cap is accidentally removed?1

Removing the blue safety cap prepares EpiPen® for activation.

If the EpiPen® Auto-Injector has not been activated (ie, pressed against the thigh), then the blue safety cap can be carefully replaced:

  • Keep your fingers away from the orange tip.
  • Gently place the EpiPen® Auto-Injector in its needle-safe carrier tube with the uncovered safety release end at the top.
  • Secure the blue safety cap back in place.
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®.

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

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 expiry. 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 is the EpiPen® Expiration Reminder Service?

The EpiPen® Expiration Reminder Service sends alerts one month before, one week before, and on the day a registered EpiPen® Auto-Injector expires.

It provides patients with advance notice to reorder and replace their EpiPen® Auto-Injector before it expires, ensuring they have a non-expired device in a severe allergic emergency.

Visit the EpiPen® Expiration Reminder Service page for more information.

Can EpiPen® be used during pregnancy?1

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

Can sulphite-sensitive patients use EpiPen®?1

EpiPen® contains sodium metabisulphite and may cause allergic-type reactions, including anaphylactic symptoms or mild to severe asthmatic episodes.

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

How is EpiPen® properly stored?1
  • Keep EpiPen® at 25°C (room temperature); excursions permitted to temperatures between 15°C and 30°C (59– 86°F)
    • -Do not refrigerate or freeze
    • -Protect EpiPen® from light
    • -Do not keep EpiPen® in a vehicle during extremely hot or cold weather
  • Keep EpiPen® in its carrier tube to protect it from damage; however, the carrier tube is not waterproof
  • Handle with care: The EpiPen® Auto-Injector is a medical device that contains glass

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

Conditions that can compromise an EpiPen® Auto-Injector include:

  • Not storing EpiPen® at the recommended temperature
  • Submerging the auto-injector in water
  • Rough handling

Encourage patients to check the liquid in their EpiPen® Auto-Injector periodically; it should always be clear. Instruct patients to replace their auto-injector immediately if it is discoloured or brown or contains sediment (a precipitate).

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

Can patients purchase EpiPen® without a prescription?

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

However, with a prescription, EpiPen® may be covered for reimbursement by a patient’s drug plan.

What if EpiPen® is on back-order?

Please contact the 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®.

Indications and Clinical Use:
  • EpiPen® and EpiPen Jr® (epinephrine) Auto-Injectors are indicated for the emergency treatment of anaphylactic reactions in patients who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions.
  • Select dose according to patient’s body weight.
  • Inject into the outer thigh.
  • Following treatment of anaphylaxis, the patient must call 911.

There are no absolute contraindications to the use of epinephrine in a life-threatening allergic situation.

Relevant Warnings and Precautions:
  • Avoid use of epinephrine in patients with cardiogenic, traumatic, or hemorrhagic shock; cardiac dilation; cerebral arteriosclerosis; organic brain damage, and narrow-angle glaucoma
  • Use with caution in patients with cardiac arrhythmias; coronary artery or organic heart disease; hypertension and hyperthyroidism
  • Sulfite sensitivity
  • Diabetes
  • Parkinson’s disease
  • Not intended as a substitute for immediate medical care, the patient should seek immediate medical or hospital care
  • More than two sequential doses of epinephrine should only be administered under direct medical supervision
  • The patient/carer should be informed about the possibility of biphasic anaphylaxis
  • Epinephrine should only be injected into the anterolateral aspect of the thigh. Hold child's leg firmly during injection
  • Suboptimal effect in patients with a thick subcutaneous fat layer
  • Injection site infections
For More Information:

Please consult the prescribing information at www.pfizer.ca/pm/en/EPIPEN.pdf for more information relating to adverse reactions, drug interactions, and dosing information, which has not been discussed in this advertisement. The prescribing information is also available by calling 1-800-463-6001.

 

 

Reference:

EpiPen® and EpiPen Jr® Prescribing Information. Mylan, L.P., May 30, 2017.