The EpiPen — What You Need to Know
A brief overview on using an Epipen.
I am writing this to help caregivers, parents, teachers and other healthcare providers be a little more familiar with an using an EpiPen. After reading this, I don’t want everyone to just start stabbing everyone with epinephrine, this is just for informational purposes only.
Epinephrine injections are used in the case of severe allergic reactions. Sometimes, an antihistamine can be used if someone is only having an allergic reaction causing hives or some other skin reaction. However, an injection of epinephrine is needed for severe allergic reactions, known as anaphylaxis, which can be life threatening. The symptoms of a severe allergic reaction can be confusion, dizziness, swelling/tingling of the lips, tongues, shortness of breath and an itchy or tight throat, just to name a few.
There are two main types of epinephrine auto injectors available. One is the brand EpiPen and the other is a generic epinephrine auto injector. In this article we’ll mainly talk about the brand EpiPen and touch on the generics towards the end.
General Tips
When you pick your Epipen at the pharmacy, before you leave make sure it’s got an expiration date of at least a year.
You should store your Epipens at room temperature and they should not be left in the car or put into the refrigerator. Extreme temperatures can ruin the medication.
There are two types of EpiPens, one is the EpiPen and one is the EpiPen Jr. Each is color coded and these are prescribed based on weight. The color green is for smaller kids and yellow for bigger kids and adults.
Each EpiPen box comes with two EpiPens. Since each pen is a one time use only injection, having two is important because if a pen was accidentally discharged you’ll have a back up. Also, if the medication has been ruined because it was accidentally left in the car or someone put it in the fridge, you’d have a back up. Finally, some people will need a second injection of another epipen after the first was given. A second dose can be given as soon as five minutes after the first administration if symptoms have not resolved. Remember, each pen can only be used once, so a second injection would require a different Epipen. Sometimes this can be difficult for children who go to school. Some schools have it where the EpiPen may be with the child or in the classroom and the second with the school nurse and thats ok. But make sure to check with your school’s policy/protocol for EpiPens and make sure it involves children having access to two EpiPens in the case of an emergency.
There was a recent scandal where the manufacturer of Epipen drastically raised prices, but most insurance companies still cover it and there are coupons available online straight from the manufacturer to make them more affordable. If cost is an issue for you, there are generics available and some compounding pharmacies may compound epinephrine injections at a fraction of the price of a brand EpiPen.
Preparing for injection
Every Epipen has a little viewing window located on the pen (See images below). The viewing window allows you to be able to see the medication inside the pen.
The medication should be a clear liquid. If it’s dark, cloudy, brown, pink or looks like it has particles, this pen may have been damaged. With that said, if you or someone you know is having a severe allergic reaction and the medication appears damaged or is expired and there are no other EpiPens available, just use it that EpiPen. It’s better than nothing. And that person will likely experience no harm.
Take the pen out of the color coded case and hold it with your fingers and thumb wrapped around the body of the pen making a fist (YouTube video attached has a great demonstration). Each Epipen has a blue cap on the top and an orange tip at the bottom. Remember, blue to the sky, orange to the thigh. The thumb wrapped around the pen is important because this also prevents accidental discharge into your thumb if you’re holding it the wrong way. So, do not put your thumb on top, this will also help in remembering to remove cap.
Administering the Injection
Now that we’re ready to inject. Take the blue cap off. This cap MUST COME OFF! There will be no medication injected if you don’t remove the cap. But don’t remove the cap until you’re ready to use it. The needle is designed to be able to go through clothes, even jeans. You don’t need a full swing, but a fair stabbing motion should be enough for the injection. Only inject into the upper outer thigh. No where else. Not the butt, veins, or finger. The THIGH! After injection immediately call 911. After injecting an EpiPen, hearing a click lets you know it worked. If you did not hear a click, that person may not have received any medication. According to the EpiPen’s manufacturer labeling, after injection the pen should be held in place for three seconds then removed. It used to be recommended to leave it in for 10 seconds but the FDA has recently announced three seconds is enough to deliver the medication. Then, remove the pen and rub/massage the area of injection for 10 more seconds. Some people will require a second dose if symptoms have not resolved. A second EpiPen can be given AFTER five minutes has passed. If a second dose is needed, do not inject in the same site. And again do not use the same EpiPen. Epinephrine is adrenaline, so after administration it will cause some side effects like increased heart rate rate and other symptoms, which would be normal.
After injecting an EpiPen, there will not be an exposed needle which is pretty cool. This is not the case for other generics. #Segway
Generic Auto-injectors
Generic epinephrine auto injectors, similarly to the EpiPen, also have dosages for kids and for adults and will also be color-coded. However, these pens have two blue caps that must be removed, unlike the EpiPen which only had one. The generic auto-injectors will have a red tip and the red tip is what gets injected into the thigh. These pens are held in the hand the same as you would an EpiPen, as stated above.
Injecting these are a little different from injecting the EpiPen. You’ll usually place the red tip against the thigh then push down and hold for 10 seconds, then remove the injector and massage area for 10 more seconds. For these pens the needle does not retract! After injection there will be an exposed needle.
As usual please do not start or change the way you use any medications without first taking with your pharmacist or prescribing physician. Hope this was helpful.
Thanks for reading,
Take care.
-Richard
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Richard Waithe, PharmD | Richard@MedVize.com
