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Epinephrine Auto-Injectors

Epinephrine auto-injectors (EAIs) are crucial for treating severe allergic reactions (anaphylaxis) and can be used by individuals with no medical training. Understanding severe allergic reactions (anaphylaxis) is important for knowing when to seek immediate medical help.

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Severe allergic reactions can happen quickly and involve various symptoms, which may include:

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  • Skin reactions: Hives, itching, flushing, swelling (angioedema).

  • Respiratory issues: Difficulty breathing, wheezing, tightness in the chest, throat swelling, hoarseness.

  • Gastrointestinal symptoms: Nausea, vomiting, diarrhea, abdominal pain.

  • Cardiovascular symptoms: Dizziness, fainting, rapid heartbeat, low blood pressure.

  • Other symptoms: A sense of impending doom, anxiety.

 

Anaphylaxis is a medical emergency and requires immediate attention. If you suspect someone is having a severe allergic reaction, it is crucial to seek emergency medical help right away.

In the U.S., several brands of epinephrine auto-injectors (EAIs) and authorized generics are available, with the dosage determined by the patient's weight. Current available options and their weight guidelines are:

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  • EpiPen® and EpiPen Jr® (and their authorized generics by Teva and Viatris)

  • Auvi-Q®

  • Adrenaclick® (and its authorized generic by Amneal Pharmaceuticals)

  • Symjepi™ (an epinephrine pre-filled syringe, not an auto-injector)

  • Neffy® (an epinephrine nasal spray for specific weights) 

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The appropriate device and dose are based on body weight to ensure effective treatment. 

  • 0.1 mg dose:

    • Available only with Auvi-Q®.

    • For infants and toddlers weighing 16.5 to less than 33 pounds (7.5 kg to less than 15 kg).

  • 0.15 mg dose:

    • Available with all brands (EpiPen Jr®, Auvi-Q®, Adrenaclick® generic, Symjepi™).

    • For children weighing 33 to 66 pounds (15 kg to 30 kg).

  • 0.3 mg dose:

    • Available with all brands (EpiPen®, Auvi-Q®, Adrenaclick® generic, Symjepi™).

    • For individuals (children, teens, and adults) weighing 66 pounds (30 kg) or more.

The benefits of using an epinephrine auto-injector (EAI) during a life-threatening allergic reaction (anaphylaxis) far outweigh the risks, as untreated anaphylaxis can be fatal. Risks primarily involve common, temporary side effects and rare, serious complications that may be more likely in individuals with pre-existing health conditions or due to incorrect injection technique. 

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Common Side Effects:

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Anxiety, nervousness, or restlessness

  • Headache

  • Dizziness or weakness

  • Fast, pounding, or irregular heartbeat (palpitations)

  • Nausea and vomiting

  • Sweating

  • Pale skin

  • Tremors or shakiness

  • Difficulty breathing (usually temporary)

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Serious Risks and Complications are rare but can occur. 

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  • Cardiovascular events: Epinephrine can increase blood pressure and heart rate, which in rare cases can lead to chest pain, heart attack, or stroke, especially in older adults or those with pre-existing heart conditions, high blood pressure, or diabetes.

  • Injection site injury/infection:

    • Accidental injection into fingers, hands, or feet can restrict blood flow and potentially cause tissue death (ischemia), requiring immediate emergency treatment.

    • Serious infections, including gas gangrene, have been reported in rare cases, often when the injection is administered into an incorrect location like the buttocks. Symptoms include persistent redness, swelling, warmth, or tenderness at the site.

    • Lacerations or embedded needles can occur, particularly if a young child's leg is not held firmly during the injection.

  • Allergic reaction to ingredients: The EAI contains a sulfite preservative (sodium metabisulfite) that can cause allergic reactions in sensitive individuals, especially those with asthma. However, this should not deter its use during a life-threatening emergency. 

 

Important Considerations

  • Seek medical attention: Always call 911 or your local emergency services immediately after using an EAI, as symptoms of anaphylaxis can return (biphasic reaction) and further treatment may be needed.

  • Correct use: To minimize risks, the auto-injector should only be injected into the middle of the outer thigh.

  • Pre-existing conditions: Individuals with certain conditions (e.g., heart disease, high blood pressure, diabetes, thyroid disorders, Parkinson's disease) should discuss the risks and benefits with their healthcare provider to determine the appropriate use. 

If you are interested in scheduling a consultation, please contact us at our secured email at phong.lieu@pharmdprescriptions.com . We will get back to you with further details. 

Image by Damiano Baschiera
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