Epinephrine autoinjector

An old version of a 0.3 mg EpiPen auto-injector

An epinephrine autoinjector is a medical device used to deliver a measured dose (or doses) of epinephrine (also known as adrenaline) using autoinjector technology, most frequently for the treatment of anaphylaxis.

Trade names for this device include EpiPen, Emerade, Twinject, Adrenaclick, Anapen, Jext, Allerject, and Auvi-Q. The EpiPen was originally derived from the ComboPen, a product developed for the military for treating exposure to nerve agents.

Design

The devices contain a spring-loaded needle that exits the tip of the device (in some cases through a sterile membrane) and penetrates the recipient's skin, to deliver the medication via subcutaneous or intramuscular injection.

Epinephrine autoinjectors contain a pre-determined dose of epinephrine, usually between 300 μg and 500 μg of active ingredient at a concentration of 1:1000. They typically contain more medication than the amount needed for a single dose, but any extra amount is not intended for use and is inaccessible without destroying the device. Manufacturers have also made pediatric dosed versions available at 150 μg of active ingredient, and there is also a version which contains two individual doses (in case a repeated application is required) sold under the trade name Twinject.

On August 13, 2012, the U.S. Food and Drug Administration (FDA) approved a new version of epinephrine auto-injector made by Intelliject and Sanofi called the Auvi-Q. It is rectangular in shape, 3.5 inches by 2 inches by 0.5 inch. It has a soundchip in it to give audio cues to a patient or caregiver to aid in the proper use of the device.

In January 2013, the UK MHRA approved Emerade (from Namtall AB), the first auto-injector fitted with 25mm needles to the 300μg and 500μg models.

In most countries, epinephrine is a prescription drug, and therefore obtaining the device requires a prescription from a doctor. However, in some jurisdictions, epinephrine autoinjectors are an over-the-counter drug and may be purchased from a pharmacy counter.

Usage

After activation the patient holds the device in place for between 5 and 10 seconds as the epinephrine is delivered. This gives the drug enough time to be absorbed by the body's muscles and diffused into the bloodstream.

Auto-injectors are sometimes used unnecessarily. Injection into a vein (intravenous injection) can be fatal. It can cause ventricular tachycardia, in which the heart beats uncontrollably and is not able to pump blood adequately. It can also restrict blood flow to the area of the injection site, and damage the extremities. After administering the device, patients are advised to seek immediate medical attention.

An emergency technique (not manufacturer-approved) to obtain additional epinephrine from a used autoinjector has been published in the medical literature.

Units that have exceeded their expiry date can still be use in an emergency if a valid unit is unavailable.

Effectiveness

None of these devices prevent future episodes of anaphylaxis. Patients who experience severe or life-threatening reactions may be treated further via allergen immunotherapy for long lived protection. A series of allergy injections composed of increasing concentrations of naturally occurring substances such as venom to provide excellent and usually lifelong protections against adverse effects of future insect stings: the initial injections have a very low concentration, usually 1 ppb or less.

References

• The Anaphylaxis Campaign. Accessed on March 19, 2007.
• BMJ Clinical Review of Epinephrine Administration. Accessed on March 19, 2007.

External links

• Training video for EpiPen and Anapen from the Anaphylaxis Campaign (UK)