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EpiPen/EpiPen Jr

Generic Name: Epinephrine Injection
Drug Category: Non-Selective Alpha and Beta-Adrenergic Receptor Agonist
Litigation Alert Level: High
This drug has been approved for use by males and females over the age of 0 year old for a maximum duration of 0 year.

Approved Uses

Indicated for:

• EpiPen and EpiPen Jr are indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging insects (e.g., order Hymenoptera, which include bees, wasps, hornets, yellow jackets and fire ants) and biting insects (e.g., triatoma, mosquitoes), allergen immunotherapy, foods, drugs, diagnostic testing substances (e.g., radiocontrast media) and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.

EpiPen and EpiPen Jr are intended for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions. Anaphylactic reactions may occur within minutes after exposure and consist of flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with a fall in blood pressure, convulsions, vomiting, diarrhea and abdominal cramps, involuntary voiding, wheezing, dyspnea due to laryngeal spasm, pruritus, rashes, urticaria or angioedema.

Epinephrine (adrenaline) is the drug of choice for the emergency treatment of severe allergic reactions. The strong vasoconstrictor action of epinephrine, through its effect on alpha adrenergic receptors, quickly counteracts vasodilation and increased vascular permeability which can lead to loss of intravascular fluid volume and hypotension during anaphylactic reactions.

Each EpiPen or EpiPen Jr contains a single dose of epinephrine for single-use injection. Since the doses of epinephrine delivered from EpiPen or EpiPen Jr are fixed, consider using other forms of injectable epinephrine if doses lower than 0.15 mg are deemed necessary.

EpiPen and EpiPen Jr are intended for immediate administration as emergency supportive therapy only and are not a substitute for immediate medical care.

Epinephrine should ONLY be injected into the anterolateral aspect of the thigh. Do not inject intravenously, into buttock, or into digits, hands, or feet.

Accidental injection into the digits, hands or feet may result in loss of blood flow to the affected area.

In most patients, epinephrine is effective after 1 injection. However, symptoms may recur and further injections may be required to control the reaction. Epinephrine can be re-injected every 5 to 15 minutes until there is resolution of the anaphylaxis or signs of adrenaline excess (such as palpitations, tremor, uncomfortable apprehension and anxiety).

Selection of the appropriate dosage strength (EpiPen 0.3 mg or EpiPen Jr 0.15 mg) is determined according to patient body weight. Patients greater than or equal to 30 kg (approximately 66 pounds or more): EpiPen 0.3 mg. Patients 15 to 30 kg (33 pounds to 66 pounds): EpiPen Jr 0.15 mg.

Antihistamines and asthma medications must not be used as first line treatment for an anaphylactic reaction.

Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), have been reported at the injection site following epinephrine injection for anaphylaxis. Clostridium spores can be present on the skin and introduced into the deep tissue with subcutaneous or intramuscular injection. While cleansing with alcohol may reduce presence of bacteria on the skin, alcohol cleansing does not kill Clostridium spores. To decrease the risk of Clostridium infection, do not inject EpiPen into the buttock.

Epinephrine use should be avoided in patients with cardiogenic, traumatic, or hemorrhagic shock; cardiac dilation; and/or cerebral arteriosclerosis.

Epinephrine use should be avoided in patients with organic brain damage.

Epinephrine use should be avoided in patients with narrow-angle glaucoma.

Epinephrine should be used with caution in patients with cardiac arrhythmias, coronary artery or organic heart disease, hypertension, or in patients who are on medications that may sensitize the heart to arrhythmias, e.g., digitalis, diuretics, or anti-arrhythmics. In such patients, epinephrine may precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias. Patients with hypertension or hyperthyroidism are prone to more severe or persistent effects.

Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or those receiving certain drugs.

Angina may occur in patients with coronary artery disease.

Rare cases of stress cardiomyopathy have been reported in patients treated with epinephrine.

Epinephrine should be administered with caution to patients with hyperthyroidism, diabetes, elderly individuals, and pregnant women. Patients with Parkinson’s disease may notice a temporary worsening of symptoms.

There is a significantly increased risk of respiratory symptoms in patients with concomitant asthma, especially if poorly controlled. These patients are at increased risk of death from anaphylaxis. Fatalities may also occur from pulmonary edema resulting from peripheral constriction and cardiac stimulation.

Patients with diabetes may develop increased blood glucose levels following epinephrine administration.

Patients with Parkinson’s disease may notice a temporary worsening of symptoms after treatment with epinephrine.

Rapid rises in blood pressure have produced cerebral hemorrhage, particularly in elderly patients with cardiovascular disease.

Patients who receive epinephrine while concomitantly taking cardiac glycosides, diuretics, or anti-arrhythmics should be observed carefully for the development of cardiac arrhythmias.

There is also a risk for adverse reactions after the administration of adrenaline to patients with hyperthyroidism, phaeochromocytoma, severe renal impairment, prostate adenoma, hypercalcaemia, hypokalaemia, and in elderly patients and pregnant women.

Common adverse reactions to systemically administered epinephrine include anxiety; apprehensiveness; restlessness; tremor; weakness; dizziness; sweating; palpitations; pallor; nausea and vomiting; headache; and/or respiratory difficulties. These symptoms occur in some persons receiving therapeutic doses of epinephrine, but are more likely to occur in patients with hypertension or hyperthyroidism.

Epinephrine should be used with caution in patients who are on medications that may sensitize the heart to arrhythmias, e.g., digitalis, diuretics, or anti-arrhythmics. In such patients, epinephrine may precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias.

Caution is advised in patients receiving cardiac glycosides or diuretics, since these agents may sensitize the myocardium to beta-adrenergic stimulation and make cardiac arrhythmias more likely.

The effects of epinephrine may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine sodium, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine.

The cardio-stimulating and bronchodilating effects of epinephrine are antagonized by beta-adrenergic blocking drugs, such as propranolol. Anaphylaxis may be made worse by beta blockers because these drugs decrease the effectiveness of epinephrine.

The vasoconstricting and hypertensive effects of epinephrine are antagonized by alpha adrenergic blocking drugs, such as phentolamine.

Phenothiazines may also reverse the pressor effects of epinephrine.

Ergot alkaloids may also reverse the pressor effects of epinephrine.

Deaths have been reported in asthmatic patients treated with epinephrine following the use of isoproterenol, orciprenaline, salbutamol, and long acting beta agonists.

Cocaine sensitizes the heart to catecholamines (as does uncontrolled hyperthyroidism), and epinephrine use in these patients should be cautious.

There are no adequate and well controlled studies of the acute effect of epinephrine in pregnant women. Animal studies: Epinephrine was teratogenic. 

There is no information on the presence of epinephrine in human milk, the effects on breastfed infants, or the effects on milk production.

GoToSource

Off-label Uses

• Cardiac arrest. GoToSource

Adverse Events

Arrhythmias. GoToSource

Digital ischemia. GoToSource 

Tremor, anxiety, palpitations and increased systolic blood pressure. GoToSource 

Neurological damage, stroke and hemiparesis (muscular weakness or partial paralysis on one side of body). GoToSource

Litigation

Lawsuits filed for product defects. 

The material contained in GoToPills is for informational purposes only and not intended to replace the judgment, evaluation and treatment of physicians, pharmacists and other healthcare providers. GoToPills does not provide medical advice, diagnoses or treatment. Always seek the advice of your physician or other qualified health provider regarding a medical condition or treatment.

 

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Site Last Updated March 29, 2024