The price of EpiPens has been in the news a lot recently.
Most people know that they went Mylan’s EpiPen 2-Pak went from costing about $100 in 2006 to over $600 today and that there has been little or no competition.
One competing device, Auvi-Q was recalled in 2015, but it was fairly expensive too.
Good News and Bad News About EpiPens
Things have gotten better recently.
First, a generic EpiPen 2-Pak is now available. It costs $339.99. While still expensive, it does lower co-pays for many people with good insurance.
The latest news? A generic Adrenaclick injector for $109.99 at CVS pharmacies.
Even better, coupons are available that can make the injectors free for many people.
So what’s the bad news?
The directions for using the EpiPen 2-Pak and the Adrenaclick are not the same. That can cause some confusion. Do you want someone to grab one and not be sure how to use it when your child is having a life-threatening allergic reaction?
That makes it important for everyone to be familiar with both types of epinephrine injectors.
Adrenaclick vs EpiPen 2-Pak Directions
The fact that the Adrenaclick has two caps that you need to remove before use, while the EpiPen only has one, can lead to confusion. Also, the Adrenaclick injector, despite its name, doesn’t actually ‘click’ after you use it, like the EpiPen does.
EpiPen 2-Pak auto-injector directions:
- Remove the EpiPen Auto-Injector from the clear carrier tube to find an EpiPen Jr (green label) or EpiPen (yellow label).
- Remove the blue safety release by pulling straight up without bending or twisting it.
- Swing and firmly push orange tip against mid-outer thigh until it ‘clicks’.
- Hold firmly in place for 3 seconds (count slowly 1, 2, 3).
- Remove auto-injector from the thigh and massage the injection area for 10 seconds.
Remember that the orange end is the needle end! And you know that your child got your dose if you heard the click sound.
Adrenaclick epinephrine auto-injector directions:
- Remove the outer case.
- Remove grey caps labeled “1” and “2”.
- Place red rounded tip against mid-outer thigh.
- Press down hard until needle enters thigh.
- Hold in place for 10 seconds. Remove from thigh.
With the Adrenaclick injector, the red tip end is the needle end! Do not touch this end or you could unintentionally inject your self. After use, the needle should be visible.
Avoiding Confusion About Your Epinephrine Injector
All of the epinephrine injectors are easy to use. At least on paper.
In the heat of the moment though, when a child is having a life-threatening allergic reaction, it may not seem so easy though.
It will likely be even more difficult if the epinephrine injector you grab is not what you are expecting. Make sure you know how to use your epinephrine injector, both when your pediatrician prescribes it and when your pharmacist dispenses it to you (in case you get a different one, which is allowed in some states).
- Read the instructions.
- Watch a video.
- Use a trainer device.
- Be prepared!
It is also important that anyone that watches your child, whether it is a family member or the school nurse, knows how to use your child’s epinephrine injector.
“Individuals and caregivers are often reluctant to use self-injectable epinephrine in anaphylaxis despite instruction to do so.”
Pediatrics March 2007
Other things that can lead to confusion about epinephrine injectors include that you:
- use an EpiPen or Adrenaclick training pen instead of the real injector with active medication when your child is having an anaphalytic reaction
- use the real injector when you meant to use the training pen
- don’t carry your child’s epinephrine injector with you at all times, which is why it is important to get more than one injector each time, allowing you to keep one at school, one at home, and one and travels with your child, etc., eventually allowing your child to carry his or own epinephrine injector at an age-appropriate time
- forget to move to a higher dose of epinephrine as you child grows, keeping in mind that the Jr (0.15mg) dosing is only for kids under 66 pounds
- aren’t sure when to use your EpiPen or Adrenaclick injector or are afraid to use it, which can lead to an unnecessary delay in your child getting a lifesaving treatment
- don’t get a refill if your epinephrine injectors have expired or you actually needed to use one
- understand that you still need to call 911 after you have used your epinephrine injector, even if your child begins to immediately feel better. Symptoms can return, which is why you are given two doses (2-Pack) of epinephrine.
A good Food Allergy & Anaphylaxis Emergency Care Plan can help avoid much of this confusion. In addition to easy to read instructions on when to give epinephrine, this type of plan should include directions for your child’s epinephrine injector.
When in doubt – you should usually give epinephrine if you have any concerns that your child is having an anaphylactic reaction. It is a safe medicine.
More Information About Epinephrine Injectors
- How to use Adrenaclick
- How to Use Your EpiPen
- GoodRx – EpiPen vs Adrenaclick: You Have Options
- Know Your Auto-Injector! Epinephrine Options & Training
- Generic Epinephrine Injector May Cause Confusion
- What price must we pay for safety? Excessive cost of EPINEPHrine auto-injectors leads to error-prone use of ampuls or vials and unprepared consumers
- Study – Sonia Dhanjal, PharmD, Stacie Lampkin, PharmD. Confusion With Substituting Epinephrine Auto-Injectors: A Focus On Medication Counseling, Dispensing, and Patient Education. Journal of Allergy and Clinical Immunology. Volume 133, Issue 2, Supplement, February 2014.
- AAP – Self-injectable Epinephrine for First-Aid Management of Anaphylaxis. Pediatrics. March 2007, VOLUME 119 / ISSUE 3
- AAAAI – When should an epinephrine injection be given to a patient with a known food allergy who has ingested the food in question, but has no symptoms
- AAAAI – Storage and stability of automatic epinephrine injectors
- CVS Health Announces Low Priced Generic Epinephrine Auto-Injector
- How I accidentally injected myself with an EpiPen
- Study – Frew A.J. What are the ‘ideal’ features of an adrenaline (epinephrine) auto-injector in the treatment of anaphylaxis? Allergy 2011; 66: 15–24.
- NASN – Food Allergy and Anaphylaxis Toolkit
- American Red Cross – Anaphylaxis and Epinephrine Auto-Injector Training
Last Updated on January 14, 2017 by Vincent Iannelli, MD