Of the medicines that you would hope that we would never run out of, epinephrine is probably on the top of the list for many people.
Unfortunately, many parents are still stuck dealing with shortages and delays of epinephrine injectors.
“The purpose of this letter is to inform you that in a very small number of cases, some EpiPen® 0.3 mg and EpiPen Jr® 0.15 mg Auto-Injectors, and their authorized generic versions, may not easily slide out of their carrier tube, which could delay or potentially prevent use of the device during an emergency.”Dear Healthcare Provider Letter for Potential Label Defect of EpiPen Auto-Injectors and its Authorized Generic
For EpiPens, there was a problem with the labels on the injectors so that “in a very small number of cases, labels were not fully adhered to the surface of the auto-injector such that the device label may become stuck to the inside of the carrier tube.”
And for the Adrenaclick generic injectors, “Some lots of Epinephrine Injection auto-injector have passed all levels of inspection and met product specifications at the manufacturing facility, but have been found to contain particles upon further inspection.”
So both are now suffering from manufacturing delays after fixing these issues.
Luckily, most still have options for their kids with severe allergies.
Options During the Epinephrine Shortage
Can’t get your child’s prescription for epinephrine filled?
“Currently, EpiPen, EpiPen Jr and Adrenaclick remain in either a spot shortage or constrained supply.”Alert – Epinephrine Shortage Update September 17, 2019
One of the first things to keep in mind is that the FDA has allowed for temporary extensions of expiration dates:
- on EpiPen and its authorized generic for 4 months (not EpiPen Jr)
- on the Adrenaclick authorized generic for 2 months
So check the NDC number and the original expiration date and see if you even need a refill yet.
Next, know that many more versions of epinephrine are available than ever before!
If you can’t refill your child’s prescription because your pharmacy doesn’t have it, you might ask them which form of epinephrine they do have in stock, and then ask your pediatrician if you can use that version.
There are now six forms of epinephrine injectors available (with three that may be hard to find), including:
- EpiPen, EpiPen Jr – coupon – the auto-injector with the notorious reputation for the $670 retail price tag
- Epinephrine injection (EpiPen, EpiPen Jr authorized generics) – coupon
- Epineprhine injection (EpiPen, EpiPen Jr Teva manufactured generics) – coupon
- Adrenaclick Adult, Child authorized generic – coupon – this is the epinephrine auto-injector that is available for $109.99 at CVS
- SYMJEPI 0.3mg, 0.15mg – coupon – a new epinephrine pre-filled, ready-to-use device – not an auto-injector!
- Auvi-Q – financial support – the epinephrine auto-injector that talks to you and has the notorious reputation for the $5,000 retail price tag
Whichever version you get, if you have commercial insurance without a high deductible, the coupon will likely cover your copay.
And in a worst case scenario, if necessary, use an expired epinephrine injector, even if it is out of range of an extension, and seek immediate medical attention.
“If an in-date auto-injector is not available, it is better to use an expired auto-injector than to not give epinephrine.“Expired Epinephrine Can Still Save Lives
Hopefully you won’t be when you need to use your child’s epinephrine injector!
One very big issue with so many different types of epinephrine injectors is that their instructions for use are a little different.
“There are several different epinephrine auto-injectors available – Mylan EpiPen and Mylan Generic, Auvi-Q, and Adrenaclick; these auto-injectors have different steps for use.”How to Use an Epinephrine Auto-Injector
We can also hope that once the shortages are resolved, a little competition will bring down the prices of all of these drugs, as even the generic EpiPens are at least $300!
More on Options During the Epinephrine Shortage
- Avoiding Confusion During an Allergy Attack – Adrenaclick vs EpiPen Directions
- Have Questions About the First Generic Version of EpiPen?
- Are Drug Coupons Behind the Jump in the Cost of an EpiPen?
- Prescribe These Inexpensive Medications for Kids, Not Tho$e
- Food Allergy & Anaphylaxis Emergency Care Plan
- Alert – Epinephrine Shortage Update September 17, 2019
- Epinephrine Options and Training
- Expired Epinephrine Can Still Save Lives
- Public Access to Epinephrine
- Availability of Prescribed Epinephrine Survey
- Impax Generics Epinephrine Injection Auto-Injector Important Safety Information as of June 18, 2018
- FDA Drug Shortages
- FDA – Search List of Extended Use Dates to Assist with Drug Shortages
- FDA – Expiration Dating Extension
- AAP – How to Use an Epinephrine Auto-Injector
- FDA extends some EpiPen expiration dates as shortages continue
- Learn about anaphylaxis and how to use Teva’s Epinephrine Auto-Injector.
- How to use SYMJEPI
- Low-cash-price epinephrine auto-injector available at CVS Pharmacy
- Teva’s generic EpiPen Jr. is about to hit the market for $300
- In Rube Goldberg Price Scheme, EpiPen Competitor Auvi-Q To Be Free For Patients, $4,500 For Their Insurers
- Mylan’s Patient Assistance Program
- Auvi-Q Patient Assistance Program (income less than $100,000)
- AAFA Letter to Secretary Azar for Epinephrine Shortage
- Dear Healthcare Provider Letter for Potential Label Defect of EpiPen Auto-Injectors and its Authorized Generic
- Reminder Advisory – Patient inspection instructions due to potential of particles in Epinephrine Injection auto-injector.
Last Updated on October 20, 2019 by Vincent Iannelli, MD