Frequently asked questions
Frequently asked questions
EpiPen® should be injected at the first sign or symptom of a severe allergic response. Severe allergic reactions are not always predictable. Obvious warning signs are not always present before serious reactions occur.
EpiPen® is recommended at the start of any reaction to a known or suspected allergen contact. For people with a history of a severe cardiovascular collapse on exposure to an allergen, the physician may advise that epinephrine be administered immediately after exposure to that allergen, before any reaction has begun.
EpiPen®, when used as directed immediately following exposure to a known allergen, may prove life-saving.
Call 911 after using EpiPen®.
Using EpiPen® does not replace seeing a doctor or going to the hospital.
Seek medical attention immediately.
The effects of epinephrine can wear off or you could have a second reaction, so call 911, or go to the emergency room right after using EpiPen.
When the dose is delivered and EpiPen® is released from the injection site, the orange needle cover will automatically extend and immediately locks in place.
Give any used EpiPen® Auto-Injectors to emergency responders or emergency room personnel to discard.
These instructions are found on the barrel of EpiPen® as well as in the prescribing information.
It is recommended that you swing your arm to inject EpiPen®. You do not need to apply excessive force to the swing, just enough to gain sufficient momentum to ensure the auto-injector deploys. Swinging your arm helps provide enough load on the tip of the EpiPen® to deliver an intramuscular (IM) injection. Administering EpiPen® in this manner also helps facilitate the ideal angle for the IM injection into the anterolateral aspect of the thigh, which is perpendicular or at 90 degrees to the injection site.
The instructions on the EpiPen® cartridge state you should swing the arm and push the orange tip firmly into the mid-outer thigh so it ‘clicks’ and hold it on the thigh for several seconds. Holding EpiPen® in place at the injection site for several seconds helps to properly deliver the dose of epinephrine.
The extended orange needle cover and obscured window indicates that EpiPen® has delivered the drug.
There is a viewing window on the barrel of EpiPen® which prior to delivery is clear and after delivery is obscured or shaded. Also, once the dose is administered and EpiPen® is released from the injection site, the orange needle cover extends and immediately locks in place encasing the needle to prevent accidental needle sticks. These visual indicators show that the dose of epinephrine has been delivered. Once the orange needle cover is extended, EpiPen® will not fit back into the carrier tube.
Yes. If necessary, you can inject EpiPen® through clothing.
Accidental injection into the hands or feet may result in loss of blood flow to the affected areas and should be avoided. If there is an accidental injection into these areas, go immediately to the nearest emergency room for treatment.
After using EpiPen®, seek medical attention. The used EpiPen® should be taken to the nearest Emergency Room for proper disposal and to show the medical personnel what medication has already been administered.
For an expired EpiPen®, contact your local pharmacy to assist in disposal of the product according to regulations.
If the unit has not been activated, then the safety release can be carefully replaced. Because removing the safety release prepares the unit for activation, you should gently place the unit in its needle-safe storage tube. Make sure the safety release end faces towards the opening and secure the blue safety release in place. Be very careful to keep your fingers clear of each end.
EpiPen® has a built-in needle protection device (orange needle cover). This device automatically extends when the dose is administered and the EpiPen® Auto-Injector is removed from the injection site.
The extended needle protection sheath will prevent the EpiPen® Auto-Injector from fitting back into the carrier tube.
Emergency administration of EpiPen® in the case of a suspected severe allergic reaction does not require certification. The patient’s physician or pharmacist should review the package insert in detail with the patient or caregiver to ensure that he/she understands the indications and use of EpiPen®.
Actual demonstration of the injection technique by a physician or pharmacist is recommended. A training device for patient instruction purposes is also available and can be ordered here
It is important that people at risk of a severe allergic reaction educate others on how to use EpiPen®.
EpiPen® and EpiPen® Jr are designed as emergency supportive therapy only and not as a replacement or substitute for subsequent medical or hospital care. After administration, patients should seek medical attention immediately or go to the emergency room. For the next 48 hours, patients must stay within close proximity to a healthcare facility or where they can call 911.
Dosage in any specific patient should be based on body weight.
- EpiPen®: EpiPen® delivers a dose of 0.3 mg in 0.3 mL of 1:1000 dilution of epinephrine injection, USP. EpiPen® is intended for adults and children who weigh 30 kg or more.
- EpiPen® Jr: EpiPen® Jr delivers a dose of 0.15 mg in 0.3 mL of 1:2000 dilution of epinephrine injection, USP. EpiPen® Jr is intended for children who weigh between 15 kg and 30 kg (33 to 66 lbs).
- Dosing in children <15 kg: Since the dose of epinephrine delivered from EpiPen® Jr is fixed at 0.15 mg, the physician can consider other forms of injectable epinephrine if doses lower than 0.15 mg are felt to be necessary (e.g., for children weighing less than 15 kg).
Dosage adjustments are at the discretion of a healthcare provider.
In most cases, epinephrine is effective after 1 injection. However, symptoms may recur and further injections may be required.
A severe allergic reaction is a serious, acute, allergic reaction that may cause death. It has a sudden onset and generally lasts less than 24 hours. Because a severe allergic reaction is a generalized reaction, a wide variety of clinical signs and symptoms may be observed.
Physicians may determine that a single dose of epinephrine may not be enough to reverse the symptoms of a severe allergic reaction. As such, your healthcare provider may prescribe more than one EpiPen® to have on hand. Epinephrine can be re-injected every 5 to 15 minutes until there is resolution of the severe allergic reaction or signs of adrenaline excess (such as palpitations, tremor, uncomfortable apprehension, and anxiety).
After receiving epinephrine, you must be transported to hospital, for evaluation and a period of observation of no less than 4 hours. This is because of the possibility of either a “biphasic” reaction (a second reaction) or a prolonged reaction. The attending physician will consider such factors as the severity of the reaction, your history and response, and the distance from the hospital to your home.
Severe allergic reactions typically follow a uniphasic course; however, 20% will be biphasic in nature. The second phase usually occurs after an asymptomatic period of 1 to 8 hours, but may occur up to 38 hours (mean 10 hours) after the initial reaction. About 1/3 of the second-phase reactions are more severe, 1/3 are as severe, and 1/3 are less severe. The second-phase reactions can occur even following administration of corticosteroids. After administration, you should seek medical attention immediately or go to the emergency room. For the next 48 hours, you must stay within close proximity to a healthcare facility or where you can call 911.
Protracted anaphylaxis, which is frequently associated with profound hypotension and sometimes lasts longer than 24 hours, is minimally responsive to aggressive therapy, and has a poor prognosis.
Each new EpiPen® should have a minimum of 12 months before expiry. If you have recently bought an EpiPen® or EpiPen® Jr Auto-Injector that has a shorter expiry date, please talk to your pharmacist.
The expiration date is expressed as the month and the last 2 digits of the year. For example, an expiration designation of “Exp: JA 15” indicates that the EpiPen® expires the last day (31st) of January 2015, thus the expiration date in this example would be January 31, 2015.
Further, expiration dates on EpiPen® (Canada) are different than product from the U.S. The Canadian product is designed to be "bilingual friendly", e.g. JA = Jan, JN = June, JL = July, MA = May, MR = March.
We cannot recommend using an expired product. To help ensure your EpiPen® Auto-Injectors are replaced before they expire, you can register here for the Expiration Reminder Service.
It’s important to properly store EpiPen® to help ensure it’s ready to use in the event of a severe allergic reaction.
- Always store EpiPen® in the carrier tube with the safety release on until you need to use it.
- Keep EpiPen® at room temperature. Do not refrigerate.
- EpiPen® can be exposed to temperatures between 15° to 30°C.
- Do not keep EpiPen® in a vehicle during extremely hot or cold weather.
- Protect your EpiPen® from light.
- Submerging EpiPen® in water can compromise the delivery mechanism.
Occasionally look through the viewing window on your EpiPen® to make sure the solution in the auto-injector is not brown, discoloured, cloudy. Replace your EpiPen® if the solution is discoloured or cloudy.
If EpiPen® has not been stored according to the above storage recommendations, using the auto-injector cannot be recommended.
EpiPen® is a medical device that contains glass and should be handled with care.
Discoloured EpiPen® Auto-Injectors should not be used. Discoloration is extremely rare and usually signifies that the drug has come in contact with oxygen, extreme temperatures, light, or some foreign element such as a piece of metal. When EpiPen® discolours, it will turn to a dark coffee color.
If this ever happens, contact your local pharmacy to assist with its proper disposal.
This product contains sodium metabisulphite, a substance that may cause allergic-type reactions including anaphylactic symptoms or mild to severe asthmatic episodes in certain susceptible persons.
Epinephrine is the drug of choice for serious allergic reactions and the presence of a sulphite in this product should not prevent administration of the drug for treatment of serious allergic or other emergency situations, even if the patient is sulphite-sensitive.
No. EpiPen® is latex-free.
In Canada, EpiPen® can be purchased with or without a prescription.
It is recommended to always carry EpiPen® in the plastic carrier tube provided when it is dispensed at the pharmacy. This carrier tube is designed specifically for EpiPen® and protects the device from UVB, accidental discharge and damage. However, EpiPen® will fit in most commercially available carrying cases. Please check with manufacturers for updates.
If travelling by air, always inform security that you are carrying an EpiPen® or EpiPen® Jr Auto-Injector and keep it in your hand luggage. The baggage compartment of the aircraft is not temperature controlled, so temperatures may not be ideal (25ºC/77ºF) or within the permitted range of 15º–30ºC (59º–86ºF).
Be sure to carry your EpiPen® or EpiPen® Jr Auto-Injector in its original carrier tube. You may also require a pharmacy label that includes the name of the person the pen was prescribed for and the name of the prescribing physician.
The following links may offer additional resources and information on severe allergic reactions and treatment for patients with allergies:
- Health Canada
- World Allergy Organization Education in Allergy
- Food Allergy Canada
- Food Allergy and Anaphylaxis Network
- Allergy Safe Communities
- Allergy Asthma Information Association
- Allergy Asthma & Immunology Society of Ontario
- Association Québécoise des Allergies Alimentaires
- L’Association des Allergologues et Immunologues du Québec