Everything you need to know about using an EpiPen

An anaphylactic allergy can turn the most mundane tasks into stressful situations. An otherwise fun hike can require careful planning and precautions if you’re allergic to wasp or bee stings; eating meals prepared by others can be stressful if you’re severely allergic to peanuts, milk, or any other food. For people with anaphylactic allergies, an epinephrine injection—like the popular brand EpiPen auto-injector, is a life-saving and necessary prescription drug that should be carried at all times.

More than 50 million Americans suffer from allergies each year—a truly staggering number. May is Allergy Awareness Month, and according to the Centers for Disease Control and Prevention (CDC), allergies are the sixth leading cause of chronic illness in the United States. There are many different types of allergies, some more severe than others, but an allergy that results in an anaphylactic reaction requires immediate medical attention.

A study conducted by the Asthma and Allergy Foundation of America found that anaphylaxis reactions occur in at least 1 in 50 Americans, but the report goes on to clarify that the prevalence is likely closer to 1 in 20 Americans, due to low reporting and low education on what an anaphylactic reaction really is. A severe allergic reaction, known as an anaphylactic reaction, can be life-threatening. Signs include hives, tightness or swelling in the throat, difficulty breathing, loss of consciousness, or any other allergy-related symptoms.

What is an EpiPen used for?

Dr. Monya De, an internal medicine physician in Los Angeles, advises that anyone who has had an anaphylaxis reaction, or alarm symptoms, should carry an EpiPen with them. An EpiPen delivers the life-saving drug epinephrine through auto-injection. Alarm symptoms indicating you should use the injector, Dr. De says, include throat closing, lips swelling, difficulty breathing, and/or an immediate rash upon contact with the allergen. 

Note: Epinephrine is the first line of defense against serious allergic reactions after exposure to an allergy trigger. Antihistamines should only be used to ease mild allergy symptoms, like sneezing. Antihistamines, like Benadryl, are not sufficient to stop or treat anaphylaxis. 

How much does an EpiPen cost?

EpiPen—manufactured by Mylan—is the most widely known brand of epinephrine auto-injectors, but there are other brand names approved by the Food and Drug Administration (FDA), including Symjepi, Adrenaclick, AUVI-Q, and more. EpiPen prices are high. A two-pack can cost upward of $600. Authorized generic versions of epinephrine, which are manufactured by Mylan, Teva, and Impax, are cheaper alternatives to the brand-name auto-injectors, though they may still be somewhat expensive.

EpiPen Jr is also available for children who require a lower dose of epinephrine. EpiPen Jr contains 0.15 mg and is approved for use in people who are 33 to 66 pounds. EpiPen contains 0.3 mg and is used in people who weigh more than 66 pounds.

Keeping multiple epinephrine auto-injectors is also advised. Both generic EpiPen and EpiPen 2-Pak are sold as two units per package.

“[People with allergies] should have at least two, one to be carried with them at all times and one at work,” says Dr. Susan L. Besser, a primary care physician at Mercy Medical Center in Baltimore. “It would be good if they also had a third one at home.”

Dr. Besser also suggests that if you have severe allergies, that you let someone at work and home know where your EpiPen is located, “just in case the person is too incapacitated to use it themselves,” she adds. 

What happens if you use an expired EpiPen?

Just having EpiPens isn’t enough: You must always make sure that your EpiPens aren’t expired, and refill them in time so you’re never caught in an emergency situation without an effective EpiPen. Dr. De recommends that you refill your prescription several weeks before the expiration date listed on the EpiPen, and stagger your pick-up times so that your EpiPens don’t expire all at once. 

In the case where there’s an EpiPen shortage (which has been known to happen), or you’re unable to get a new EpiPen in time, Dr. Besser says you can continue to use the expired EpiPen. “According to the CDC and other experts, the Epipen is ‘good’ for six months to a year after the expiry date,” she explains.

How does an EpiPen work?

The middle of the outer thigh is the ideal injection site. EpiPen can be used through clothing if necessary. You should push the auto-injector until it clicks. Then, hold it in place for three seconds. Do not administer an epinephrine injection in hands or feet as it could result in decreased blood flow.

EpiPen packaging now contains straightforward instructions for using the auto-injector, but it’s still a good idea to review the instructions, and have close friends, family, and co-workers review it, too. If you’re unsure how to use an EpiPen, ask a healthcare professional—such as your doctor or a pharmacist—for medical advice specific to your needs. There are also EpiPen training pens available for purchase; they contain no medication or needle, but simulate the auto-injector and allow for greater preparation.

EpiPens are life-saving devices, but they don’t negate the fact that a serious allergic reaction is an emergency situation that requires immediate medical help. You will need to visit the ER if you come in contact with your allergen. 

“Use the EpiPen at first sign of an allergic reaction,” Dr. Besser instructs. “Once it has been administered … go directly to the ER. The medication in the EpiPen may wear off causing the reaction to begin again so being in an environment where the patient can get medical support is critical.”

EpiPen side effects

EpiPens aren’t without their side effects. Epinephrine is adrenalin, so you could experience a sense of nervousness, fearfulness, or anxiety along with a racing heart or tremors. Weakness, dizziness, headaches, nausea, and vomiting are also possible side effects. 

An overdose of epinephrine can be fatal. Epinephrine raises blood pressure and can cause heart arrhythmias, strokes, and heart attacks. After using an EpiPen, it’s best to find yourself in the company of healthcare professionals who can provide emergency treatment.                                                                                                   

And it probably goes without saying, but, Dr. De gives one final word of advice: “Don’t let anyone inject you in the heart like in Pulp Fiction, please.”