Can’t find an Epipen? Here’s what to do

Millions of families rely on having an epinephrine autoinjector available for their child. Epinephrine is the only effective treatment for a severe allergic reaction known as anaphylaxis. Anaphylaxis can occur from food allergies, venom allergies, and medication allergies. Children can experience rapid onset hives, swelling, difficulty breathing, and vomiting, and rare cases can result in death.

Epinephrine not only treats all symptoms associated with anaphylaxis, but can prevent the reaction from progressing. Anyone who is at risk for anaphylaxis should have their own prescription epinephrine autoinjector immediately available at all times in case a reaction occurs. The one factor associated with almost all cases of severe anaphylaxis is lack of timely administration of epinephrine, which works best when used promptly as soon as anaphylaxis is recognized. Waiting for emergency personnel to arrive with this potentially life-saving treatment will result in unnecessary delay and potential for more severe reactions.

Unfortunately, epinephrine autoinjectors typically expire within one year of the prescription being filled. Prescriptions must be refilled each year, and it is strongly recommended that devices not only be available at home but also given to schools, daycares, and other childcare providers. It is also advised that two autoinjectors be available at all times, as a subset of people who have anaphylaxis require a second dose to treat their symptoms. Thus, most families need at least two, and often four or more devices.

A recent dramatic price increase for the most popular brand of epinephrine autoinjector, Epipen and Epipen Jr., has made the headlines over the past couple of years. When not covered by insurance, the $600 retail price is cost-prohibitive for most families, and the generic Epipen can cost $300. In May 2018, Mylan, the manufacturer of Epipen and Epipen Jr devices, announced intermittent supply constraints due to manufacturing delays. This shortage of Epipen devices is really being felt by families now that the new school year has started and children need to refill their prescriptions.

What options do parents have? First, it is important to understand that there is no shortage of epinephrine, but only of specific devices. Here are some tips to help navigate:

• Different Devices: If Epipen is unavailable, ask the pharmacy or your doctor about the two other available devices, AuviQ and Adrenaclick, and if they can be substituted. These may be suitable options and more widely available. AuviQ even has a program to mail two free devices directly to patients. This may require a different prescription from your doctor. It is important to understand that each device has a different technique, which should be practiced with a training device at the pharmacy or physician’s office.
• Regional Availability: Epipen availability varies by supplier and pharmacy. It may be worth calling a few different pharmacies in your area to ask about their supply.
• Epinephrine Viability: Having an up-to-date, non-expired epinephrine autoinjector is always the preferred route. However, studies have demonstrated that the medication remains viable for months after the printed expiration date. If an outdated epinephrine autoinjector is the only treatment option available when someone is having acute anaphylaxis, then the device should still be used as it will likely provide benefit and will not cause any harm. 911 should always be called regardless, but particularly if an expired device is used.
• Limited Distribution: Some families have eight or more epinephrine autoinjector prescriptions filled each year to make sure they have ample supply at home, school, camp, relative’s homes, and with various caregivers. Many of those same families never use any of those devices but have them “just in case.” During times of limited availability, a change in the accustomed routine may be necessary. Instead of asking for eight different devices, a new system could be implemented that helps ensure one or two devices travel everywhere the child goes.

While limited availability of a potentially life-saving medication can understandably raise anxiety levels of parents, it helps to know that options are available. As always, contact your personal doctor to determine the best approach pertaining to your individual circumstances.