Epinephrine (ep-i-NEF-rin)

Treats severe allergic reactions (including anaphylaxis) in an emergency situation. Also increases blood pressure in patients with septic shock.

Brand Name(s):

Adrenaclick, Adrenalin, Adrenalin Novaplus, Auvi-Q, EpiPen, EpiPen Auto-Injector, EpiPen Jr Auto-Injector, Epipen Jr 2-Pak Auto-Injector, PremierPro Rx Adrenalin, Symjepi

When This Medicine Should Not Be Used:

How to Use This Medicine:

Injectable

• For treatment of low blood pressure with septic shock: A nurse or other trained health professional will give you this medicine in a medical facility. It is given through a needle placed into one of your veins.
• Your doctor should teach you how and when to inject this medicine. Each injection kit contains a single-use dose of medicine prescribed for you.
• Give yourself a shot right away if you start to have a severe allergic reaction.
• Inject this medicine under the skin or into the muscle on the outside of your thigh only. Never inject this medicine into a vein, into the muscles of your buttocks, or into your fingers, toes, hands, or feet.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• This medicine might come with an autoinjector trainer so you can practice giving the medicine before you have an actual allergic reaction. The autoinjector trainer is gray (for EpiPen® or EpiPen Jr®) or beige (for Adrenaclick®) and does not contain any medicine or needle.
• Inspect the autoinjector from time to time before needing it to ensure the blue safety release (EpiPen® or EpiPen Jr®) is not raised and that the autoinjector can be easily remove from the carrier tube.
• Do not remove the blue safety release (EpiPen® or EpiPen Jr®) or the gray end caps (Adrenaclick®) on the autoinjector until you are ready to use it. Do not put your thumb, fingers, or hand over the orange (EpiPen® or EpiPen Jr®) or red (Adrenaclick®) tip of the autoinjector or over the needle of the Symjepi™ prefilled syringe.
• If you are about to use the autoinjector, pull up straight the blue safety release (EpiPen® or EpiPen Jr®) with one hand and hold the pen with the other hand. Do not flip the blue safety release off using the thumb or by pulling it sideways, or by bending and twisting it. This may activate the device by accident (a "click" is heard, the orange needle is extended, and the window is blocked), making it unusable in case of an emergency. Push the needle end (orange end of the autoinjector) firmly against the outer thigh until it "clicks". This signals that the injection has started. The autoinjector needs to stay in place for a minimum of 3 seconds following activation.
• If you use the Symjepi™ prefilled syringe, do not remove the needle cap until you are ready to use it.
• You may need to use more than one injection if your allergic reaction does not get better after the first shot. Your doctor will give you additional doses if you need more than 2 injections. If you are using Adrenalin®, you may inject every 5 to 10 minutes as needed.
• You may inject the medicine through your clothing, if you need to.
• Some liquid will remain in the autoinjector or vial after the medicine has been injected. This medicine cannot be reused. Give your used autoinjector or vial to your healthcare provider when you seek medical care.
• Carry this medicine with you at all times for emergency use in case you have a severe allergic reaction.
• Make sure family members or other people you are with know how to inject the medicine in case you are not able to do it yourself.
• Check your injection kits regularly to make sure the liquid has not changed color. It should be clear and colorless. Do not use the autoinjector, prefilled syringe, or vial if the liquid is discolored or cloudy, or if there are particles in it. You should not use the autoinjector or vial if the expiration date has passed.
• If you are using the epinephrine injection in a child, make sure to hold his leg firmly in place and limit movement before and during an injection.
• Store the injection kit at room temperature, away from heat, moisture, and direct light. Do not store the medicine in the refrigerator or freezer, or inside a car.
• Keep the autoinjector and prefilled syringe in its carrier tube or case to protect it from damage. This tube or case is not waterproof. If you accidentally drop it, check for damage or leaks.
• Throw away expired, unwanted, or unused EpiPen® or EpiPen Jr® in an FDA-cleared sharps container. Do not throw it away in the trash bin.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some foods and medicines can affect how epinephrine works. Tell your doctor if you are using any of the following:
  • Clonidine, digoxin, doxapram, levothyroxine, oxytocin, phentolamine, theophylline
  • Blood pressure medicine (including propranolol)
  • Certain allergy medicines (including chlorpheniramine, diphenhydramine, tripelennamine)
  • Diuretic (water pill)
  • Ergot medicines
  • Medicine for heart rhythm problems
  • Medicine to treat depression (including MAO inhibitors, TCAs)
  • Nitrate medicine
  • Steroid medicine
  • Thyroid medicine

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, heart disease, asthma, diabetes, heart rhythm problems, high blood pressure, an overactive thyroid, or Parkinson disease.
• This medicine may cause the following problems:
  • Serious skin infections at the injection site (including necrotizing fasciitis, myonecrosis)
  • High blood pressure
  • Pulmonary edema (fluid in the lungs)
  • Kidney problems
  • Heart and heart rhythm problems
  • High blood sugar
• A severe allergic reaction is a medical emergency. Go to an emergency room as soon as possible, even if you feel better after you use this medicine.
• Do not inject this medicine into your buttocks, hands, fingers, toes, or feet. Go to the emergency room right away if you accidently inject epinephrine into any part of your body other than your thigh. Epinephrine reduces blood flow, and this could damage areas that have small blood vessels, including the hands and feet.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Chest pain, trouble breathing, blue lips and fingernails, swelling in the legs or ankles
• Decrease in how much or how often you urinate, bloody urine
• Dizziness, lightheadedness, or fainting
• Fast, pounding, or uneven heartbeat
• Heavy sweating, nausea, vomiting
• Persistent pain, redness, swelling, tenderness, or warmth at the injection site
• Tremors, shakiness

If you notice these less serious side effects, talk with your doctor:

• Feeling anxious, nervous, scared, or weak
• Headache
• Pale skin

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088