Living With Food Allergies

Epinephrine Is the First Line of Treatment for Severe Allergic Reactions (Anaphylaxis)

Epinephrine is the only treatment for a severe allergic reaction known as anaphylaxis (anna-fih-LACK-sis). Epinephrine comes in the form of easy-to-use auto-injectors. It is only available through a prescription by your doctor.

Children or adults who have severe food allergies need two of these auto-injectors with them at all times. For children, this might mean having more than one set of medicine. For example, the child may need to keep one set at school and one set at after-school care. Another set typically remains at home. For adults, two auto-injectors might be enough.

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Epinephrine Auto-Injectors Available With a Prescription in the United States

Epinephrine auto-injectors are the treatment for anaphylaxis. Several epinephrine auto-injectors are now available in the United States. There are also generic versions. Each contains the drug epinephrine. But, each device has its own unique set of instructions for use. Understanding the differences is important so that you get the device you want and you know how to properly use it.

The chart below summarizes the key facts about each of the available epinephrine auto-injectors. More details are available at the manufacturers’ websites. These websites also have patient instructional videos.

Pharmacists must follow state and federal regulations when filling your prescription for epinephrine. You should keep this in mind when filling your prescription.

There are many states in which the pharmacist can substitute a generic form of the prescription. This must be on the prescription in writing. The pharmacist must also get a verbal approval from the doctor. If you or your doctor prefer to receive a specific brand name, your doctor must write the brand name and “DAW” (dispense as written) or “do not substitute” on the prescription. This notation prohibits the pharmacist from dispensing a generic form of the prescription. Before you leave the pharmacy, make sure the pharmacy fills your prescription exactly as you and your child’s doctor expects.

Remember to speak to your child’s doctor to determine which epinephrine product is best for your child. Each device operates differently. Make sure that you have been trained to use the device that you leave the pharmacy with. Also, you should review the training video for that device.

PRODUCT NAME (website)
PRODUCT IMAGE
AUVI-Q®1
auvi-q.com

Training video

UPDATE: The November 2017 update to the AUVI-Q (epinephrine injection, USP) label included a change in hold time from 5 seconds to 2 seconds.

 
Auvi-Q epinephrine auto-injector
Available strengths
Manufacturer
Generic available
Discount program

0.1 mg, 0.15 mg and
0.3 mg
 

kaléo

No
  Eligible patients with commercial insurance can get AUVI-Q through their AUVI-Q Direct Delivery Service. U.S. residents with commercial insurance, including those with high-deductible plans, will be able to obtain AUVI-Q for $0 out-of-pocket. Order directly from Kaléo by giving the enrollment form to your doctor. AUVI-Q is also available free of charge to U.S. residents with a household income of less than $100,000 who do not have government or commercial prescription drug coverage through their kaléo Cares Patient Assistance Program. But patients who qualify for Medicaid may be able to receive AUVI-Q for free. Call 1-877-30-AUVI-Q for questions about eligibility.
Includes trainer
Talking feature
Needle exposed
after injection
Refill reminder feature
 

Yes

Yes

 

No

 

No
 
PRODUCT NAME (website)
PRODUCT IMAGE
EpiPen™ and
EpiPen Jr™2
epipen.com

Training video
EpiPen epinephrine auto-injector
Available strengths
Manufacturer
Generic available
Discount program

0.15 mg and
0.3 mg
 

Mylan Inc.
 

Yes, see below
 

Copay card provides maximum
benefit of $300 per EpiPen®
two-pack and can be redeemed up to six times. The site states the savings card expires Dec. 31, 2018. But according to a Mylan representative, you can still download and use the savings card. If your pharmacy does not accept the card, your pharmacist can call Mylan to confirm at 800-657-7613 (8 am-8 pm EST, Monday-Friday).
 Mylan also has a Patient Assistance Program

Includes trainer
Talking feature
Needle exposed
after injection
Refill reminder feature

Yes
 

 


No

 

No

 
 

Patients can register on the product website for an e-mail reminder when their medicine will expire  

 

PRODUCT NAME (website)
PRODUCT IMAGE
Epinephrine injection, USP auto-injector, authorized generic (AG) for EpiPen®3
my-generic-epinephrine-auto-injector.com/

Training video
EpiPen authorized generic epinephrine auto-injector
Available strengths
Manufacturer
Generic available
Discount program

0.15 mg and
0.3 mg
 

Mylan Inc.
 

**
 

Copay card provides maximum benefit of up to $25 off in savings per two-pack and can be used up to three times. The site states the savings card expires Dec. 31, 2018. But according to a Mylan representative, you can still download and use the savings card. If your pharmacy does not accept the card, your pharmacist can call Mylan to confirm at 800-657-7613 (8 am-8 pm EST, Monday-Friday).

Includes trainer
Talking feature
Needle exposed
after injection
Refill reminder feature

Yes

 

No

 

No

 

Patients can register on the product website for an e-mail reminder when their medicine will expire.

 

PRODUCT NAME (website)
PRODUCT IMAGE
Epinephrine injection, USP auto-injector, generic

tevaepinephrine.com/

Training video
EpiPen authorized generic epinephrine auto-injector
Available strengths
Manufacturer
Generic available
Discount program

0.3 mg
0.15 mg available in 2019
 

Teva Pharmaceutical Industries
 

**
 

Savings card for up to $30 off
a two-pack with
commercial insurance,
maximum of three cartons
per prescription

Includes trainer
Talking feature
Needle exposed
after injection
Refill reminder feature

Yes

 

No

 

Yes

 
 

Yes

 

PRODUCT NAME (website)
PRODUCT IMAGE
Epinephrine injection, USP auto-injector, authorized generic (AG) of Adrenaclick™4
epinephrineautoinject.com

Training video
authorized generic Adrenaclick epinephrine auto-injector
Available strengths
Manufacturer
Generic available
Discount program

0.15 mg and
0.3 mg*
 

Distributed by Lineage Therapeutics
 

**
 

Copay card provides maximum benefit of $25 per two-pack.
 

Includes trainer
Talking feature
Needle exposed
after injection
Refill reminder feature

Training devices are available for free via web or telephone.


No

Yes


No

 *Available as a single injection or a two-pack.

** Epinephrine, USP auto-injector is the authorized generic of Adrenaclick (not currently available).

 

Other Epinephrine Options

There are other options that do not auto-inject the epinephrine. Glass vials of epinephrine with needles/syringes may be in emergency kits as seen on airplanes. There is also a new pre-filled syringe device that you can use to inject epinephrine. This device works differently than the auto-injectors. Be sure to have your doctor, nurse or pharmacist demonstrate how to use your device.

 

PRODUCT NAME (website)
PRODUCT IMAGE
Sympjepi epinephrine auto-injector
Available strengths
Manufacturer
Generic available
Discount program

0.15 mg and 0.3 mg

 

Sandoz Inc., a Novartis Division

No

With insurance, SYMJEPI Savings Program covers up to $300 per prescription, up to $1,000 per year. Eligible patients may pay as little as $0. People without insurance coverage receive $100 off each prescription.
Includes trainer
Talking feature
Needle exposed
after injection
Refill reminder feature
 

N/A

N/A

 

Yes

 

N/A
 

 

Everything You Wanted to Know About Epinephrine

Kids With Food Allergies (KFA), a division of the Asthma and Allergy Foundation of America, hosted a free educational webinar on Feb. 26, 2014, featuring two of our medical advisors, Michael Pistiner, MD, and Angela Nace, PharmD. They discussed:

What If You Can’t Afford Your Epinephrine Auto-Injectors?

Unfortunately, some people cannot afford to buy this potentially life-saving medicine. If this is the case for you, there are options to help. On our blog, we offer up-to-date details about:

  • Savings programs
  • Pharmacy differences
  • Insurance preferences
  • Other sources of assistance

Blog: What to Do If You Can’t Afford Epinephrine
 

Stocking Epinephrine in Schools and Public Places

Up to 25% of severe allergic reactions that occur on school campuses happen to people who are experiencing their very first anaphylaxis reaction. Since these people (children, staff and visitors) have not been previously diagnosed with allergies, they may not have their own epinephrine auto-injectors on hand. Most states have passed legislation to allow schools to stock undesignated epinephrine as a part of their emergency medical kits. This allows specified staff to treat someone suffering anaphylaxis, even for their very first allergic reaction. Many states are looking beyond the classroom to other areas where food allergy triggers could be present. In any public space where food is present – such as sports and recreation venues, summer camps, amusement parks, movie theaters – there is a risk for an allergic person to come in contact with their allergen. To find out the status of epinephrine laws in your state, visit www.aafa.org/epinephrine.

Strides for safe kids
Children show their support for Pennsylvania’s epinephrine stocking bill.

 

Related Epinephrine Resources

 

REFERENCES
1. Product information for AUVI-Q. kaléo, Richmond, VA 23219. July 2019.
2. Product information for EpiPen. Mylan Inc. Basking Ridge, NJ 07920. July 2019.
3. Epinephrine Injection, USP auto-injector, the authorized generic (AG) of EpiPen®, Mylan Inc. Basking Ridge, NJ 07920. July 2019.
4. Product information for Epinephrine Injection, USP auto­injector, the authorized generic (AG) of Adrenaclick™. Lineage Therapeutics. Horsham, PA 19044. July 2019..

Medical review February 2014, June 2014, January 2015. Updated January 2016, August 2016, December 2016, January 2017, February 2017 and July 2019.