EPIPEN ADULT 0.3MG INJECTION Adult

EPIPEN Adult contains adrenaline (epinephrine) 0.3 mg in a pre-filled auto-injector device. Adrenaline is a naturally occurring catecholamine that stimulates alpha- and beta-adrenergic receptors throughout the body.

In anaphylaxis, it counteracts the life-threatening cardiovascular and respiratory effects of massive mast cell degranulation: constricting blood vessels (raises blood pressure), relaxing bronchial smooth muscle (relieves bronchospasm), and increasing heart rate and contractility.

EPIPEN Adult is the first-line emergency treatment for severe anaphylaxis (Type I hypersensitivity reaction) in adults and children weighing 30 kg or more.

Anaphylaxis is defined by the rapid onset of life-threatening airway, breathing, or circulatory problems, usually accompanied by skin changes. Common triggers include insect stings, food allergens (nuts, shellfish), drugs (penicillin, aspirin, contrast media), and latex.

EPIPEN Adult delivers a fixed dose of 0.3 mg adrenaline into the outer thigh muscle (vastus lateralis). It is a rescue device designed for use by the patient themselves, a carer, or a bystander as immediate first aid while awaiting emergency services.

It can also be used for acute severe asthma, cardiac arrest, hypotension or shock and to provide inotropic support.

EPIPEN is for intramuscular (IM) injection into the outer mid-thigh only. It can be given through clothing if necessary. Use only when anaphylaxis is suspected — do not wait for symptoms to worsen.

How to Use the EPIPEN Auto-injector

•       Step 1: Remove the EPIPEN from its carrier tube. Hold firmly in your dominant hand with the orange tip pointing downwards.

•       Step 2: With the other hand, pull off the blue safety cap (pull straight up, do not bend or twist).

•       Step 3: Swing and push the orange tip firmly against the outer mid-thigh (at a 90-degree angle) until you hear or feel a click.

•       Step 4: Hold firmly in place for 3 seconds, then remove.

•       Step 5: Massage the injection area for 10 seconds.

•       Step 6: Note the time of injection. Call emergency services (999 or local equivalent) immediately.

•       If symptoms do not improve or worsen after 5–15 minutes, use a second EPIPEN if available.

After Injection

All patients who use an EpiPen must be taken to the hospital immediately for observation for at least 4–6 hours, as anaphylaxis can have a biphasic reaction (a second wave of symptoms hours later). Bring the used auto-injector to the hospital as evidence of the dose given.

Effects of Adrenaline (Therapeutic and Adverse)

•       Rapid heartbeat (tachycardia), palpitations — expected pharmacological effect.

•       Pallor, tremor, anxiety — adrenergic stimulation.

•       Headache, dizziness.

•       Nausea, vomiting.

•       Hypertension — can be severe in patients with pre-existing hypertension or those on MAOIs.

Local Reactions

•       Pain, bruising, swelling at injection site.

•       Accidental injection into a finger or hand — causes intense vasoconstriction and ischaemia; requires emergency treatment with phentolamine.

Serious Adverse Effects (Rare at Therapeutic Dose)

•       Cardiac arrhythmias — particularly in patients with underlying heart disease.

•       Angina or myocardial infarction — in those with coronary artery disease.

•       Pulmonary oedema.

No Absolute Contraindications in Anaphylaxis

Adrenaline must be given in all cases of genuine anaphylaxis regardless of patient comorbidities (heart disease, hypertension, pregnancy, age). The risk of withholding adrenaline in anaphylaxis is death. Relative cautions (e.g., cardiac disease) affect post-treatment monitoring intensity, not the decision to give the drug.

Accidental Injection

If EPIPEN is accidentally injected into a finger, hand, or foot, the intense alpha-vasoconstriction causes blanching and ischaemia. The affected extremity must be treated with local infiltration of phentolamine 5–10 mg in saline in an emergency department. Keep the affected part warm to encourage circulation. Do not rub vigorously.

Device Maintenance

Inspect the EPIPEN regularly through the viewing window — the solution should be clear and colourless. Discard and replace if discoloured, cloudy, or if the expiry date has passed. Carry two EPIPENs at all times — severe reactions may require a second dose. Store away from heat, direct sunlight, and cold.

•       MAOIs (phenelzine, tranylcypromine) — dangerously potentiate the hypertensive and tachycardic effects of adrenaline; in true anaphylaxis, still give adrenaline, but be prepared to treat severe hypertension.

•       Non-selective beta-blockers (propranolol) — may blunt the cardiac beta-2 effects of adrenaline; higher doses of adrenaline may be required; risk of paradoxical severe hypertension from unopposed alpha-adrenergic effect.

•       Tricyclic antidepressants — may enhance the cardiovascular effects of adrenaline.

•       Digoxin, volatile halogenated anaesthetics — increased risk of cardiac arrhythmias.

•       Store below 25 degrees Celsius. Do not refrigerate or freeze.

•       Do not expose to light — keep in the original carrying tube.

•       Do not store in the car glove compartment or leave in direct sunlight — heat degrades adrenaline.

•       Regularly check the expiry date and solution clarity through the viewing window.

•       Replace immediately upon use or expiry.

•       Keep out of reach of children — accidental injection causes serious vasoconstriction.

EPIPEN Adult is a prescription-only medicine (POM) in Kenya, prescribed by allergists, immunologists, emergency physicians, or general practitioners following diagnosis of severe allergy or anaphylaxis risk.

Patients with a known risk of anaphylaxis should always carry two EPIPENs with them and have a written anaphylaxis action plan from their doctor.

Prescribing and Anaphylaxis Action Plan

Always prescribe EPIPEN in pairs (two auto-injectors per prescription). Provide a personalised written anaphylaxis action plan at each prescription. The plan should include: recognised triggers, early warning signs, when to use EpiPen, post-injection instructions, emergency contact numbers.

Patient and Carer Training

Demonstrate correct EpiPen use at every dispensing event using the trainer device (orange tip, no needle). Confirm patient and carer competence. Key points: outer thigh only, 90-degree angle, click confirmation, hold 3 seconds, then call 999/emergency services.

Indications for Immediate Specialist Referral

Refer all patients post-anaphylaxis to a specialist allergist for: allergy testing to identify triggers; desensitisation immunotherapy (where available and indicated); and comprehensive anaphylaxis management planning. Do not delay EpiPen prescribing pending a specialist appointment.

How do I know when to use the EpiPen?

Use the EpiPen immediately if you experience signs of anaphylaxis: severe difficulty breathing, significant swelling of the throat or tongue, a sudden severe drop in blood pressure causing dizziness or collapse, or a combination of skin reactions (widespread hives, swelling) plus breathing difficulty or low blood pressure after exposure to a known allergen. Do not wait — acting quickly saves lives.

What should I do after I have used the EpiPen?

After using the EpiPen, call emergency services (999 or local equivalent) immediately, even if you start to feel better. Lie down with your legs raised (unless breathing difficulty makes this worse). If you have a second EpiPen and symptoms return or do not improve after 5–15 minutes, use the second device. Always go to the hospital after anaphylaxis — a second wave of symptoms (biphasic reaction) can occur hours later.

Can I use my EpiPen through my clothing?

Yes — in an emergency, the EpiPen can be used through one layer of clothing into the outer thigh. This is useful if accessing the bare skin quickly is not possible. The needle is long enough to reach the muscle through standard clothing thickness.