Epinephrine Injection (patient information)

Why this medication is prescribed

Epinephrine injection is used to treat life-threatening allergic reactions caused by insect bites, foods, medications, latex, and other causes. Symptoms of allergic reaction include wheezing, shortness of breath, low blood pressure, hives, itching, swelling, stomach cramps, diarrhea, and loss of bladder control. Epinephrine is in a class of medications called sympathomimetic agents. It works by relaxing the muscles in the airways and tightening the blood vessels.

How this medication should be used

Epinephrine injection comes as a single-dose pre-filled automatic injection device to be injected into the thigh. You should only use it when you are experiencing or are likely to begin experiencing a serious allergic reaction. Talk to your doctor about substances that may cause serious allergic reactions and symptoms of these reactions.

Under certain conditions, you may need more than one epinephrine injection to treat an allergic reaction. Your doctor will tell you if and when you should use a second dose. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Use epinephrine injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

To use the automatic injection device, follow these steps:

• Hold the device firmly in your fist with the black tip pointing down. Do not touch the black tip; hold only the cylinder.
• Remove the gray activation cap.
• Move your hand so the black tip is near your outer thigh.
• Swing your hand away from your body, then jab the black tip firmly into your outer thigh at a 90-degree angle. You may inject the needle through clothing that is covering your thigh.
• Keep the device firmly in this position for several seconds.
• Remove the device from your thigh and rub the area with your fingers.
• Look at the black tip to see if the needle is showing. If the needle is not showing, repeat steps 3-6.
• If the needle is showing, you have received the full dose of epinephrine. You will notice that most of the liquid remains in the device. This is extra liquid that cannot be used.
• Press the needle against a hard surface.
• Replace the device in the carrying tube (without the activation cap) and cover with the cap.

After you use the automatic injection device, follow these steps:

• If you were stung by an insect, try to remove the stinger with your fingernails. Be careful not to push the stinger deeper into the skin and not to pinch or squeeze the area. If you can, put ice and/or baking soda soaks on the area.
• Go to the nearest hospital emergency room right away. Take the used injection device with you. *Tell the doctor that you have used the device and give it to him for disposal.
• Rest and avoid physical activity as directed by your doctor.

Handle the automatic injection device carefully to avoid accidentally injecting the epinephrine into your hands. If you do accidentally inject the epinephrine into any part of your body except your thigh, go to the nearest emergency room right away.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Special precautions

Before using epinephrine injection:

• tell your doctor or pharmacist if you are allergic to epinephrine, sulfites, or any other medications. Your doctor may tell you to use epinephrine injection even if you are allergic to one of the ingredients because it is a life-saving medication. The epinephrine automatic injection device does not contain latex and is safe to use if you have a latex allergy.
• tell your doctor or pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); digoxin (Digitek, Lanoxicaps, Lanoxin); and quinidine (Quinidex). Also tell your doctor if you are taking a monoamine oxidase inhibitor such as phenelzine (Nardil) or tranylcypromine (Parnate) or have stopped taking it within the past two weeks. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had chest pain or a heart attack, irregular heart beat, diabetes, high blood pressure, or an overactive thyroid gland (hyperthyroidism).
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking epinephrine injection, call your doctor.

Special dietary instructions

Unless your doctor tells you otherwise, continue your normal diet.

Side Effects

Minor Side Effects

Epinephrine injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• vomiting
• sweating
• dizziness
• nervousness
• weakness
• pale skin
• headache
• shaking hands that you cannot control

Severe Side Effects

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• difficulty breathing
• pounding, fast, or irregular heartbeat

Epinephrine injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storage conditions needed for this medication

Keep this medication in the plastic carrying tube it came in, tightly closed, and out of reach of children. Store it in a dark place at room temperature and away from excess heat and moisture (not in the bathroom). Pay attention to the expiration date of your automatic injection device, and be sure to always have an unexpired device available. Look at the liquid in the clear window of the device from time to time. Throw away the device if the liquid has changed color, is cloudy, or contains solid pieces, or if the expiration date has passed. Talk to your pharmacist about the proper disposal of your medication.

If you are experiencing an allergic emergency and the liquid in your device is discolored or otherwise appears abnormal, consult your doctor. He may tell you to use the device if you cannot get a fresh one quickly.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Other information

Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

Brand names

• Adrenalin® Chloride Solution
• EpiPen® Auto-Injector
• EpiPen® Jr. Auto-Injector