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Attribution: Jfoldmei
per Creative Commons Attribution-Share
Alike 3.0 Unported license.
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Disclaimer:
I’m not a doctor. Please use the following blog post for informational purposes
only and not as medical advice. Any questions or concerns should be directed to
your doctor or other appropriate medical professional.
Epinephrine
autoinjectors (sometimes referred to as the brand name, EpiPen) aren’t the
typical outdoor gadget, but for some with severe allergies, it might be the
single most important thing they take with them when they head to the outdoors
or leave the house (well, except for maybe their keys and phone).
I’ve recently taken a
fascination with these marvels of engineering and I want to take this opportunity
to provide a brief overview of epinephrine autoinjectors for those who might be
confused, curious or seeking more information about something they have to
carry everywhere they go.
What’s
an Epinephrine Autoinjector?
An epinephrine
autoinjector is a unique type of syringe that automatically injects epinephrine
into an individual. Unlike a regular syringe, autoinjectors are special because
they already have a preloaded dose of medication and contain an internal
mechanism that allow the user to inject the medication without having to see
the needle or press down on a plunger.
In the United States,
epinephrine autoinjectors usually come in two doses: 0.3 mg for adults (or
anyone who weighs 66 pounds or more) and 0.15 mg for children (or anyone weighing
between 33 and 66 pounds). There’s also a 0.1 mg dose for infants and toddlers
(or anyone weighting between 16.5 and 33 pounds), but it’s not as common.
Why
Do We Have Epinephrine Autoinjectors?
The primary purpose of
epinephrine autoinjectors is to deliver an emergency injection of epinephrine
(also known as adrenaline) to an individual suffering a severe allergic
reaction, specifically anaphylaxis. Anaphylaxis has a variety of symptoms, but
the most serious include swelling of the throat, fainting and trouble
breathing. In rare cases of anaphylaxis, death can occur.
For more information
about anaphylaxis, I encourage you to check out the following online resources:
https://www.webmd.com/allergies/anaphylaxis#1
https://www.foodallergy.org/life-with-food-allergies/anaphylaxis
Types
of Epinephrine Autoinjectors Available
A few years ago, there
was pretty much just one option for anyone looking for an epinephrine
autoinjector: the EpiPen. Now, there are many more options, most of which are cheaper.
I’ll go over most of the epinephrine autoinjector options available (or soon to
be available) in the United States.
Amedra Pharmaceutical’s
Adrenaclick
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Caption: Adrenaclick
with 0.15 mg dose
Attribution: https://www.cnbc.com/2017/04/25/kmart-pharmacy-sharply-cuts-price-of-adrenaclick-competitor-to-epipen-anti-allergy-device.html
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To be honest, I don’t
think this is still available for sale in the United States and if so, I don’t
know how easy it will be to obtain. But I still want to mention it because it’s
closely related to a current and past version of an epinephrine autoinjector.
The past version is the
Twinject. I don’t know the exact relationship between the Twinject and the
Adrenaclick, but they are based on very similar designs. What made the Twinject
special was that it has an internal syringe could be removed to provide a
second dose of epinephrine if necessary.
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Caption: Twinject,
“adult” version with the 0.3 mg dose.
Attribution: http://dxline.org/drug/medicament/23830/
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The current version of
the Adrenaclick is its generic equivalent. Who makes it is a bit confusing, but
I think it’s either Impax, Lineage or Amneal. My understanding is that Impax
acquired the rights to Adrenaclick and then merged with Amneal. And Lineage is
(was) a whole-owned subsidiary of Impax. You can see what it looks like below:
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Caption: Generic version
of the Adrenaclick in both the 0.15 mg and 0.3 mg doses
Attribution: https://epinephrineautoinject.com/
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With some MacGyver-ing,
you can get a second dose of epinephrine relatively easily from the generic
version of the Adrenaclick (and the EpiPen). Just keep in mind this is an
improper (and possibly illegal? I don’t know) use of this medication. But in an
extreme emergency where medical care is hours or days away and a second
injection is needed, it’s an option.
Mylan’s EpiPen
Just to set the record
straight or clear up any confusion, “EpiPen” is the brand name of a particular
type of epinephrine autoinjector. Specifically it’s the epinephrine
autoinjector made by Mylan. Many people, including doctors, will use the term
EpiPen to reference any epinephrine autoinjector.
If the name and device
sounds or looks familiar, it’s because they got a lot of bad press recently
about price hikes on the EpiPen when there was no alternative available and
many customers felt like they were being price gouged. Whether Mylan was acting
unethically or were just acting as a business savvy company, I’ll leave it up
to you to research and decide on your own.
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Caption: The older
version of the EpiPen. Its overall design might look familiar to those who have
served our country in the Armed Forces.
Attribution: Sean
William per Creative Commons Attribution-Share
Alike 3.0 Unported license.
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Caption: Current version
of the EpiPen, 0.3mg dose
Attribution: Author’s
own work
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The EpiPen probably has
the largest share of the epinephrine autoinjector market, thanks to the efforts
of Mylan. If you know someone who carries an epinephrine autoinjector, chances
are pretty good they’re carrying the EpiPen. There are also more accessories
specifically designed for the EpiPen, such as smart cases that link to a
smartphone and provide a host of features such as notification of activation.
Mylan’s Authorized
Generic Version of the EpiPen
Mylan now has an
authorized generic version of the EpiPen. It’s exactly like the EpiPen except
for the sticker/label put on the epinephrine autoinjector. According to the
FDA, an authorized generic is EXACTLY like the brand name version, except the
brand name doesn’t show up on the products label. You can see the below
pictures to see how similar they look to the actual EpiPen:
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Caption: Authorized
generic versions of the EpiPen, 0.3mg (yellow) and 0.15mg (green) doses
Attribution: http://newsroom.mylan.com/2016-12-16-Mylan-Launches-the-First-Generic-for-EpiPen-epinephrine-injection-USP-Auto-Injector-as-an-Authorized-Generic
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One feature of the
EpiPen is that after injection, the orange plastic tip will protrude from the
bottom of the EpiPen so the needle is covered and not exposed to the user or
anyone else.
Sanofi’s AUVI-Q
The AUVI-Q is the new
kid on the autoinjector block, although it’s been on the market (off and on)
for the past few years. It has three features that separates it from other
epinephrine autoinjectors. First, it’s shaped like a really, really thick
credit card. This shape can make it easier to carry around for some users.
Second, it talks and
provides step-by-step prompts and information to users. According to Sanofi,
the AUVI-Q has a higher percentage of successful use when users have little to
no training. Basically, it’s a square shaped epinephrine autoinjector with a
built in speaker.
Third, it comes in a 0.1
mg dose for infants and toddlers. Most of you reading this probably won’t need
a dose this small, but it’s available for the small minority who might have a
small one with a documented severe allergy.
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Caption: Auvi-Q, the
“talking” autoinjector in the 3 doses it’s offered in
Attribution: https://www.auvi-q.com/about-auvi-q
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Teva’s Generic Version
of the EpiPen
At the time of writing,
this may have only been on the market for a few weeks. It’s similar to the
EpiPen in overall appearance and function, but there are two main differences.
First, it doesn’t come
with a case. Instead, it has a cap covering the part where the needle comes out.
Second, the blue safety release comes off in a slightly different manner.
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Caption: Teva’s generic
version of the EpiPen in both the 0.3mg and 0.15mg versions
Attribution: https://www.tevaepinephrine.com/howtouse
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Adamis
Pharmaceutical’s SYMJEPI
I believe this one still
hasn’t reached pharmacy shelves, but it’s really close from my understanding.
Its main selling point is supposed to be its lower price than most epinephrine
autoinjectors. The main reason for this is probably that it’s not really an
autoinjector, but rather, a preloaded syringe.
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Caption: The Symjepi
(Note: may not be a picture of the final product)
Attribution: https://snacksafely.com/2018/10/additional-symjepi-dosage-strength-approved-for-anaphylaxis-treatment/
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To learn more about
these various types of epinephrine autoinjectors, I recommended you check out
Dr. Julie Brown’s Youtube page. She posts many videos showing most of these
autoinjectors in action and other useful and interesting information relating
to them.
Which
One to Use?
That’s not an easy
question to answer. Each one has its advantages and disadvantages, but what’s
an advantage to one user may not be an advantage for another user.
For example, buying
Teva’s EpiPen generic will save money, but for those who have hit their
out-of-pocket limit on their health insurance, that feature won’t matter.
Instead, they may still want the brand name EpiPen due to its familiarity to
the general public and the greater number of accessories available (such as
special cases). And when cost is a serious concern (such as those without
insurance), the SYMJEPI might be the best option. However, it will not be an
autoinjector and for those with a fear of needles or who might need others to
assist in the injection, this could be a deal breaker.
As another example, if a
young child has to carry an epinephrine autoinjector, the AUVI-Q might be the
best one to use because of the high probability a teacher, childcare provider
or complete stranger may be the one who will actually provide the epinephrine
injection. The talking instructions could be crucial to an untrained
individual.
Then there’s the
availability of certain devices. Some pharmacies may have one version, but not
the other. Anyone who needs to carry an epinephrine autoinjector should
probably talk with their doctor and discuss their options. Some of these might
be available directly from the pharmaceutical company for those who don’t have
a nearby pharmacy that carries it.
Bottom
Line
This blog post wasn’t
intended (nor should it be interpreted) to provide a recommendation as to which
epinephrine autoinjector to use. Rather, it hopefully provides more information
so individuals can ask more informed question to their medical care providers.
