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Medicine Informations

 

What is Epipen and what its used for? 

Adrenaline autoinjector for immediate emergency treament of a severe allergic reaction (also known as anaphylaxis) caused by for eg. hypersensitivity to

  • food 
  • medicines
  • stinging insects/insect bites
  • latex or
  • other allergens, possibly unidentified/unknown.

Avoidance of known allergens is most important in preventing severe allergic reactions.

A severe allergic reaction can be life-threatening as it affects the whole body particularly the: 

  • heart and blood circulation which can cause low blood pressure, collapse, abnormal heartbeat.
  • air passages and lungs which can cause breathing problems such noisy wheezing or gasping, possibly with sneezing and a very runny nose.
  • stomach and bowels which may cause nausea, vomiting, diarrhoea and abdominal cramps which is often severe. 
  • skin (very common) which may cause flushing, itching, skin rash, hives or swelling that is widespread or in one part of the body.
  • brain where they may be fits or confusion due to lack of oxygen.                                                        Usually several parts of the body are affected and you may feel extremely unwell due to anaphylaxis so its important to act quickly to treat a severe allergic reaction.

So how can Epipen help?

The adrenaline (epinephrine) in EpiPen® treats allergic emergencies by shrinking the abnormally wide blood vessels and makes the heart beat strongly and this helps improve the very low blood pressure and poor circulation that occur in a severe allergic reaction.

Adrenaline (epinephrine) also relaxes the lungs by helping to breathe better and reduce wheezing. It also helps stop swelling of And helps stop- swelling, for example, of the face and lips, skin rash and/or itching.

The EpiPen® Auto-Injector is for people who has been prescribed an Epipen by their doctor to treat their severe allergic reaction and who weigh over 30kg. However a person weighing 15-30kg may be prescribed an Epipen Auto-injector if the doctor think this person need a higher dose of adrenaline compared to the smaller dose from the Epipen Junior. Otherwise they will be on the Epipen Junior.

Note: Selection of the appropriate dosage is determined according to patient body weight.

If you have any questions about this, talk to your doctor.

EpiPen®

  • provides convenient first-aid
  • may be self-administered or administered by a carer
  • has a spring-activated, hidden needle
  • automatically injects one pre-measured dose of adrenaline (epinephrine)
  • is for single use only

EpiPen® may be prescribed by your doctor. You can also purchase it directly from a pharmacy.

What you need to know before using the Epipen?

* Do not remove the blue safety release until you need to use EpiPen® and are ready to use it becuse the safety release stops EpiPen® from “firing” or working. There is no visible needle. This helps overcome fear of injection as the hidden needle is very fine so that the injection does not usually hurt.

EpiPen® is a life-saving treatment in the emergency management of severe allergic reactions/anaphylaxis. Therefore, it should not be withheld from anyone who is considered to need it.

* The EpiPen® Auto-Injector has a clear “viewing window” so you can see the contents. But if the contents appear cloudy/coloured/contain sediment/hard to see through "viewing window"/obscured then do not use it. Because the drug product's effectiveness may be decreased or it has already been "fired" and can't be used again.

So please check your Epipen regularly so its ready for use when needed.

Do not use EpiPen® after the expiry date on the EpiPen® Auto-Injector and carton or if the packaging is torn, doesn’t look quite right or shows signs of tampering. If these things happen return it to your pharmacist for disposal and get a replacement.

How can you get help in using Epipen?

Because its important to know how to use it properly in case anaphylaxis occurs you need to get the proper education and advice from your doctor, nurse or pharmacist. You can get an Epipen Training Device for practice which is similar to the real Epipen but has no medicine and no needle and "fires" quietly and less forcefully and have your doctor or pharmacist show you how to use it correctly to prepare you for when you need to use it in an emergency.

Its good idea to regularly ask your doctor or pharmacist to demonstrate use with an Epipen Training device regularly to ensure you get it right.

Who needs caution when using Epipen?

Give WITH CAUTION to those who have

  • high blood pressure 
  • thyroid problems
  • high pressure in the eye (narrow-angle glaucoma)
  • having an anaesthetic
  • diabetes
  • heart disease
  • allergy to Epipen
  • brain damage

So you should tell your doctor if you have:

  • depression/ taking depression medication
  • thyroid problems/ taking thyroid medication
  • heart disease/high blood pressure
  • diabetes/medicines for diabetes
  • high pressure in the eye (narrow angle glaucoma)
  • asthma
  • are pregnant or planning to become pregnant.
  • ever had an allergic reaction to sodium metabisulfite.

Because the medicines you may be taking for depression, thyroid problems, diabetes, high blood pressure and antihistamines can affect how Epipen works. They can tell you what to do if you are taking any of those medicines.

When to use Epipen

Use EpiPen® immediately if you have signs and symptoms of a severe allergic reaction which may include: 

  • collapse
  • difficulty in breathing
  • wheezing
  • swelling, especially of the face, lips, tongue or throat
  • flushing of the face
  • irregular or faint pulse
  • vomiting, diarrhoea, stomach cramps
  • skin rash, hives
  • itching

How to use it 

Step 1 Flip open the yellow cap on the protective carry tube. Carefully tip and slide the EpiPen® Auto-Injector out of the carry tube. Never place thumb, fingers or hand over the orange end as this contains the needle. Always point the orange end (which contains the needle) away from any part of the body except the planned injection site which is usually the thigh of the person with anaphylaxis. Check the contents of the EpiPen® Auto-Injector through the “viewing window”. Make sure the solution is clear, colourless and sediment-free. If the “viewing window” is obscured, the EpiPen® has already “fired” and cannot be used again.

Step 2 Make a fist around the EpiPen® Auto-Injector, with your thumb nearest to the blue safety release. Grip only the mid-section of the EpiPen® Auto-Injector. Avoid touching either end, except when you remove the blue safety release. The blue safety release stops the EpiPen® from “firing” or working. Keep it away from face and eyes.

Step 3 Activate the EpiPen® Auto-Injector by removing the blue safety release with your other hand. This “triggers” the EpiPen®. It is now ready to "fire" the needle and inject the medicine through the needle into the thigh muscle.

After you remove the blue safety release do not touch or place thumb, fingers or hand over the orange end as this contains the needle.

Step 4 Hold the EpiPen® Auto-Injector at a 90° angle (right angle) to the outer part of the thigh. Hold the orange end about 5cm away from the thigh.

Step 5 Push the orange end FIRMLY into the outer mid-thigh until a “click” is heard or felt as this is when the hidden needle "fires" a measured dose of adrenaline into the thigh muscle. Keep pressing the EpiPen® Auto-Injector firmly against the thigh for approximately 10 seconds.

NOTE: EpiPen® may be used either through clothing or directly onto skin.

Step 6 Carefully take the EpiPen® Auto-Injector away from the thigh.

The orange needle cover will extend to cover the needle.

Gently rub the thigh in the area of the injection for about 10 seconds.

Check the “viewing window” - it should now be obscured. If it isn’t, the EpiPen® has not “fired” or worked. If the “viewing window” is not obscured, repeat steps 2-6 above.

Step 7 Record the time EpiPen® was given.

Step 8 Seek further medical attention for yourself immediately. Although you have received adrenaline (epinephrine) from EpiPen®, you may need more medical treatment.

Either call your doctor or an ambulance and state that adrenaline (epinephrine) treatment may be needed. 

NOTE: EpiPen® is only for immediate emergency treatment of a severe allergic reaction. Further treatment is usually needed.

Step 9 Explain to the doctor that you have had EpiPen® (intramuscular adrenaline (epinephrine)).

Take your used EpiPen® Auto-Injector with you.

To avoid injury, follow the used EpiPen® disposal instructions below (see Disposal).

Additional information about treatment of insect sting allergy

Use EpiPen® immediately if you have been stung or bitten by the insect and experience the signs and symptoms as described by your doctor or pharmacist.

If the insect’s sting is easily accessible, remove the sting with your fingernails. Do not squeeze, pinch or push the sting deeper into the skin. If available, ice packs or sodium bicarbonate soaks may then be applied to the stung area.

Keep warm, calm, and as still as possible.

If you use too much (overdose)

Because each EpiPen® contains only one dose, overdosage is unlikely. Overdosage may lead to a rise in blood pressure. This may cause bleeding in the brain or fluid in the lung.

If you think you or anyone else may have used too much of this medicine call your doctor immediately or the Poisons Information Centre (13 11 26) for advice or to Accident and Emergency at your nearest hospital. Do this even if there are no signs of discomfort or poisoning. Urgent medical attention may be required.

Things you must do

Check what the expiry date is on your EpiPen® and mark it in your diary/calendar and have the Epipen replaced before the expiry date. Also note on your calendar/diary to check the contents of your Epipen each month through its "viewing window" where it should be clear, colourless and sediment free. If not then get a new one immediately from your doctor or pharmacist and return your old/current one for disposal too.

The EpiPen® Auto-Injector can be damaged and made unusable if it is not handled properly with care. 

EpiPen® is NOT a toy. Keep it out of reach of children.

Things you must not do

Do not use EpiPen® to treat any other medical conditions including other types of shock unless your doctor tells you to.

Do not use Epipen if the solution is brown, has sediment, cloudy or obscured through the "viewing window".

Do not use Epipen Auto-injector in a child weighing 15-30kg unless advised by your doctor as an Epipen Junior is generally recommended for them although in some cases they may be prescribed an Epipen Auto-injector if a higher dose is needed.

Do not use Epipen in a child who weighs less than 15 kg. Talk to your doctor if this is the case so that a careful assessment can be made and the appropriate dose selected based on the child’s weight and the life-threatening nature of the reaction(s) for which EpiPen® is being prescribed.

Do not take off the blue safety release until you need to use EpiPen® and are ready to use it.

Remember that the EpiPen® Auto-Injector is activated (“triggered”, ready to “fire”) as soon as you take off the blue safety release.

Do not touch the orange end on any person or object while you are taking off the blue safety release and/or after you have taken off the blue safety release.

The orange end holds the hidden needle, ready to “fire” and inject the adrenaline (epinephrine).

After you take off the blue safety release:

* Do not "click" on either end of the Epipen as its not like a retractable ballpoint pen. See step 3 above in How to use it. 

* Do not bump the Epipen until you purposedly push the orange end firmly into the thigh. See step 4 in How to use it above. This will help prevent accidental activation of Epipen before using it.

* Do not inject into hands, feet, ears, nose, buttocks, genital area or into a blood vessel.

If this does happen accidentally you must immediately seek medical attention.

Side effects

Like all medicines, EpiPen® can cause some side effects. Side effects not listed in this leaflet may occur in some patients.

Tell your doctor or pharmacist if you experience any unpleasant side effects after using EpiPen®, even if you do not think the effect is connected with the medicine or is listed in this leaflet. Ask your doctor or pharmacist to answer any questions you may have.

Do not be alarmed by the following list of side effects. You may not experience any of them.

Tell your doctor or pharmacist if you have any of the following:

  • fast or noticeable heart beat
  • difficulty breathing
  • shortness of breath  
  • dizziness
  • pale skin colour
  • weakness
  • tremor
  • headache
  • throbbing
  • sweating
  • nausea or vomiting
  • sleeplessness
  • coldness
  • hallucinations
  • restlessness
  • anxiety
  • fear
  • flushing/redness of face/skin

These side effects are minor and short lasting.

Accidental injection into the hands, fingers or feet may result in the following:

  • fast or noticeable heart beat
  • pale skin colour at the site of accidental injection
  • feeling of coldness at the site of accidental injection
  • bruising or discolouration at the site of accidental injection
  • bleeding

If an accidental injection occurs at one of these areas, seek medical attention immediately.

More severe side effects can occur occasionally. They are caused by adrenaline (epinephrine) stimulating the heart and increasing the blood pressure. Rarely, these side effects can cause, for example, a stroke, lung problems or severe irregular heartbeat.

Adrenaline (epinephrine) may also cause disorientation and impaired memory.

Sodium metabisulfite EpiPen® contains a very small quantity of sodium metabisulfite as a preservative. In people who are allergic to sodium metabisulfite, this could cause, for example, severe asthma. However, the active ingredient, adrenaline (epinephrine), in EpiPen® is expected to overcome any allergic reaction to sodium metabisulfite. In an emergency, the risk of exposure to the very small amount of sodium metabisulfite is generally outweighed by the benefits of EpiPen®.

Storing EpiPen® before use

Always handle the EpiPen® Auto-Injector carefully, so as not to accidentally activate it or make it “fire” or work.

Keep EpiPen® available with the person for whom it is intended.

Keep EpiPen® in a cool dry place below 25°C. Temperature excursions between 15°C to 25°C permitted.

Do not place EpiPen® in the fridge. Do not leave EpiPen® in your car. Extreme temperatures may cause the auto-injector unit to malfunction/not work.

Protect EpiPen® from light. Keep EpiPen® in the protective carry tube until required.

Do not store EpiPen® or any other medicine in the bathroom or near a sink. Do not leave it on a windowsill or in the car. Heat and dampness can destroy some medicines.

Keep EpiPen® where children cannot accidentally reach it.

After using EpiPen®

Disposal

After the EpiPen® Auto-Injector has “fired” or worked, the orange needle cover will extend to cover the exposed needle. After use, continue to handle the EpiPen® Auto-Injector safely and with care. Do this even if you think the EpiPen® Auto-Injector has not “triggered”, “fired” or worked properly.

You CANNOT RE-USE the EpiPen® Auto-Injector even though some adrenaline (epinephrine) is left inside it.

After use, do not just throw away the EpiPen® Auto-Injector.

Give your used EpiPen®, to the doctor’s office or to a hospital. This is for inspection, if required, and also for safe disposal. The used EpiPen®, should be placed in a rigid sharps disposal unit.

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