EpiPen 2-Pak

Generic Name: epinephrine injection (EP i NEF rin)
Brand Names: Adrenalin, EpiPen 2-Pak, EpiPen Auto-Injector, EpiPen JR 2-Pak, EpiPen JR Auto-Injector, Twinject Auto-Injector, Twinject Auto-Injector Two Pack

What is the most important information I should know about epinephrine injection?

Before using this medication, tell your doctor if you have heart disease or high blood pressure, a heart rhythm disorder, coronary artery disease, Parkinson's disease, diabetes, or a thyroid disorder.

Before using epinephrine, tell your doctor about all other medications you use, especially digoxin (digitalis, Lanoxin), heart or blood pressure medicine, heart rhythm medication, an antidepressant, a diuretic (water pill), thyroid medication, migraine headache medicine, cold or sleep medicine that contains an antihistamine, or an MAO inhibitor such as Marplan, Nardil, Azilect, Eldepryl, Emsam, or Parnate.

Do not inject epinephrine into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh.

Accidentally injecting epinephrine into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness. If this occurs, seek emergency medical attention.

Seek emergency medical attention even after you use epinephrine to treat a severe allergic reaction. The effects of epinephrine injection may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.

Before using epinephrine a second time, tell your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Store the auto-injector device in the original tube it came in. Keep this tube at room temperature away from direct sunlight, heat, and moisture. Do not refrigerate this medication, or store it in a car.


What is epinephrine injection?

Epinephrine is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.

Epinephrine injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis.

Epinephrine auto-injectors such as EpiPen and EpiPen Jr. may be kept on hand for self-injection by a person with a history of an severe allergic reaction.

Epinephrine injection may also be used for other purposes not listed in this medication guide.


What should I discuss with my healthcare provider before using epinephrine injection?

If you have certain conditions, you may not be able to use epinephrine, or you may need a dose adjustment or special tests to safely use the medication. Before using epinephrine, tell your doctor if you have:

  • heart disease or high blood pressure;
  • a heart rhythm disorder;
  • coronary artery disease;
  • Parkinson's disease;
  • diabetes; or
  • a thyroid disorder.

FDA pregnancy category C. It is not known whether epinephrine is harmful to an unborn baby. If possible before using this medication, tell your doctor if you are pregnant or plan to become pregnant.

Before an emergency occurs, talk to your doctor about using epinephrine injection if you are breast-feeding a baby.


How should I use epinephrine injection?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Seek emergency medical attention even after you use this medication to treat a severe allergic reaction. The effects of epinephrine injection may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.

The auto-injector device this medicine comes in is a disposable single-use system that contains a spring-loaded needle. Epinephrine injection comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Do not remove the safety cap until you are ready to use the auto-injector. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed.

To use an epinephrine auto-injector:

  • Form a fist around the auto-injector with the black tip pointing down. Pull off the safety cap.
  • Place the black tip against the fleshy portion of your outer thigh. You may give the injection directly through your clothing. Do not put your thumb over the end of the unit.
  • With a quick motion, push the auto-injector firmly against your thigh. This will release the spring-loaded needle that injects the dose of epinephrine. Hold the auto-injector in place for a few seconds after activation.
  • Remove the auto-injector from your thigh. Carefully re-insert the used device needle-first into the carrying tube. Re-cap the tube and take it with you to the emergency room so that anyone who treats you will know how much epinephrine you have received.
  • Use each auto-injector only one time. Even though a small amount of liquid may remain inside the unit, throw it away after one use.

Do not use the medication if it has changed colors or has any particles in it, or if the expiration date printed on the label has passed. Call your doctor for a new prescription.

Store this medication at room temperature away from direct sunlight, heat, and moisture. Do not refrigerate this medication, and do not store it in a car.


What happens if I miss a dose?

Since epinephrine is normally used only as needed in an emergency, you are not likely to be on a dosing schedule. Do not use repeat doses of epinephrine injection without a doctor's advice.


What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include fast or pounding heartbeats, sudden and severe headache, sudden numbness or weakness, feeling like you might pass out, or sudden problems with vision, speech, or balance.


What should I avoid while using epinephrine ?

Do not inject epinephrine into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh.

Accidentally injecting epinephrine into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness. If this occurs, seek emergency medical attention.


What are the possible side effects of epinephrine ?

Before using epinephrine a second time, tell your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious side effects may include:

  • fast, pounding, or uneven heatbeats;
  • sweating;
  • nausea and vomiting;
  • pale skin;
  • dizziness;
  • weakness or tremors;
  • headache; or
  • feeling nervous or anxious.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


What other drugs will affect epinephrine?

The following drugs can interact with epinephrine injection. Tell your doctor if you are using any of these:

  • digoxin (digitalis, Lanoxin, Lanoxicaps);
  • cold or sleep medication that contains chlorpheniramine (Coricidin, Robitussin Cough and Cold, Triaminic Allergy, and others) or diphenhydramine (Benadryl, Sominex, Nytol, Compoz, and others);
  • a diuretic (water pill);
  • levothyroxine (Synthroid);
  • an antidepressant such as amitriptyline (Elavil, Etrafon), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), and others;
  • a beta-blocker such as propranolol (Inderal, InnoPran), and others;
  • ergot medicine such as ergotamine (Ergomar), dihydroergotamine (D.H.E. 45, Migranal Nasal Spray), ergonovine (Ergotrate), or methylergonovine (Methergine);
  • heart rhythm medication such as quinidine (Cardioquin, Quinaglute, Quinidex); or
  • an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with epinephrine injection. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.


Where can I get more information?

Your pharmacist can provide more information about epinephrine injection.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2009 Cerner Multum, Inc. Version: 3.05. Revision date: 11/19/2009.