Commercially Available Epinephrine Auto-Injectors Available with a Prescription in the United States

Update: On October 28, 2015, all Auvi-Q epinephrine auto-injector devices were recalled. Please visit the www.auvi-q.com website for details about the recall and when the devices will become available again.

by Angela Nace, PharmD

Epinephrine auto-injectors are the treatment for anaphylaxis. Several epinephrine auto-injectors are now available in the United States. There is also a generic version. Each contains the drug epinephrine. But, each device has its own unique set of instructions for use. Understanding the differences is important so that you get the device you want and you know how to properly use it.

The chart below summarizes the key facts about each of the available epinephrine auto-injectors. All listed auto-injectors are available in twin packs which contain two (2) devices. Epinephrine Injection, USP auto-injector is also available as a single injection. This is the authorized generic of Adrenaclick. More details are available at the manufacturers’ websites. These websites also have patient instructional videos.

Pharmacists must follow state and federal regulations when filling your prescription for epinephrine. You should keep this in mind when filling your prescription.

There are many states in which the pharmacist can substitute a generic form of the prescription. This must be on the prescription in writing. The pharmacist must also get a verbal approval from the physician. If you or your physician prefer to receive a specific brand name, your physician must write the brand name and “DAW” (dispense as written) or “do not substitute” on the prescription. This notation prohibits the pharmacist from dispensing a generic form of the prescription. Before you leave the pharmacy, make sure the pharmacy fills your prescription exactly as you and your child's doctor expects.

Remember to speak to your child’s physician to determine which epinephrine product is best for your child. Each device operates differently. Make sure that you have been trained to use the device that you leave the pharmacy with. Also, you should review the training video for that device.

PRODUCT NAME (website)		PRODUCT IMAGE
Adrenaclick™ www.adrenaclick.com
Available Strengths	Manufacturer	Generic available	Discount Program
0.15 mg and 0.3 mg	Amedra Pharmaceuticals LLC	Yes	Co-pay card provides maximum benefit of $100 per twin pack (can be redeemed up to 3 times)
Includes Trainer	Talking feature	Needle exposed after injection	Refill reminder feature
Not included, but training devices are available for free via web or telephone.	No	Yes	No

PRODUCT NAME (website)		PRODUCT IMAGE
EpiPen™ and EpiPen Jr™ www.epipen.com
Available Strengths	Manufacturer	Generic available	Discount Program
0.15 mg and 0.3 mg	Mylan Inc.	No	Co-pay card provides maximum benefit of $100 per EpiPen® twin pack and can be redeemed up to 3 times until December 31, 2014.
Includes Trainer	Talking feature	Needle exposed after injection	Refill reminder feature
Yes	No	No	Patients can register on the product website for an e-mail reminder when their medication will expire

PRODUCT NAME (website)		PRODUCT IMAGE
Epinephrine Injection, USP auto-injector, authorized generic (AG) of Adrenaclick™ www.epinephrineautoinject.com
Available Strengths	Manufacturer	Generic available	Discount Program
0.15 mg and 0.3 mg*	Distributed by Lineage Therapeutics	**	Co-pay card provides maximum benefit of $100 per twin pack (can be redeemed up to 3 times)
Includes Trainer	Talking feature	Needle exposed after injection	Refill reminder feature
Not included, but training devices are available for free via web or telephone.	No	Yes	When you register for the refill reminder program, a reminder email will be sent one month prior to expiration date

*Available as a single injection or a twin pack.

** Epinephrine, USP auto-injector is the generically available option for Adrenaclick.

REFERENCES
1. Product information for Adrenaclick™. Amedra Pharmaceuticals LLC. Horsham, PA 19044. April 2013.
2. Product information for Auvi-Q™. Sanofi-Aventis U.S. Bridgewater, NJ 08807. February 2014.
3. Product information for Epinephrine Injection, USP auto-injector, the authorized generic (AG) of Adrenaclick™. Lineage Therapeutics. Horsham, PA 19044. April 2013.
4. Product information for EpiPen. Mylan Inc. Basking Ridge, NJ 07920. August 2012.


Angela Nace is Field Coordinator for Experiential Education, Department of Pharmacy Practice, at Jefferson University School of Pharmacy. She is also a member of the Kids With Food Allergies (KFA) Advisory Board and Medical Advisory Team.