Adrenaline auto-injector for anaphylaxis

This leaflet is about the use of adrenaline auto-injector (Anapen or EpiPen) for anaphylaxis.

Information Standard quality markThis leaflet has been written specifically for parents and carers about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Anaphylaxis is a severe and life-threatening allergic reaction – it can be fatal if treatment is not given quickly. The adrenaline auto-injectors should be used in an emergency whilst waiting for medical help. Make sure that your child always has their auto-injector with them, and that anyone who looks after them knows how to use it as well.

Name of drug

Adrenaline (also known as epinephrine)
Brand names: EpiPen®, Anapen® (intramuscular injection for self-administration)

Why is it important to use the adrenaline?

Anaphylaxis is a severe allergic reaction, which may be life-threatening. It usually occurs straight after coming into contact with the trigger (also called the allergen); however, it can occur some hours later. Different people have different triggers, such as foods (e.g. peanuts, eggs or seafood), medicines (e.g. penicillin) or animals (e.g. bee or wasp stings).

By using the adrenaline auto-injector as soon as your child has any signs of an anaphylactic reaction, you may be able to prevent a full-blown reaction, while you wait for an ambulance.

What is adrenaline available as?

  • EpiPen Auto-injector 0.3 mg (yellow label): delivers 300 micrograms of adrenaline
  • EpiPen Jr Auto-injector 0.15 mg (white label with yellow stripe): delivers 150 micrograms of adrenaline
  • Anapen 0.3 mg (also called Anapen 300) (green case): delivers 300 micrograms of adrenaline
  • Anapen Junior 0.15 mg (also called Anapen 150) (yellow case): delivers 150 micrograms of adrenaline 

When should I use the adrenaline auto-injector?

You should use the adrenaline auto-injector if your child has symptoms of an anaphylactic reaction. If your child also has an asthma inhaler, they should use this too.

  • The early signs of an anaphylactic reaction are tightening of the throat, difficulty breathing, swelling or tingling of the mouth or tongue, developing a skin rash or itching. In many cases the reaction will follow exposure to a known trigger.
  • The following symptoms may indicate a severe reaction: difficulty swallowing, speaking or breathing, swelling of the throat and mouth, a skin rash anywhere on the body or generalised flushing of the skin, abdominal cramps, feeling sick (nausea), being sick (vomiting), sudden feeling of weakness, racing heart, panic and anxiety. The person may collapse or become unconscious.

If symptoms have not improved 5 minutes after using the auto-injector, give another dose with a new pen.

Telephone for an ambulance and say that your child is having an anaphylactic reaction.

You must take your child to hospital after using the auto-injector, even if they seem well. Tell the doctor which auto-injector you used, and how many.

How much should I give?

Your doctor will work out which size of auto-injector is right for your child. Each auto-injector delivers a fixed amount of adrenaline. Each auto-injector can be used only once.

How should I give it?

There are two different types of adrenaline auto-injector – EpiPen and Anapen. These are used in different ways. You MUST follow the instructions provided with your auto-injector. If you follow the wrong instructions, you risk injecting the adrenaline into your own thumb. If you are not sure which you have, or how to use it, ask your doctor, nurse or pharmacist to show you.

Giving adrenaline auto-injector in the thigh

The auto-injector must only be used in the thigh. Never inject it anywhere else on the body, as this could do harm.

EpiPen

EpiPen

  • Hold the EpiPen in your dominant hand (the hand that you write with), with your thumb closest to the grey safety cap.
  • Pull off grey safety cap with your other hand.
  • Jab the black tip firmly into the child’s outer thigh – through clothing if necessary – at an angle of 90° (a right angle) to the leg. Listen for the click.
  • Hold in place for 10 seconds.
  • Remove the pen and throw it away.
  • You may see that there is still some liquid in the pen. This is normal. It does not mean that the injection hasn’t worked.

Anapen

Anapen

  • Remove the black needle cap and the black safety cap from the firing button.
  • Hold the Anapen against the outer thigh, at an angle of 90° (a right angle). 
  • Press the red firing button. You can inject through clothing if necessary.
  • Hold the Anapen in position for 10 seconds. This allows the full dose of adrenaline to be injected.
  • Remove the pen and throw it away.

When should the medicine start working?

The medicine should start working almost immediately. If your child’s symptoms have not improved 5 minutes after using the auto-injector, give another dose of adrenaline using a new pen.

You must wait at least 5 minutes, even if you are not sure if the first injection worked properly, otherwise you risk giving too much.

What if my child is sick (vomits)?

You do not need to give another dose of adrenaline, as it will still work.

What if I give too much?

If you have accidently given your child two doses, tell the doctor.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Your child may get any (or none) of the following side-effects after using the adrenaline auto-injector but they usually do not last for long:

  • feeling sick or being sick (vomit)
  • fast or irregular heart rate (feeling that the heart is racing or fluttery)
  • cold hands and feet
  • difficulty breathing 
  • feeling anxious, shaky, restless, weak or dizzy
  • headache
  • sweating
  • difficulty passing urine (doing a wee)
  • the skin where the adrenaline was injected may go pale or feel sore.

Is there anything else I need to know about this medicine?

The auto-injector must only be used in the thigh. Never inject it anywhere else on the body, as this could do harm.

  • Make sure you know how to use the auto-injector correctly, otherwise it may not work. Remember that EpiPen and Anapen are used in different ways, so make sure you know how to use the one your child has.

Make sure that your child has their auto-injector with them at all times. 

Make sure that anyone who looks after your child knows what to do and how to use the auto-injector if your child has an anaphylactic reaction. You may need to make special arrangements with your child’s school.

If someone accidentally injects the adrenaline into their hands or fingers, the blood flow to this area may stop (the skin will go pale). Take the person to hospital straight away.

  • Make sure that you always have at least two auto-injectors. Order a new prescription as soon as you have used one.
  • Make sure that the auto-injector you carry with you is still within its ‘use by’ date. Give old pens to your pharmacist to dispose of.

Only use the auto-injector for your child. Never use it on anyone else, even if their condition appears to be the same, as this could do harm.

Where I should keep this medicine?

  • Keep the auto-injectors out of the reach and sight of other children.
  • Do not store above 25°C. Do not put auto-injectors in the fridge or freezer.
  • Keep the auto-injectors in the box they came in, to protect the contents from light.

If you have EpiPen auto-injectors, check, from time to time, that the liquid in the glass container is clear and colourless. If it is pink or brown, or has bits in it, order a new prescription and throw the old auto-injector away.

Where I should keep this medicine?

  • Keep the auto-injectors out of the reach and sight of other children.
  • Do not store above 25°C. Do not put auto-injectors in the fridge or freezer.
  • Keep the auto-injectors in the box they came in, to protect the contents from light.

Who to contact for more information

Your child’s doctor, pharmacist or nurse will be able to give you more information about adrenaline auto-injectors and about other medicines used to treat allergies and anaphylaxis.


You can also get useful information from:


Publication Date

13/1/2012

Copyright Disclaimer

Version 1.2, November 2011. © NPPG, RCPCH and WellChild 2011, all rights reserved. Reviewed by: November 2013.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk. We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.