Epinephrine is a chemical which narrows blood vessels and opens airways in the lungs. This counteracts severe low blood pressure and wheezing. Epinephrine also relieves itching and hives.

Epinephrine injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens as well as exercise-induced (idiopathic) anaphylaxis. Epinephrine auto-injectors such as EpiPen and EpiPen Jr. are intended for immediate self-administration by a person with a history of an anaphylactic reaction.

Epinephrine injection may also be used for purposes other than those listed in this medication guide.

Use epinephrine injection exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, pharmacist, or nurse to explain them to you.

Seek emergency medical attention for any severe allergic reaction that occurs. The effects of epinephrine injection wear off after 10 to 20 minutes. Epinephrine emergency kits are designed for emergency use only and are not a replacement or substitute for immediate medical or hospital care.

The EpiPen and EpiPen Jr. auto-injectors are disposable delivery systems that have a spring activated, concealed needle. Read the instructions included in each package immediately so you are familiar with them before a emergency occurs.

Do not remove the safety cap until you are ready to inject this medication. Never put your fingers over the black 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 gray safety cap. Once the safety cap is removed, the auto-injector is ready for use and can be activated.

• Place the black tip against your outer thigh. Do not inject epinephrine into a vein or the buttocks. Inject it only into the fleshy outer portion of the thigh. It is not necessary to remove your clothing first, the EpiPen auto-injector is designed to work through 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 a spring-activated mechanism that injects a 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 auto-injector - needle first - into the amber carrying tube. Re-cap the amber tube and take it with you to the emergency room so that the doctor will know that you have had a shot of epinephrine and what amount you received.

• Each auto-injector delivers a single dose of epinephrine. Even though a small amount of liquid remains inside, the unit cannot be used again.

With severe reactions, repeat injections may be necessary. Follow your doctor’s instructions.

Accidental injection of epinephrine into the hands or feet may result in a loss of blood flow to the affected area. If this occurs, go immediately to the nearest emergency room for treatment.

Do not use epinephrine that is discolored, has particles in it, or has passed the expiration date printed on the side of the unit.

Store epinephrine injectable in the tube provided at room temperature away from direct sunlight, heat, and moisture. Do not refrigerate this medication.

Before an emergency occurs, talk to your doctor about using epinephrine injection if you are taking any of the following medications:

• digoxin (Lanoxin, Lanoxicaps, Cardoxin, others);

• quinidine (Cardioquin, Quinaglute, Quinidex, others);

• a tricyclic antidepressant such as amitriptyline (Elavil, Endep), nortriptyline (Pamelor), doxepin (Sinequan), imipramine (Tofranil), and others; or

• a monoamine oxidase inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), or phenelzine (Nardil).

You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with epinephrine injection. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Do not inject epinephrine into a vein or the buttocks. Inject it only into the fleshy outer portion of the thigh.

Seek emergency medical attention if an overdose is suspected.

Symptoms of an epinephrine overdose include an increased and irregular heart beat, a more forceful heartbeat, a severe, throbbing headache, and stroke.

Since epinephrine injection is used to treat allergic reactions, missing a dose is not a problem. Use only the dose or doses you need according to your doctor’s instructions.

Do not inject epinephrine into a vein or the buttocks. Inject it only into the fleshy outer portion of the thigh.

Accidental injection of epinephrine into the hands or feet may result in a loss of blood flow to the affected area. If this occurs, go immediately to the nearest emergency room for treatment.

Do not remove the safety cap until you are ready to inject this medication. Never put your fingers over the black tip when removing the safety cap or after the safety cap has been removed.

Before an emergency occurs, talk to your doctor about using epinephrine injection if you

• have heart disease or high blood pressure;

• take medicines to treat a heart condition;

• have diabetes; or

• have thyroid problems.

You may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Epinephrine is in the FDA pregnancy category C. This means that it is not known whether epinephrine will be harmful to an unborn baby. Before an emergency occurs, talk to your doctor about the use of epinephrine injection if you are pregnant.

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

Your pharmacist has additional information about epinephrine injection written for health professionals that you may read.

Epinephrine injection is available with a prescription generically and under several brand names. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• EpiPen Auto-Injector - 0.3 mg of 1:1,000 epinephrine

• EpiPen Jr. Auto-Injector - 0.15 mg of 1:2,000 epinephrine