Matching articles for "Epipen"

Drugs Past Their Expiration Date

   
The Medical Letter on Drugs and Therapeutics • July 27, 2020;  (Issue 1603)
Healthcare providers are often asked if drugs can be used past their expiration date. Because of legal restrictions and liability concerns, manufacturers do not sanction such use and usually do not...
Healthcare providers are often asked if drugs can be used past their expiration date. Because of legal restrictions and liability concerns, manufacturers do not sanction such use and usually do not comment on the safety or effectiveness of their products beyond the date on the label. Since our last article on this subject, more data have become available.
Med Lett Drugs Ther. 2020 Jul 27;62(1603):117-9 | Show Full IntroductionHide Full Introduction

An Epinephrine Prefilled Syringe (Symjepi) for Anaphylaxis

   
The Medical Letter on Drugs and Therapeutics • February 25, 2019;  (Issue 1566)
The FDA has approved a manually injected, single-dose, prefilled epinephrine syringe (Symjepi – Adamis/Sandoz) for emergency treatment of anaphylaxis. The new device is approved in 0.3- and 0.15-mg...
The FDA has approved a manually injected, single-dose, prefilled epinephrine syringe (Symjepi – Adamis/Sandoz) for emergency treatment of anaphylaxis. The new device is approved in 0.3- and 0.15-mg strengths for treatment of patients weighing ≥30 kg and 15 to 30 kg, respectively; only the 0.3-mg strength is currently available. According to Sandoz, Symjepi will be made available first to institutions and later to the retail market.
Med Lett Drugs Ther. 2019 Feb 25;61(1566):25-6 | Show Full IntroductionHide Full Introduction

In Brief: Auvi-Q Epinephrine Auto-Injector for Infants and Toddlers

   
The Medical Letter on Drugs and Therapeutics • May 21, 2018;  (Issue 1547)
The FDA has approved a lower-dose epinephrine auto-injector (Auvi-Q 0.1 mg – Kaléo) for emergency treatment of anaphylaxis in children weighing 7.5-15 kg (16.5-33 lbs). It is the first epinephrine...
The FDA has approved a lower-dose epinephrine auto-injector (Auvi-Q 0.1 mg – Kaléo) for emergency treatment of anaphylaxis in children weighing 7.5-15 kg (16.5-33 lbs). It is the first epinephrine auto-injector to be approved for use in infants and toddlers weighing less than 15 kg. Previously, Auvi-Q and other epinephrine auto-injectors were only available in 0.15- and 0.3-mg strengths for patients weighing 15-30 kg or ≥30 kg, respectively.

The recommended dose of epinephrine for intramuscular (IM) or subcutaneous (SC) administration is 0.01 mg/kg. None of the previously available epinephrine auto-injectors provided a weight-appropriate dose for infants, so many physicians prescribed a 0.15-mg auto-injector off-label for this age group.2

The Auvi-Q device is about the length and width of a credit card and as thick as a cell phone. It has an automatic needle retraction system and a red safety guard at the needle-end of the device. Removal of the outer case initiates visual signals and an audio recording that provides step-by-step instructions and a 2-second countdown during the injection process.

Auvi-Q should be injected IM into the anterolateral aspect of the thigh (through clothing, if necessary). After treatment with epinephrine, the patient should be taken to the nearest emergency department; anaphylaxis symptoms recur in up to 15% of patients hours after resolution of the initial symptoms.3

The needle length in the new 0.1-mg auto-injector is shorter than in other epinephrine auto-injectors. Use of a shorter needle decreases the risk of striking bone when administering a dose to a small child, but may result in SC rather than IM injection.4,5 Higher levels of epinephrine are obtained with IM injection than with SC injection.6

Auvi-Q 0.1 mg is supplied in a carton containing two single-use auto-injectors and a training device without a needle. The outer case protects the epinephrine solution from light; exposure to excessive heat or cold should be avoided. The shelf-life of the epinephrine in the auto-injector is 18 months. All three strengths of Auvi-Q are priced the same.

  1. Drugs for allergic disorders. Med Lett Drugs Ther 2017; 59:71.
  2. SH Sicherer and FER Simons et al. Epinephrine for first-aid management of anaphylaxis. Pediatrics 2017; 139:e20164006.
  3. S Lee et al. Update on biphasic anaphylaxis. Curr Opin Allergy Clin Immunol 2016; 16:346.
  4. H Kim et al. Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers. Ann Allergy Asthma Immunol 2017; 118:719.
  5. S Dreborg et al. Epinephrine auto-injector needle lengths: can both subcutaneous and periosteal/intraosseous injection be avoided? Ann Allergy Asthma Immunol 2018 Feb 27 (epub).
  6. FE Simons et al. Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunol 1998; 101:33.


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Med Lett Drugs Ther. 2018 May 21;60(1547):83 | Show Full IntroductionHide Full Introduction

Odactra - Sublingual Immunotherapy for House Dust Mite-Induced Allergic Rhinitis

   
The Medical Letter on Drugs and Therapeutics • February 26, 2018;  (Issue 1541)
The FDA has approved Odactra (ALK), a sublingual allergen extract, for immunotherapy in adults 18-65 years old with house dust mite (HDM)-induced allergic rhinitis, with or without conjunctivitis. Odactra is...
The FDA has approved Odactra (ALK), a sublingual allergen extract, for immunotherapy in adults 18-65 years old with house dust mite (HDM)-induced allergic rhinitis, with or without conjunctivitis. Odactra is the first sublingual allergen extract to be approved in the US for this indication. Three other sublingual allergen extracts were approved earlier (see Table 1).
Med Lett Drugs Ther. 2018 Feb 26;60(1541):37-9 | Show Full IntroductionHide Full Introduction

Prescription Drug Prices in the US

   
The Medical Letter on Drugs and Therapeutics • May 22, 2017;  (Issue 1521)
Per capita spending on prescription drugs in the US is higher than in other industrialized nations,...
Per capita spending on prescription drugs in the US is higher than in other industrialized nations, including Canada.
Med Lett Drugs Ther. 2017 May 22;59(1521):81-3 | Show Full IntroductionHide Full Introduction

Drugs for Allergic Disorders

   
The Medical Letter on Drugs and Therapeutics • May 8, 2017;  (Issue 1520)
Allergic rhinitis can be classified as seasonal, perennial, or episodic. It is often associated with allergic conjunctivitis, rhinosinusitis, and asthma. H1-ANTIHISTAMINES — Oral – Oral...
Allergic rhinitis can be classified as seasonal, perennial, or episodic. It is often associated with allergic conjunctivitis, rhinosinusitis, and asthma.

H1-ANTIHISTAMINES — Oral – Oral second-generation H1-antihistamines are the preferred first-line treatment for relief of the itching, sneezing, and rhinorrhea that characterize mild-to-moderate allergic rhinitis. They are less effective for nasal congestion.
Med Lett Drugs Ther. 2017 May 8;59(1520):71-82 | Show Full IntroductionHide Full Introduction

Auvi-Q Epinephrine Auto-Injector Returns

   
The Medical Letter on Drugs and Therapeutics • February 27, 2017;  (Issue 1515)
Auvi-Q (Kaléo; previously manufactured and marketed by Sanofi), the epinephrine auto-injector approved by the FDA in 2012 for emergency treatment of anaphylaxis and voluntarily withdrawn in 2015 due to...
Auvi-Q (Kaléo; previously manufactured and marketed by Sanofi), the epinephrine auto-injector approved by the FDA in 2012 for emergency treatment of anaphylaxis and voluntarily withdrawn in 2015 due to potential inaccurate dosage delivery, has become available once more. According to Kaléo, improvements in the manufacturing process have addressed the concerns that led to its recall.
Med Lett Drugs Ther. 2017 Feb 27;59(1515):33 | Show Full IntroductionHide Full Introduction

In Brief: Epinephrine Auto-Injectors for Anaphylaxis (online only)

   
The Medical Letter on Drugs and Therapeutics • September 12, 2016;  (Issue 1503)
News about recent price increases for EpiPen and EpiPen Jr (Mylan) may have patients asking about other options for emergency treatment of anaphylaxis. Adrenaclick and its generic equivalent (epinephrine...
News about recent price increases for EpiPen and EpiPen Jr (Mylan) may have patients asking about other options for emergency treatment of anaphylaxis. Adrenaclick and its generic equivalent (epinephrine injection auto-injector) are the only other epinephrine auto-injectors currently available in the US. According to Impax (the manufacturer of both the brand and generic products), Adrenaclick is no longer being manufactured; the generic product will continue to be marketed after supplies of Adrenaclick are depleted. Auvi-Q (Sanofi), an epinephrine auto-injector that was approved by the FDA in 2013, was removed from the market in 2015 due to inconsistencies in delivery of epinephrine doses, including failure to deliver the drug.1

Adrenaclick and its generic equivalent are similar to EpiPen and EpiPen Jr in size and functionality, but they are not considered interchangeable with the EpiPen products due to differences in device design and instructions for use. One pack (two auto-injectors) of EpiPen or EpiPen Jr costs $608.60. One pack of Impax's generic auto-injectors costs $395.20.2

According to Mylan, generic versions of EpiPen and EpiPen Jr will soon become available at about half the cost of the brand-name products.

  1. FDA. Updated: Sanofi US issues voluntary nationwide recall of all Auvi-Q due to potential inaccurate dosage delivery. Available at www.fda.gov. Accessed September 1, 2016.
  2. Approximate WAC. WAC = wholesaler acquisition cost or manufacturer's published price to wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. August 5, 2016. Reprinted with permission by First Databank, Inc. All rights reserved. ©2016. www.fdbhealth.com/policies/drug-pricing-policy.


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Med Lett Drugs Ther. 2016 Sep 12;58(1503):e120 | Show Full IntroductionHide Full Introduction

Drugs Past Their Expiration Date

   
The Medical Letter on Drugs and Therapeutics • December 7, 2015;  (Issue 1483)
Healthcare providers are often asked if drugs can be used past their expiration date. Because of legal restrictions and liability concerns, manufacturers do not sanction such use and usually do not even...
Healthcare providers are often asked if drugs can be used past their expiration date. Because of legal restrictions and liability concerns, manufacturers do not sanction such use and usually do not even comment on the safety or effectiveness of their products beyond the date on the label. Since our last publication on this subject, more data have become available.
Med Lett Drugs Ther. 2015 Dec 7;57(1483):164-5 | Show Full IntroductionHide Full Introduction

Drugs for Allergic Disorders

   
The Medical Letter on Drugs and Therapeutics • May 1, 2013;  (Issue 129)
The use of drugs to prevent and control symptoms of allergic disorders can be optimized when patients avoid exposure to specific allergens and/or environmental conditions that trigger or worsen their...
The use of drugs to prevent and control symptoms of allergic disorders can be optimized when patients avoid exposure to specific allergens and/or environmental conditions that trigger or worsen their symptoms.
Treat Guidel Med Lett. 2013 May;11(129):43-52 | Show Full IntroductionHide Full Introduction

In Brief: Auvi-Q - A New Epinephrine Auto-Injector

   
The Medical Letter on Drugs and Therapeutics • February 18, 2013;  (Issue 1410)
A new epinephrine auto-injector is available in the US (Auvi-Q – Sanofi; Allerject in Canada) for emergency treatment of anaphylaxis. The new device is about the length and width of a credit card and as thick...
A new epinephrine auto-injector is available in the US (Auvi-Q – Sanofi; Allerject in Canada) for emergency treatment of anaphylaxis. The new device is about the length and width of a credit card and as thick as a smartphone. It has a retractable needle system and a red safety guard located at the same end as the needle. Activation of the device by removing the outer case initiates an audio voice recording that provides step-by-step instructions and a 5-second countdown during the injection. The shelf-life of the epinephrine in the auto-injector is 18 months; the shelf-life of the battery is longer.

Auvi-Q’s needle length, gauge and injection force are similar to those of EpiPen. A randomized, crossover, bioavailability study found that injection of epinephrine 0.3 mg from Auvi-Q and EpiPen resulted in similar peak epinephrine levels and total epinephrine exposure.1 Like EpiPen, Auvi-Q is available in 2 doses: 0.15 mg (for children weighing 15-30 kg) and 0.3 mg. The cost for 2 Auvi-Qs containing either 0.15 mg or 0.3 mg is $241, compared to $240.66 for an EpiPen Jr or EpiPen 2-Pak.2

CONCLUSIONAuvi-Q is a new, smaller epinephrine auto-injector that provides audio instructions as it is being used. It appears to be more convenient to carry and easier to use than EpiPen.

1. ES Edwards et al. J Allergy Clin Immunol 2012;129:AB179, abstract 678.

2. Wholesale acquisition cost (WAC). Source: $ource® Monthly (Selected from FDB MedKnowledge™) February 5, 2013. Reprinted with permission by FDB, Inc. All rights reserved. ©2013. www.fdbhealth.com/policies/drug-pricing-policy. Actual retail prices may vary.

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Med Lett Drugs Ther. 2013 Feb 18;55(1410):13 | Show Full IntroductionHide Full Introduction

Drugs Past Their Expiration Date

   
The Medical Letter on Drugs and Therapeutics • December 14, 2009;  (Issue 1327)
Healthcare providers are often asked if patients can use drugs after their expiration date. Pharmaceutical companies, because of legal restrictions and liability concerns, will not sanction such use and might...
Healthcare providers are often asked if patients can use drugs after their expiration date. Pharmaceutical companies, because of legal restrictions and liability concerns, will not sanction such use and might not even comment on the safety or effectiveness of using their products beyond the date on the label. Since the last Medical Letter publication on this subject, more data have become available.
Med Lett Drugs Ther. 2009 Dec 14;51(1327):100-1 | Show Full IntroductionHide Full Introduction

Drugs for Allergic Disorders

   
The Medical Letter on Drugs and Therapeutics • August 1, 2007;  (Issue 60)
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria, anaphylaxis and asthma (reviewed in Treatment Guidelines 2005; 3:33 and not included here), are prevalent worldwide, especially in...
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria, anaphylaxis and asthma (reviewed in Treatment Guidelines 2005; 3:33 and not included here), are prevalent worldwide, especially in industrialized countries. Pharmacologic treatment of these disorders continues to improve in efficacy and safety. In addition to using drugs to prevent and control the symptoms of their allergic diseases, patients should also be instructed to avoid, if possible, specific allergens and/or environmental conditions that trigger or worsen their symptoms.
Treat Guidel Med Lett. 2007 Aug;5(60):71-80 | Show Full IntroductionHide Full Introduction

Drugs for Allergic Disorders

   
The Medical Letter on Drugs and Therapeutics • November 1, 2003;  (Issue 15)
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria and anaphylaxis, along with asthma (reviewed in Treatment Guidelines 2002; 1:7 and not included here), have increased in prevalence...
Allergic rhinitis, allergic conjunctivitis, atopic dermatitis, urticaria and anaphylaxis, along with asthma (reviewed in Treatment Guidelines 2002; 1:7 and not included here), have increased in prevalence during the past 30 years and are now epidemic worldwide, especially in industrialized countries. Many safe and effective drugs are currently available for prevention and relief of symptoms in these disorders, but pharmacological treatment alone may not be sufficient. Patients should also be instructed to avoid specific allergens or environmental conditions that trigger their symptoms. Allergen-specific immunotherapy, parenteral administration of gradually increasing doses of the allergen ("allergy shots"), has been effective in allergic rhinitis, allergic conjunctivitis and allergic asthma, and also in prevention of anaphylaxis triggered by stings from bees, yellow jackets, hornets and wasps. It has not been effective in food allergy, atopic dermatitis or urticaria.
Treat Guidel Med Lett. 2003 Nov;1(15):93-100 | Show Full IntroductionHide Full Introduction

Drugs Past Their Expiration Date

   
The Medical Letter on Drugs and Therapeutics • October 28, 2002;  (Issue 1142)
Physicians and pharmacists are often asked if patients can use drugs after their expiration date. Pharmaceutical companies, because of legal restrictions and liability concerns, will not sanction such use and...
Physicians and pharmacists are often asked if patients can use drugs after their expiration date. Pharmaceutical companies, because of legal restrictions and liability concerns, will not sanction such use and may not even comment on the safety or effectiveness of using their products beyond the date on the label.
Med Lett Drugs Ther. 2002 Oct 28;44(1142):93-4 | Show Full IntroductionHide Full Introduction