Brand Name(s):

• Adrenaclick®
• Adrenalin®Chloride Solution
• EpiPen®Auto-Injector
• EpiPen®Jr. Auto-Injector
• Twinject®

WHY is this medicine prescribed?

Epinephrine injection is used along with emergency medical treatment to treat life-threatening allergic reactions caused by insect bites or stings, foods, medications, latex, and other causes. Epinephrine is in a class of medications called alpha- and beta-adrenergic agonists (sympathomimetic agents). It works by relaxing the muscles in the airways and tightening the blood vessels.

HOW should this medicine be used?

Epinephrine injection comes as a pre-filled automatic injection device containing a solution (liquid) to inject under the skin or into the muscle in the outer side of the thigh. It is usually injected as needed at the first sign of a serious allergic reaction. Use epinephrine injection exactly as directed; do not inject it more often or inject more or less of it than prescribed by your doctor.

You should inject epinephrine injection as soon as you suspect that you may be experiencing a serious allergic reaction. Signs of a serious allergic reaction include closing of the airways, wheezing, sneezing, hoarseness, hives, itching, swelling, skin redness, fast heartbeat, weak pulse, anxiety, confusion, stomach pain, losing control of urine or bowel movements, faintness, or loss of consciousness. Talk to your doctor about these symptoms and be sure you understand how to tell when you are having a serious allergic reaction and should inject epinephrine.

Keep your automatic injection device with you or available at all times so that you will be able to inject epinephrine quickly when an allergic reaction begins. Be aware of the expiration date stamped on the device and replace the device when this date passes. Look at the solution in the device from time to time. If the solution is discolored or contains particles, call your doctor to get a new injection device.

Epinephrine injection helps to treat serious allergic reaction but does not take the place of medical treatment. Get emergency medical treatment immediately after you inject epinephrine. Rest quietly while you wait for emergency medical treatment.

Most automatic injection devices contain enough solution for one dose of epinephrine. One type of automatic injection device (Twinject) can be used according to the package directions to inject two doses of epinephrine if needed to treat an allergic reaction. If your doctor has prescribed this device for you, be sure that you know how to inject the second dose and how to tell whether you should inject a second dose.

Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it. Before you use epinephrine injection for the first time, read the patient information that comes with it. This information includes directions for how to use the pre-filled automatic injection device. Be sure to ask your pharmacist or doctor if you have any questions about how to inject this medication.

Epinephrine should be injected only in the middle of the outer side of the thigh, and can be injected through clothing if necessary in an emergency. Do not inject epinephrine into the buttocks or any other part of your body.

After you inject a dose of epinephrine injection, some solution will remain in the injection device. This is normal and does not mean that you did not receive the full dose. Do not use the extra liquid; dispose of the remaining liquid and device properly. Take the used device with you to the emergency room or ask your doctor, pharmacist, or health care provider how to throw away used injection devices safely.

Do not put your thumb, fingers, or hand over the needle area of the automatic injection device. If epinephrine is accidently injected into the fingers, hands, toes, or feet, get emergency medical treatment immediately.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before using epinephrine injection,

• tell your doctor and pharmacist if you are allergic to epinephrine, any other medications, sulfites or any of the other ingredients in epinephrine injection. Your doctor may tell you to use epinephrine injection even if you are allergic to one of the ingredients because it is a life-saving medication. The epinephrine automatic injection device does not contain latex and is safe to use if you have a latex allergy.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antidepressants such as amitriptyline (Elavil), amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), maprotiline, mirtazapine (Remeron), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); antihistamines such as chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl); beta blockers such as propranolol (Inderal); digoxin (Digitek, Lanoxicaps, Lanoxin); diuretics ('water pills'); ergot medications such as dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (in Cafergot, in Migergot), methylergonovine (Methergine), and methysergide (Sansert); levothyroxine (Levothroid, Levoxyl, Synthroid, Unithroid); and medications for irregular heartbeat such as quinidine. Also tell your doctor if you are taking a monoamine oxidase inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) or have stopped taking it within the past two weeks. Your doctor may need to monitor you carefully for side effects.
• tell your doctor if you have or have ever had chest pain, irregular heartbeat, high blood pressure, or other heart disease; diabetes; hyperthyroidism (an overactive thyroid); depression or other mental illness; or Parkinson's disease. If you will be using the Twinject device, tell your doctor if you have arthritis or difficulty using your hands.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Talk to your doctor about whether and when you should use epinephrine injection if you are pregnant.

What SIDE EFFECTS can this medicine cause?

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the plastic carrying tube it came in, tightly closed, and out of reach of children. Keep it at room temperature and away from light, excess heat and moisture (not in the bathroom). Do not refrigerate epinephrine injection or leave it in your car, especially in hot or cold weather. If the pre-filled automatic injection device is dropped, check to see if it is broken or leaking. Throw away any medication that is damaged, outdated or no longer needed and be sure to have a replacement available. Talk to your pharmacist about the proper disposal of your medication.

What should I do in case of OVERDOSE?

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• sudden weakness or numbness on one side of the body
• sudden difficulty speaking
• slow or fast heart rate
• shortness of breath
• fast breathing
• confusion
• tiredness or weakness
• cold, pale skin
• decreased urination

What OTHER INFORMATION should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. If you use a pre-filled automatic injection device, be sure to get a replacement right away. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

AHFS® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: December 15, 2012.