How to Use an Epipen

Medically reviewed by Alan O. Khadavi, MD, FACAAI

Last Updated: October 21, 2021 Approved

An EpiPen is an epinephrine auto-injector used to treat a severe allergic reaction called anaphylaxis. Anaphylaxis can be triggered by different allergies, including food, venom, and drug allergies.^{[1]
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Expert Source

Alan O. Khadavi, MD, FACAAI
Board Certified Allergist

Expert Interview. 29 July 2020.} Anaphylaxis is potentially fatal and is considered a "treat first, then call for help" medical emergency. Epinephrine is a synthetic version of naturally occurring adrenaline created by the body. A single dose of epinephrine, properly administered, is extremely low risk. Proper, timely use of an EpiPen can save the person's life. If you have been prescribed an EpiPen, keep it within reach at at all times.

Part 1

Part 1 of 3:

Identifying The Symptoms Of Anaphylaxis

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1
Identify the symptoms. Anaphylaxis can occur when a person is accidentally exposed to a known allergen, but it also can occur when a person is exposed to an allergen for the first time. It is also possible to become sensitized to an allergen, that is, to develop allergies to things that previously did not cause a reaction. In some cases the reaction can be so severe it can be life threatening. Look for the following symptoms:^{[2]
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- Flushing of the skin
- Rash on the body
- Swelling of the throat and mouth
- Difficulty swallowing and speaking
- Severe asthma
- Abdominal pain
- Nausea and vomiting
- Drop in blood pressure
- Collapse and unconsciousness
- Confusion, dizziness or an "impending sense of doom"
Anaphylaxis is considered a 'treat first' emergency. If the person knows they need an injection and can inject themselves, ensure they do so before calling emergency services. If they need you to inject them, the instructions for the EpiPen are printed on the side of the device.

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3
Call emergency services. Even if the person feels fine after injecting epinephrine/adrenaline, it's still imperative to have professional help as soon as possible. The EpiPen will only last for as long as it takes emergency services to reach you.
- Always have your country's emergency number on your phone. In the U.S. and Canada, the emergency number is 911. In the UK, 999 is the main emergency number. In Australia, dial Triple Zero (000).^{[3]
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- Tell the operator your location before anything else, so help can be sent immediately.
- Describe the condition and the emergency to the operator.
4
Check for a medical ID necklace or bracelet. If you suspect a case of anaphylaxis in someone else, look for a necklace or bracelet. People suffering from severe allergies usually carry those in case of an accident.^{[4]
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National Health Service (UK)
Public healthcare system of the UK

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- These necklaces and bracelets detail the condition and give additional information on health.
- They usually bear a Red Cross sign or other easily recognizable visual clues.
- If you suffer from severe allergies, always carry the instructions with the EpiPen. That way, if you are incapacitated and someone else has to administer it, they'll know what to do.
- Don’t give the EpiPen to someone suffering from a heart condition unless they have their own based on a doctor's prescription.^{[5]
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Part 2

Part 2 of 3:

Using the Epipen

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1
Hold the EpiPen firmly with your fist in the middle. Do not put any part of your hand over either end to avoid an accidental trigger. An EpiPen is a single-use device; once it is triggered it cannot be re-used.
- Avoid placing your finger over either end to avoid accidentally triggering the device.
- Pull off the blue activation cap (opposite end from the orange tip that holds the needle).
2
Inject into the mid-outer-thigh. Place the orange tip against the thigh and push firmly. There should be a click once the needle has entered the thigh.^{[6]
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- Hold for several seconds.
- Do not inject in any other place than the thigh. Accidental intravenous injections of adrenaline can lead to death.^{[7]
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3
Remove the EpiPen. Remove the unit and massage the injection area for 10 seconds.
- Check the tip. The orange needle cover should automatically cover the injection needle once the EpiPen is removed from the thigh.
4
Prepare for possible side effects. When you give a person an EpiPen, it may cause them to feel panicked or paranoid, and can also cause their body to shake uncontrollably. This is NOT a seizure.^{[8]
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- The shaking will subside over the next few minutes or hours. Don't freak out; just try to be calm and reassuring. Your calm will help to settle the person.
5
Get to the emergency room immediately. 20% of acute anaphylaxis episodes are quickly followed by another crisis, called biphasic anaphylaxis. Once you have administered or received the EpiPen, you should be seen by a doctor without delay.
- The second episode might be mild or severe. If not treated, it can lead to a fatality.
- The second crisis happens when patients seem to have recovered. It’s important to go to the hospital even if you feel fine.

Part 3

Part 3 of 3:

Taking Care Of An Epipen

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The carrier tube will protect the EpiPen so that it can safely be used when needed. Keep the safety release on until you need to use the EpiPen.
2
Look through the viewing window. Most EpiPens have a "window" that allows you to see through the packaging to the medicine inside. The medicine should be completely clear. If it looks cloudy or otherwise discolored, then that EpiPen has lost potency due to exposure to extreme temperatures.This can occur anytime before the expiration date. Depending on the temperature exposure and duration it may have lost significant or all of its potency.
- You can use it in an absolute emergency, but you should replace it as soon as possible.
3
Store your EpiPen in the right temperature. Your EpiPen can be kept in temperatures between 59° to 86°F (15° to 30°C). It should generally be stored at room temperature.
- Do not refrigerate it.
- Do not expose to extreme cold or heat.
4
Check the expiration date. The EpiPen has a limited life and should be replaced when the date is approaching. An expired EpiPen might not be able to save the life of a patient experiencing anaphylaxis.^{[9]
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PubMed Central
Journal archive from the U.S. National Institutes of Health

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- If you don’t have anything else at hand, use the expired EpiPen. Degraded epinephrine loses potency but does not transform into a harmful compound. It’s always better than nothing.
- Once an EpiPen has been used, it should be discarded safely. To do so, bring it to the pharmacy.

Expert Q&A

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Question

How do you get a prescription for an EpiPen?

Alan O. Khadavi, MD, FACAAI
Board Certified Allergist
Dr. Alan O. Khadavi is a Board Certified Allergist and a Pediatric Allergy Specialist based in Los Angeles, California. He holds a BS in biochemistry from the State University of New York (SUNY) at Stony Brook and an MD from the State University of New York Health Science Center at Brooklyn. Dr. Khadavi completed his pediatric residency at Schneider Children’s Hospital in New York, and then went on to complete his allergy and immunology fellowship and pediatric residency at Long Island College Hospital. He is board certified in adult and pediatric allergy/immunology. Dr. Khadavi is a Diplomate of the American Board of Allergy and Immunology, a Fellow of the American College of Allergy, Asthma & Immunology (ACAAI), and a member of the American Academy of Allergy, Asthma & Immunology (AAAAI). Dr. Khadavi's honors include Castle Connolly’s list of Top Doctors 2013-2020, and Patient Choice Awards "Most Compassionate Doctor" in 2013 & 2014.

Alan O. Khadavi, MD, FACAAI

Board Certified Allergist

Expert Answer

EpiPens are usually given to patients who are susceptible to anaphylaxis. Usually those patients predominantly have food allergies, like allergies to peanuts, nuts, shellfish, and fish. Sometimes wheat, milk, soy, and eggs in the pediatric population are big triggers too. We also give EpiPens to patients with allergies to venom, like from bee stings.

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Question

How soon after being stung should I administer an Epipen?

Jonas DeMuro, MD
Board Certified Critical Care Surgeon
Dr. DeMuro is a board certified Pediatric Critical Care Surgeon in New York. He received his MD from Stony Brook University School of Medicine in 1996. He completed his fellowship in Surgical Critical Care at North Shore-Long Island Jewish Health System and was a previous American College of Surgeons (ACS) Fellow.

Jonas DeMuro, MD

Board Certified Critical Care Surgeon

Expert Answer

An Epipen should be administered right away to an individual that is allergic to bee stings. The person should also be seen in an Emergency Room right away as they will need other medications and a period of observation.

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Warnings

Your doctor or nurse should show you how to use the EpiPen when he or she prescribes it.

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Only administer the EpiPen to its owner.

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