Allergy emergency is no time to learn how to use your EpiPen

checkupepipen new
The new redesigned EpiPens

By guest blogger Michael Cohen:

People who have a severe life-threatening allergic reaction to bee stings, peanuts, shellfish, or other causes must get help immediately. A medicine called epinephrine (adrenaline) slows down allergic reactions and can prevent a reaction from getting worse. Doctors often recommend that patients (or parents of young children) carry epinephrine injection with them in a prefilled syringe or at least keep one close by. EpiPen or one of its generic equivalents is then prescribed.

EpiPen is an auto-injector that automatically gives someone a shot of the drug in their thigh in case they experience a severe allergy. It can be used without removing clothing. There’s a special one for kids who weight less than 66 pounds called EpiPen Jr. 

EpiPen is shaped like a large pen or magic marker. One version, still on the market but recently updated, has a gray cap at one end that must be removed before use, and a black tip on the other end that holds the needle.

The needle only comes out once the black tip is pushed forcefully against a person’s leg. 

Using it as intended is very important. But after removing the gray cap, people have a natural tendency to hold the EpiPen upside down, put their thumb over the black tip, and press down, as they would a ballpoint pen. So they may accidentally inject the medicine into their thumb. Even some health professionals have had trouble figuring out which end should be placed against the thigh to give the injection.

Older version of EpiPen

Dey Pharma, the company that distributes EpiPen, recently announced a redesigned version that is supposed to make it less likely that anyone would accidentally inject into a thumb or finger. Initial use of the new device requires activation of a blue safety release at the end of the pen farthest from the needle. Once activated, the orange tip at the needle end of the syringe is placed firmly against the outer thigh for approximately 10 seconds while the drug is delivered into a thigh muscle. 

Newer version of EpiPen and EpiPen Jr.

Unfortunately, even the new version can also be used incorrectly. We recently received a report in which a nurse injected her thumb using the new device. She was administering an EpiPen injection for the first time. She was not familiar with the device and apparently had not been taught how to use it properly.

She was, however, familiar with the use of insulin pens, one of which has an orange push button that is pressed to inject the insulin. Although the orange end is clearly marked with the warning “Never put thumb, fingers, or hand over orange tip,” the nurse incorrectly assumed that, since it was a pen and had an orange tip, it operated the same way. She held her thumb against the orange tip at the EpiPen needle end, expecting the needle to exit the opposite end once she activated the safety release. But when she pushed down on the orange end, she drove the needle through her thumb.

While injecting EPINEPHrine into a thumb or finger may pose a risk to the individual attempting to administer the drug, the greater harm and risk is to the patient who needs the drug immediately in light of their severe allergic reaction. The situation could be quite serious if only a single pen is available in the field.

Instructions for proper use of the EpiPen can be found here. Remember, the EpiPen only works once. If you make a mistake, there is no second chance to get the medicine. If the doctor has prescribed the EpiPen for you or a family member, take the time now to learn how to use it, before you need it in an emergency. Ask the doctor to give you a prescription for the EpiPen trainer, too, so you can practice. Teach all family members, babysitters, school staff, and other caregivers how to use the auto-injector. (The EpiPen website, has printable information and a training video.)

For information on ISMP's consumer website go

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