Beware of the practice EpiPen

by Michael R. Cohen, R.Ph.

Patients who keep an EpiPen on hand in case of a severe allergic attack need to know about a potentially dangerous mix-up between the actual pen and a similar looking training pen.

EpiPen is an auto-injector that looks like a pen. It contains the medicine epinephrine (adrenalin) and has a needle at one end. Injected immediately for emergency treatment of a severe allergic reaction, an EpiPen can be life-saving. It slows down the allergic reaction and can prevent a reaction to a bee sting, or peanut or shellfish exposure, from getting worse.  There’s an EpiPen Jr. for children that has a lower epinephrine dose than the one for adults.

Doctors used to be able to prescribe EpiPens as a single unit.  But not too long ago the manufacturer began supplying these only in packages that hold two pen injectors along with a non-functioning training pen. The company told us that they package EpiPen this way because severe reactions often require two injections. But these “2-Paks,” as they are called, have created a potential for confusing the drug pen with the trainer. 

An EpiPen is for self-injection (or, for small children, can be used by someone else), automatically giving someone a shot of the drug in their thigh. The training pen is intended to help teach patients and family members how to properly use the pen. Unlike the real pen, where a needle comes out once the syringe tip is pushed forcefully against a person’s leg, there’s no needle, so it can be used again and again, with no one ever injected.

In an earlier blog, I wrote about the importance of proper training in preparation for needing to actually use the pen. So I was happy about availability of a training device. However, while the training pen is visually different than the EpiPen, packaging both types of devices in the same box can lead to confusion. We’re hearing from hospitals that are concerned about this happening during an emergency if the actual auto-injector is somehow picked up by mistake. 

EpiPen along with training pen

Already two hospitals have voiced their concerns. One told us that a training pen was found by itself in the storage area where EpiPens were supposed to be located. Apparently the two real pens in the package were already used and someone left the trainer by itself. So far, I am not aware of any actual hospital incidents yet. But if you look at the pens and compare them with the training device, you can see how similar these are in appearance. They are similar in size and shape. It shouldn’t take much imagination to understand how, during an emergency, a nurse or doctor could grab the wrong thing, missing the “Training Device” statement.

If a patient similarly confuses these at the time of an attack, then obviously it might have life-threatening consequences. Indeed, there is an Internet report of a mix-up actually happening, although it was the other way around. The mother of a young daughter with allergies accidentally injected herself with her child’s EpiPen when she thought she was using the training pen. She tells her story in her own blog, and I’d recommend reading it as she also gives some tips about EpiPen use that you will find useful.

We have notified FDA about the concern and have also contacted the company on two occasions to request them to provide EpiPens as a single unit, with the training device packaged separately. So far they have resisted going back to the older packaging. However, we understand that a relabeling process for the training device is being undertaken that will better differentiate the drug pen from the trainer.

The company told us that the individual pens do not need to be stored in their original 2-Pak cartons. So in the meantime, we have alerted hospitals using the EpiPen 2-Pak to unpack the pens and store only the active pens in emergency supplies. That’s a good idea for patients and parents too. Keep training pens away from the real thing. Keep this in mind too if you have kids in summer camp or when they go back to school. Send only the actual EpiPen. 

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