Why You Shouldn’t Use This Method To Save Money On The Epipen

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I saw this meme floating around facebook recommending a way that people could save money on the Epipen in the middle of this overcharging scandal.
 
V12t3NE
 
The suggestion is that people request their doctor write a prescription for a vial of epinephrine and syringes to accompany it. Then all you’d have to do is learn how to carefully measure this and administer it. Simple, right?
 
[glares in go fuck yourself]
 
There are a handful of disorders for which people administer self-filled syringes. Diabetes is one of them that we’re all pretty familiar with. In most cases when a diabetic gives themselves insulin, they have time to test their blood sugar, carefully meter out how much insulin they need depending on a number of factors, and they can do this at regularly timed intervals. 
 
Know where they did not get their advice to get self-administered syringes? From a meme on the internet. They got their medical advice directly from their doctors and there was professional training on how to appropriately self-administer their medication.
 
They also didn’t do it out of desperation to save money. Think this shit over for a minute. 
 
People self-administer other injectable medications that come from a bottle with a syringe in a controlled and planned setting. Insulin. Heparin. Other random medications that you rarely hear about and, I guarantee you, are used when you aren’t having trouble breathing. 
 
What’s the manner in which people self-administer Epipens?
 
*taps fingers and waits*
 
It happens when you’re having severe allergic reactions. These are not “someone get the benadryl, Aiden is a little itchy and I don’t think his chakras are aligned anymore.” These are for “holy mother of fuck, Madison Rainbow’s lips are turning blue, this is no time for superfoods, get the real shit.” 
 
Want to get the vial of epinephrine and the syringes for $10?
 
First and foremost, good luck trying to keep your hands steady.
 
Those three words that your doctor said when he first instructed you on if you ever needed to use this trigger a backfire in your brain:
 
“Now, don’t panic…”
 
Fuck. 
 
Your heart rate skyrockets to that of an epileptic hummingbird. 
 
 
While time is paradoxically standing still and running too fast to think, you’ll start second guessing everything that seemed so simple when your doctor trained you.
 
It was so sterile and mechanical. Now it’s your child, and they’re growing pale.
 
You’re only thirty seconds in. And it’s ugly already. 
 
You question if that many cc’s are still the same as the last time you were in the office. You’ll think, “isn’t Cameron two years older now? Do they need more epinephrine now? Are they going to start breathing again if I don’t measure this exactly right?”
 
Then the panic really starts to set in as your child starts to make a frantic hiccoughing noise while their chest spasms, lurching, begging for air.
 
Al you want to do is make this end. Your child has been drowning for a full minute. And you’ve just now managed to get the cap off the syringe. Your hands are still shaking.
 
Then you remember those times you saw a thing on CSI about a bubble of air in the syringe being deadly- was that true or was that a lazy screenwriter?
 
A minute and thirty. Jesus. H. Tapdancing.
Am I supposed to tap this thing? Is that just going to waste time?
How do all those junkies on Intervention get this done and live?
Did I just not pay attention? Am I doing this wrong?
 
Am I doing this wrong?
 
It’s been two minutes. It was the longest goddamn two minutes of your life. You’re not sure how many heart attacks you had, a lifetime worth at least.
 
Another thirty seconds of fumbling to get the thing pulled back. Is that the right amount? More? Less? Fuck fuck fuck fuck fuuuuuuuck.
 
And as your child’s lips are turning cyanotic and you can’t hear any more noises coming out of their throat, you barely manage to pull back any random amount of epinephrine that your frantically shaking hands can muster as you shove your thoughts of every last doubt and fear you have away because, at this point, seconds count.
 
You’re sure you had to get that syringe into your child’s leg sooner than that.
 
And then they breathe. And you have a sigh of relief, and then the questions start again. 
 
“Three minutes. What happened to them in three minutes of waiting?”
 
If you think I’m exaggerating for dramatic effect (I’ve met me, I’d be suspicious as well), a study showed that patients took an average of nearly two and a half minutes to prepare a syringe with epinephrine from a vial. This was both with the materials right in front of them AND without the stress of their child struggling to breathe in front of them. They also were not able to draw the dose accurately on a consistent basis.
 
Furthermore, it’s been pointed out to me from a few nurses and doctors that you generally purchase epinephrine in a glass vial. This requires a filter syringe to be used to ensure that you are not injecting small glass shards into your veins, adding more time to a process that’s already time dependent. I’ve worked with these types of vials in the lab, and it’s not too uncommon for them to shatter or cut somebody. Let me know how well you think this would work when you’re struggling to breathe.
 
In the study, they were in controlled situations after some training when there was no anaphylaxis for them or a relative to react to frantically. What happens when there’s an actual emergency? How long will it take? What are the odds that they’ll pull an inaccurate dose of epinephrine in a moment of panic and fix the breathing but cause a cardiac incident? 
 
All of this is happening because of desperation due to the actions of a horrifically greedy company. Don’t let this be unclear; it’s not a parent’s fault if this DIY kit sounds like a good idea at first given what Mylan is doing. The Epipen has been a game changer in giving peace of mind to people with severe anaphylaxis. However, Mylan purchased it and jacked the price simply because they could to the point where people are taking medical advice from a meme. This desperation is not the parents’ fault. All blame falls squarely on Mylan.
 
 
8/29/2016 edit: The misinformation spreading in this meme is no better than bullshit that says green juice can cure cancer. Whether it’s bad information because it’s telling you to use a “natural” cure that’s completely unproven and useless or it’s a cure that’s proven and just won’t give you your medication in a way that’s useful, I don’t have any agenda other than to tell you the science if you’re being given a dangerous message that preys on your desperation. You deserve better than that.
 
For this, I’ve been called a lot of nasty things and accused of being a lot of things, none of them true. Mainly I’ve been accused of working for Mylan or owning stock in the company. The company must have the weirdest social media policies if I could get away with saying the things I said about the company CEO and practices and still be an employee there. Read further for all the alternatives to Mylan’s Epipen that I highly recommend, which seems to undermine that train of thought. 
 
Following up with some comments from my website, after initially posting this to my facebook page, several of my followers who use various medications delivered by injection weighed in with their thoughts:
 
 
 
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8/29/16 Edit: Since initially posting this blog, a few alternatives on the market have been pointed out to me and I hope people will look into them. Again, I’m not on Mylan payroll (a thing I can’t believe I have to even say), I just had not seen links to generics and I am *very* glad that lower priced options are on the market. I originally mentioned one autoinjector that’s comparable and currently on the market at a significantly lower cost is Adrenaclick, but it’s utilizes a slightly different mechanism and you will need to have a conversation with your doctor on how to use it. Please talk to your doctor about if it’s a good fit for you. I have a nurse and a physician assistant on my staff and they concurred that the difficulty level and speed of administration are preferable to the syringe and vial of epinephrine. The other option is to inquire if your pharmacy stocks generic epinephrine injectors and ask your doctor to specifically write a prescription for a generic epinephrine autoinjector. Costco, CVS, and Walgreens all carry a generic autoinjector, and if your local one does not currently have it in stock, they will order it for you.
 
Without a prescription SPECIFICALLY for a generic autoinjector, your prescription will be filled for an Epipen. Please consult with your doctor about this and inquire about generics for an option that’s appropriate for you, will deliver your medication in a time appropriate fashion, and not break the bank. Additionally, please talk to your doctor if you switch autoinjectors to make sure you know exactly how to administer it long before the moment comes for when you really need it.
 
After co-pay for the generics or Adrenaclick, they might be a bit more expensive than the DIY kit. They will be far less expensive than the Epipen. The punchline is that it’s worth it.
 
So the good news is that there are options other than Epipen. The prices aren’t perfect, but they’re better. Fixing the conditions that got us to this point takes work because Mylan is a symptom of the problems in the pharmaceutical industry, and to nip it, it takes legislation, not just yelling at Mylan or a coupon for a temporary patch. The company needs pressure to be put on it from customers (and the loudmouths currently running for office need to throw down some serious plans about pharmaceutical industry investigation and reform) without making potentially fatal decisions in the meantime.
 
Money and money alone is driving good people to gamble with their health.  Before taking advice from a meme, please look into the alternatives that are listed here. If you’re a parent who’s considered this, I urge you to stick to one of the available autoinjectors. Are the actions of Mylan terrible? Yes. Please use an autoinjector from another company. 
 
One would hope I could point out misinformation that could potentially save a life without being told that I’m shilling for something, but welcome to the internet.
 
One would hope that eventually the pharmaceutical industry wouldn’t look as terrible as the bullshit artists, but even if they’re making medications that really work… they both suck.
 
One would hope that the morally bankrupt head of a pharmaceutical company eventually would say “I had a good run making $18 million a year, just a correlation and not a causation I assure you. Why yes, it’s about the same percentage increase as the price increase in the Epipen. Totally coincidental. No, I wasn’t winking, I had something in that eye. However, as a magnanimous person who is doing this out of the bottom of my heart and not out of intense media scrutiny, $600 was an overreach for a co-pay while I’m only charging $1oo to the Canadians, proving it’s possible but I’m just overcharging because I like living in Prada conducting research or something. Instead of throwing you a coupon for it to be just moderately ridiculous at $300 a pop, the pharmaceutical equivalent of Let-Them-Eat-Cake, I’ll come down from my ivory tower and give you as good health care as the goddamn Canadians have because even I knows that a meme shouldn’t be what drives my customers off a cliff to potentially fatal medical decisions.”
 
Or maybe not. 
 
Murika or something?
 
-SciBabe

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185 Comments

  1. You made a very accurate synopsis of what goes on internally when preparing an epinephrine from vial dose.
    I know, as I’ve done it for a soldier who had a severe reaction to a bee sting.

    Oh, getting that tiny needle into the tiny hole created when you broke the top off of the vial and your hands are shaking like leaves in a hurricane is a feat unto itself.
    Doing so repeatedly as the patient crashes repeatedly, a priceless experience.

  2. Is your loved one’s life worth risking??? I am a diabetic and give myself insulin. You need the right dose administered at the right time. I have given myself 2 kinds of insulin twice a day for the last 16 yrs and in a hurry many things can go wrong – wrong insulin, wrong dosage. I wouldn’t mess with epinephrine and syringes on a bet. What if the epinephrine is left in the car and gets either overheated or frozen? Is it still good. What if you forget to bring syringes? What if the needle on the syringe gets broken? All things I have done. Not life threatening to this diabetic. Seconds and minutes matter to diabetics but not like someone with anaphylaxis. BOTTOM LINE Is your loved one’s life worth risking???

    • I’m wondering if you could elucidate on this point for me. My family is planning to immigrate to Canada in the next year or two, just as soon as we take the language tests and sell our house. Part of the reason we’re moving is because of healthcare. Thanks in advance!

  3. Agree. However as a physician and someone who has had anaphylactic reactions requiring epi, I offer this. True anaphylactic reactions and shock are very uncommon. There are however some alternatives. Over the counter Benadryl and primatene inhalers. The latter contains epi inhaled and came help halt the reaction. Benadryl is slower but will reverse the reaction. Parents should keep these around as well. Clearly EMT is the best option in any situation.

      • Epi pens get prescribed to anyone who comes in the ED complaining of an “itchy feeling”. Every parent thinks they need to carry one “just in case” and requests a script even if their kid was only having a side-effect issue and not an allergic reaction.
        Actual anaphylactic reactions are rare.

        • Not quite as rare as you think, or we may have had different experiences, who knows. I only have a few friends who carry them, and it’s because their allergies make their throats close up, not because they get itchy.

          But… we may have had different experiences with the healthcare system/prescribing practices.

      • The Epipen was designed and developed by the VA. Congress gave the patent rights away for election donations that assured their own re-election (1st rule of politicians? pay yourself first). A class action lawsuit against the congressional voters/signers (the bill was written by ALEC)from the insurance companies, patients, and doctors affected seeking reimbursement for government/taxpayer funded expenses and exemptions from price gouging ought to be considered, but bribery is just free speech in America these days

  4. I could use this method if the person in my family who could need it wasn’t me. But I wouldn’t recommend it for the general public. The only reason I could do it for someone else is many years of experience in drawing up meds in emergency situations.

  5. whats your level of actual medical training\experience??? yeah. i thought so.. ive been a field paramedic for a long time (likely for longer than you’ve been able to tie your own shoes). you’re a dumbass…

    • So you’re saying that somebody going into anaphylactic shock would be able to self-administer in a timely fashion?

      My EMT brother, the physician assistant and emergency room nurse on my staff along with the study that I cited all say that you’re probably a dumbass.

  6. It definitely isn’t a viable option for emergency self-care.
    As I mentioned above, I have had to use phial based medicines in emergency conditions in the military. For civilians who are not well trained, I could never recommend that dispensing method.
    Not at all.

    One of the most difficult things to teach those who treat patients under emergency conditions is, it’s not your problem, you have enough of your own problems and you don’t need the patient’s problems to become your problems. Some never learn that lesson and it eats them alive, eventually ending their career.

  7. Long before epipens l backcountry skied with a woman who had a syringe and vial and every time we went on a trip she re explained how to use it and where it was so we could get it quickly ( I think the vial was taped to her skin to keep it warm )

  8. As far as Washington doing anything? The CEO here is the daughter of US Senator Joe Manchin. I hope these aren’t the values he passed on to her.

  9. In my experience, the Epipen in Canada comes one to a package so the $100 price is for one pen, $600 in the U.S. is for two pens. Still ridiculous but less so.

    • In Ireland, the price was 70 Euros (about $75 USD) a couple weeks ago for 1 pen. May be worth the shipping & handling.

      We’ll see what this new “generic” epipen that Mylan will release costs.

  10. And it should be intramuscular, not subcutaneously. And that makes a big difference in the speed. Epi naturally induces blood flow to muscles, but restricts it to the skin. So you gotta get that right too.

    The dose doesn’t matter, honestly. If you overdose your BP goes too high for a bit, but most folks will happily deal with 5 minutes of hypertension in order to breathe. Also, since the second most common life threatening problem with anaphylactic reactions is hypotension, high blood pressure is a feature, not a bug.

    Im pretty confident in my own ability to do this. But I’m an ICU doc and I do this kind of stuff daily.

  11. I have no idea why she’d care about keeping epinephrine warm, comfort on injection really isn’t a consideration in an emergency.
    Hell, the patient is typically semi-conscious to unconscious by the time even a pen is administered.

  12. There are more problems with the meme than you’ve covered here. If you would like a response to the meme from a trained healthcare professional, please let me know.

  13. Well, doc, I’ve used phials for epi and also phials of diphenhydramine. I’ve even used multi-dose vials of other drugs, to include Prednisone. Operable here, as Prednisone can also halt the reaction and indeed has done so.
    With the program of epi if shock is present or airway occlusion ongoing. Diphenhydramine 50 mg, IM initially of shock and airway occlusion is not apparent, second if airway occlusion or shock is present, followed by Prednisone PRN subsequent reactions (or guided by the severity of initial reactions).

    That was documented in our protocol book, that section being part that I was personally involved in creating and maintaining.

  14. I dosed animals for research routinely and I’m not willing to go this route! A little extra epi could be just as bad as my allergy attack. Personally, I have been trying to find out how much efficacy epi-pens lose over time. They have a 1 yr expiration date, but Tylenol is good for almost 4 yrs past its expiration…

  15. I love that the meme shows an ampoule. Sterile products tech in training here – if it’s an ampoule, you need two needles. One filters out the glass and if you don’t use that kind or use it twice, you risk teeny glass fragments going into the patient.
    Hopefully, it’s actually a vial. However, if so, you need to inject equal volume of air into the vial before removing the volume of liquid or you screw with pressure inequality aka partial vacuum creation. That’s another reason the time factor is high on this – while getting an injection into a syringe from an ampoule or vial isn’t rocket science, it takes training. You also want the needle to enter at the right angle and not end up with a rubber core in your epinephrine. The steps involved would be automatic to someone with training, but they are important.

  16. I for one WILL use this method. I have carried EpiPens for years, never used one. I have had 3 visits to ER where I got epinephrine shots. My wasp sting allergy has not been severe enough the six times it has happened to cause panic. Just high anxiety. I refuse to let my insurance pay these scoundrels that usurious amount. I’ll deal with self-administering if I ever have to. For people with severe, rapid reactions, Epi is appropriate, and the price needs to go back to where it was ten years ago. But I’ll opt out in the meantime.

  17. i guess you answered my question. no training or experience. i thought so… not everyone can afford an epi-pen (even at $100 each) better to have them have a chance with manual sub-q.(like the old ana-kit) than nothing at all….

  18. i guess you answered my question. no training or experience. i thought so… not everyone can afford an epi-pen (even at $100 each) better to have them have a chance with manual sub-q.(like the old ana-kit) than nothing at all….

  19. Particularly as you should never administer adrenalin for anaphylaxis subcut, as it is slower and less reliable a route, it should be an intramuscular injection into the lateral thigh. *sigh*

  20. @Jim d, having that which one is unable to use is quite the same as having nothing whatsoever.
    What good is a phial that’s accidentally dumped to a patient? Or a phial that the one handling it remains unopened, due to a lack of knowledge on how to properly open that phial and fill a syringe?

    The Epipen was designed for the military, a derivation of the atropine and Pralidoxime (2-Pam Chloride) autoinjectors for use in the Mark I neve agent autoinjector kit.
    Why an autoinjector kit over syrette based system? Hesitation when seconds count.

    But hey, I’ve not your vast experience, only 30 years of experience and all as an SF medic.

  21. What I am seeing, however, are people that just simply cannot afford this! It’s this or buy food for the entire family to eat. It’s easy to sit there and say it should be an expense for them, but some folks just simply don’t have that much money to hand out and no insurance to cover it. AND, it’s ridiculous that the prices jumped up so drastically so quickly for no good reason at all. This was at least “affordable” before, why not now?

  22. If you are patiently and professionally taught this technique,you should have no problem administering this. You should have an extra empty syringe,sterile h2o and an orange to practice periodically so you feel comfortable in an emergency. I’m an RN and believe me, scaring people with these comments is totally unnecessary. Pull yourselves together.

    • You’re an RN and that’s awesome, but are you a person that has required (or had your child require)immediate use of the epipen?

  23. [Now-]civie medic here in Israel (hi!)…what happened to the filter needle, so you’re not also injecting microscopic glass fragments that will eschar? Also…WTF AMERICA? Our epi autoinjectors are like $15 for a pair, if I’m converting correctly. And because they’re not from Mylan, they don’t “expire” every 6 months, either. At least no ones teaching SL inhections, anymore?

  24. Just one question. Why can’t the Epinephrine be predawn and placed in the ten box for instant use as needed like the EpiPen? It can be refrigerated if needed. No mistakes in dosing at time of emergency.

  25. Intramuscular injection in the lateral thigh (not a subq injection…which takes MORE fiddling around) has been shown to provide the fastest uptake of epi. It’s faster than IM in the deltoid muscle, and decidedly faster than subq in the arm. You’re not really too concerned about a “minor” overdose (I’m not talking about giving a 500% overdose here). The other thing worthy of note is…don’t throw it out the day it expires. We’re not talking about whole milk here. It would have to get REALLY old before it lost much of its “goody”, and old epi is way better than no epi when you need it. There was a case not long ago where a woman watched her 19 yr old son DIE because the 911 dispatcher told her not to administer a (slightly) expired epi pen and she didn’t. That was criminally stupid!…but if you DO use a vial, don’t “save what’s left for the next time”…replace it at once, and you’re right that this isn’t something that you’re likely to successfully self-administer.

  26. I totally disagree with the author. Paying $500 dollars for convenience isn’t really convenient for most people. So get a list of dose vs. weight and check when the time comes. Speaking as a physician, 2-3 minutes is not going to end your child’s life. If you’re really concerned, practice with an orange.

  27. That is the most horrid commentary I have ever heard from (supposed) physician. Benadryl is NOT a viable replacement for Epinephrine. As a matter of fact, most Allergists will tell you a number of reasons NOT to use it for anaphylaxis, even with Epinephrine. I want to know, why didn’t you use it for your reaction? You used Epinephrine…why isn’t what’s good for the goose good for the gander? Also, Anaphylaxis is NOT uncommon. Where on earth are you getting your information from? When did you attend medical school and how long ago? Pleeeease for the benefit of your patients, brush up. And stay away from advising the allergy community until you do before this advice really hurts someone.

  28. Christine, perhaps you should check this link.
    The estimate was between 1.6 and 5.1% actually having anaphylactic reaction. By any mathematical analysis, that’s uncommon.

    http://www.aafa.org/media/Anaphylaxis-in-America-JACI-Article-2014.pdf

    You’ve missed the mark in regards to diphenhydramine, I’ve personally used it in treating anaphylaxis after administering epinephrine. Following that, prednisone was used, if the reaction were ongoing still.
    The entire reaction is due to histamine being massively released, so an antihistamine is called for and effective.
    Epinephrine is used as it’s a vasoconstrictor, raising the blood pressure, but leaving the histamine still in the circulatory system.
    Indeed, if one caught the reaction extremely early on with injectable diphenhydramine, one very well may avoid the need for epinephrine.

    Please learn about what you’re speaking about and the pathophysiology involved in an anaphylactic reaction!

  29. It’s probably so it works correctly. I have a disease where I have to inject high dose liquid hydrocortisone into my leg if I go into a crisis state, and the info on it clearly states that it must be kept between 15-30 degrees celsius. I have to use a vial and syringe and it sucks because when you need it you are not in a good state of mind. I wish there was an auto injector.

  30. I must be missing something there, Jim.
    Usually, if one is to perform a lifesaving procedure, they should also have the equipment and knowledge on how to do that lifesaving.
    Do you know how to properly sanitize, open and fill a syringe from a phial? Most people don’t.

  31. I with the, “Why wouldn’t you pre-draw syringes and store/carry them in a hard case?” crowd. IM injections are not difficult to administer. We give our own vaccinations and IM medications to our livestock. I have to draw oxytocin and administer it prior to milking certain cows. From the time I pick up the bottle to when I remove the needle from their butt is less than a minute and I have to draw exactly 1cc. Preparing your injections ahead of time would eliminate the stress of measuring anything. All you’d have to do is uncap the needle, jab into their thigh and press the plunger. It would probably take the same amount of time as the epi pen to administer.

  32. I was a field medic for almost 15 years and I’ve been a Registered Nurse for almost 30. I can say unequivocally that SciBabe is 100% CORRECT in everything she says.

    Even when it wasn’t me or my family member going into (or already in) anaphylaxis, it is difficult and time consuming to draw up the CORRECT amount of Epi from a vial. And I wasn’t the one panicking!

    Then add in trying to figure out your child’s weight (every dose you give a kid is weight-based) while he/she is turning blue. It’s not going to happen. IF you choose to use the syringe / vial combo, I can GUARANTEE that the child will get the WRONG dose 99 times out of 100.

    Mylan, the manufacturers of EpiPen, need to get their heads out of their asses and do what is RIGHT, rather than what will make their CEO more money (BTW – she is a HUGE Hillary contributor).

  33. Ok so this is where we are….Little Jimmy is having an allergic reaction to peanuts Jimmy doesn’t have a pen….mom could not afford EpiPen. The kit is the next best thing while waiting for 911 to get there… NONE OR SOME?

  34. I don’t believe anybody sane or rational is recommending that untrained individuals go out and acquire hypodermic needles and epinephrine just because they’re being cheap.

    If the money is simply not there to pay the $600 because one is too poor and doesn’t have insurance to cover it then this method when prescribed by a doctor and when one has been properly trained and has been practicing the technique so that in an emergency one can in fact deliver to the injection safely then utilizing this method is certainly better than dying.

    Of course we should all recognize that the

  35. Note to the moderator of this site… I just spent a half-hour composing a very long response 90% of which was deleted… Please cancel that last posting as it is missing the last 90% of what I wrote.

    It’s a mistake to compose anything in these kinds of fields on the internet… Far better to do it in the word processor and then put it up so you have a record of what you wrote… Apologies for that error.

  36. If you are a dr and you believe that this was an appropriate comment, then you sir need to return to medical school.

  37. What about epinephrine prefilled syringe kits? They’re basically ready to use syringes filled wt adrenaline and with an attached needle.

  38. In an emergency situation, one would not worry about “sanitization of the vial”, but hands could be shaky as far as filling the syringe, I agree.
    For Type 1 diabetes, there is an emergency medication glucagon that, the last time I checked, consisted of a Vial with powder, a vial with Liquid and a syringe. The user needed to mix the solution with the powder, withdraw into the syringe and then administer. This has been standard for years.

  39. I can only say that the one time I encountered the bee sting reaction in a child in my care, I was terrified that if I administered the epinephrine shot wrong, that I would injure the child. What if I got the dose wrong? What if I didn’t hit the right part of the muscle? What if the shot didn’t work? How would I know if it did work? The epi-pen is the safe sensible alternative in that anyone can use it, no matter how unskilled, no matter how nervous and even if you are, yourself, in need of the medication and close to passing out. The greed of the manufacturer is the issue here, not the fact that alternatives exist.

  40. When backcountry skiing, the vial freezing is a real risk. Frozen epinephrine can’t be injected. Extreme temperatures also degrade the medication.

  41. I am not medically trained, but am susceptible to anaphylaxis. I have read in official medical research journals that epinephrine is more than a vasoconstrictor, but also diminishes or halts the release of histamine, so is considered the 1st medication to be used in a severe reaction. Antihistamines counteract the histamine already released, but does nothing to halt the reaction. Sorry, no links.

  42. Ms. SciBabe (wtf kind of byline is that?! Certainly not one that garners my respect for intelligence or medical knowledge) But I digress… while a few things the author says sort of make some sense,
    she willfully and completely glosses over
    the MAIN POINT OF THE CURRENT CONTROVERSY:
    A great number of Real People **cannot AFFORD** EpiPens.
    FACT.
    And THAT FACT is what is TRULY threatening people’s lives.

    So no scathing, “you’re all so stupid & **I** know-it-ALL” articles like this one can change that simple fact:
    That given the choice between this cheaper alternative
    and NO alternative whatsoever, THIS single kit CAN save lives.

    If you want guarantees in your clearly well-insured, well-paid little life, Ms. SciBabe … if you want to chip in and buy artificially exorbitant EpiPens for the hundreds of thousands of people who absolutely need them but cannot afford even one, then by all means, speak up and step up to the plate. Take your best shot with our thanks.

    But until you are willing to walk a mile in real people’s shoes, until you can write FOR people and not DOWN to them (who the F are you to proclaim instant, fatal hysteria will happen in each and every case?!), in short: STFU.

  43. First, I thinking an Epipen or equivalent would be the best option. However, if the person absolutely can not afford one (and there are those people), a vial, a syringe, and training is better than nothing.

    I’m on insulin, my son is on a very rare injected medication. I’m comfortable with injections.

    I also have hypoglycemia unawareness. I have another injection for that. When this is given is if I’m unconscious or well on my way there. This med requires some preparation because it is not stable after it is a solution. You must pop off the top from the vial, inject the liquid into the vial, mix the powder in the vial, and then draw the correct about and inject. I sure hope you’ve never had your blood sugar in the 20’s and rapidly dropping, but I have, and I’ve had to do this for myself (while simultaneously calling 911). It sucks, but it is the only option other than to wait for EMTs to arrive.

    Then there are the periodic deaths I hear of in the US (abroad it is much more common, but for different reasons) because a person tried to not take as much/any insulin because they can not afford it. I’ve been put in circumstances where I have had to pay out of pocket (I broke my last vial and couldn’t get an override to get more sooner, I was out of state and we just couldn’t get it to go through). The insulin I typically use is $500 a vial (I use 3 vials a month). I can make do (doesn’t work as well, but I can make it work well enough) for $150 a vial. I can go to Walmart and get the same thing as the as the cheaper one for $25. (Note these insulins are $12 and $2 respectively in India). Each time I’ve done this, the pharmacist comes and tells me that what I’m about to do (switching types of insulin) is dangerous. Yes, but if I didn’t I would be dead.

    So would it be best, safest, and easiest if you could have Epipens- yes. But if people can not afford them and the choice is them having nothing at all, or something that is harder to administer and gives the person a chance to live- I will always choose the second.

    • But the syringe and vial isn’t second choice. Adrenaclick is second choice. Then the generic epipen is third choice, and they are available and you have to ask for them by name.

      This option can leave you dead or brain damaged due to lack of oxygen to the brain. I’m not sure what people are missing here.

  44. Sooooo what does all of that have to do with the average Joe or Jane attempting to administer vialed Epinephrine to their loved one or themselves during a severe allergic reaction?

  45. My level of medical training? That’d be completed doctor of veterinary medicine, and 11 years full time practice + after hours emergency rotations. And I agree with SciBabe.

    I would not recommend someone without medical experience try to draw up emergency medications and administer them… I’ve seen entirely too many clients misdose medications that were demonstrated in clinic, dispensed with written instructions, and given at scheduled times under no pressure.

    Add in the whole “my eyes are swelling shut” factor, and expecting someone having an anaphylactic reaction to be able to calmly, quickly, and accurately measure a dose of infrequently used medication in a small syringe is just asking for trouble.

    Also, you should consider taking your mansplaining arrogance on a long hike without company and leave the reasonable people alone.

  46. Hey SciBabe… I’m not saying you’re wrong because you may very well be right, but did you bother to click on the link that was attached to that meme before you decided to lay this on the crackpots on the net?

    http://abc22now.com/news/local/epinephrine-injection-kit-for-under-10

    “Dr. Marcus Romanello is the Chief Medical Officer and the Emergency Medicine Physician at Ft. Hamilton Hospital in Hamilton.”

    Maybe you professionals should hash this out before you decide what the medical establishment should say about this…

  47. WHAT? PHYSICIAN? OF WHAT? No no no!!! It is a known fact look up in cdc guidelines, in all the AAAA guidelines it specifically says benadryl/antihistamines is not a treatment for anaphylaxis. Epinephrine is the ONLY LIFE SAVING MEDICATION AVAILABLE and should be the first and immediate administration when treating anaphylaxis. Only after giving epinephrine then can you give antihistamines and Inhalers after you have called 911. Shame on you for spreading terrible misinformation. My son Giovanni Cipriano is dead because I had a doctor who told us what you are saying. That is old protocol. Deadly please check your facts so you don’t kill yourself or anyone else.

  48. Epinephrine must maintain a certain temp. If it gets too cold or too hot it is not effective. Those who travel with epinephrine go to great lengths to keep it at temp. It has nothing to do with COMFORT.

  49. While you make very valid points…has it occurred to you that maybe not everyone has $600 to spend on the epipen? Maybe some people aren’t just “trying to save some money” but actually don’t have it to spend?! My family is one of those families. We literally live paycheck to paycheck.

    • It’s probably why I said to look into Adrenaclick or the generics that are available. Because there are options, but this one isn’t valid if you want your kid to live.

  50. Jim says:
    August 28, 2016 at 12:18 pm
    Wzrd1 – Epipen does it within 30 seconds

    Yea but most people have to choose. Anaphalaxis is uncommon – even people who do suffer from severe reactions may go several years without ever getting a reaction.
    Hunger is a 100% guaranteed killer. No food = die.

    For most people that is the choice – risk having to rely on untrained people administering the syringe, but have food to eat, or buy the autoinjector but go several weeks with No Food.

    Option 1 gives you a slightly worse chance of survival if you go into anaphalaxis. Option 2 you have a better chance of surviving that, but you are going to die from hunger anyway.

  51. One dose for Adults and one dose for kids.
    Just like an EpiPen. No fiddling with doses.

    Don’t over-dramatise anaphylaxis.
    Not all anaphylaxis presents as catastrophic circulatory collapse and shouldn’t be presented that way either. That is how kids don’t get treated. They are expected to be treated with adrenaline far earlier.

    It isn’t hard to teach.

    It is an Intramuscular injection, not subcutaneous. Just as an EpiPen or other auto injector would do.

    The issue of price gouging is a seperate and unconnected issue to the ability of lay people to provide a life saving intervention.

  52. Thank you. So many people *don’t* have the option of getting anything else. For them, this post would have been served better in explaining exactly how to do it effectively.

  53. What’s criminal is scaring people into thinking they can’t do a simple injection on their own so that they have to pay the $600. Shame on you!!!!

    • Yes, using science- studies showing that people have not been able to accomplish this task in an appropriate amount of time to get oxygen to them or their children- to get them to make a smart decision- means I’m morally bankrupt.

      Totally.

  54. As someone who takes a medication via sub-q injection, it’s not nearly as difficult as people make it and you can certainly inject it in a hurry. Even with the epi-pen, you still need to be somewhat coherent to inject it and need to make sure you’re in a muscle correctly. Not everyone would panic and its asinine to pay $600 for an epipen. Obviously this isn’t the best way but it certainly isn’t as bad as you’re portraying it.

  55. Ugh – you guys, i s not that hard. I used to give myself injections every day too. But an epi pen is not for self administering. You’re going into shock- you’re not able to stab yourself. Someone is going to do it for you. If this kit is the only way someone can afford to have the necessary tools to save their child who is allergic to something, this will work just fine. If I needed an epi pen, I would completely consider this as an alternative to being charged more than half of my rent! It will do the trick. If you’re worried about it, you can buy little injectors that do it for you and it’s still under 30 dollars for the kit! The injectors are great- you fill the syringe, put the whole injection into the automatic injector, push the button, administer the medicine, and your life is saved.

  56. Primatine inhalers aren’t on the market any more.

    More recently, many medical societies have recommended the prescribing of Epipen for people with asthma but no history of anaphylaxis. There’s an economic demand/supply/cost component to this as well.

    Sincerely,
    A former SciBabe, now a PharmacistBabe

  57. Ah, 30 seconds from IM injection to the circulatory system ignoring the vasoconstrictive effects of epinephrine.
    Turning that 30 seconds into a minute or two.

    Meanwhile, ignoring the hell out of the argument against the use of a phial of epinephrine, for which you seem to have repeatedly argued for, against the insanely priced pen.

  58. Years ago there were no epi-pens. You got a pre-filled injection. You took the top off and gave yourself a shot. I know because I had to use it myself for bee sting allergy. If you REALLY need to do it you will. Ask about a pre-filled injection from the drug store. They may still be available. I recall that they did expire every year but hey it would be less expensive if you can not afford it.

    • It’s feasible, but they expire more quickly in the small syringes and, at that rate if money is the issue, you might be better off buying one of the other alternatives/generics that I’ve linked to in the article.

  59. many medical professionals feel this meme is appropriate, not as medical advice, (although for medical professionals used to working in high stress environments it would be), but to point out the price gouging and absolute corruption displayed by this situation.
    The drugs are dirt cheap
    the technology such as it is is decades old no need to recover the cost
    it is simple greed and holding peoples lives hostage. period.

    sorry if you did not get the idea behind the meme.

    • Could you point me towards these “many medical professionals,” because I have a PA and an ER Nurse on my staff who both said this meme is stupid and dangerous.

  60. Must be a stock holder. Many people will have NO protection for their kids or themselves, $300-$600 a pen is not even an option for many. Greed will bring this company down. This article is just “sore grapes” because people and doctors are finding an alternative to the Epipen

      • Sorry, kiddo, but it’s a valid point.
        One is prescribed 1cc of epinephrine 1:1000. One delivers 1.5cc, the patient isn’t going to stroke out.
        Shoot at 3, things *might* get interesting. Maybe.
        6cc, yeah, things are gonna start to get real.
        10cc, so totally, flat out.
        A *little* off isn’t that big of a deal.
        Indeed, few are the drugs in common usage where the therapeutic window is so narrow, save APAP.

  61. Nurse here. I’ve treated anaphylactic(oid) reactions to iodinated contrast (think CT scans or angiograms) many times in the past. Even in the extremely controlled conditions found in an angiography suite having to draw up the correct dose of epi and administer it can be anxiety inducing. But you get it done. I agree that giving a little more won’t hurt in the long run. We have a saying during emergencies, we can fix _____ but we can’t fix death. Of course you do everything possible to mitigate or eliminate issues not associated with the original problem but you do what is need to save the patients life. This applies to the idea that things MUST to be swabbed to give the injection. If you have the presence of mind go for it but don’t worry about it if not and DON’T WASTE TIME. Same goes if you give a little too much.

    Privledge allows us to say that this is not a viable alternative to the EpiPen. What Mylan has done is despicable and there are thousands of people around the country that simply cannot afford the Pen at the current price and will go without it. What are they then to do? Watch as their child suffocates because they can’t afford the Pen or at least try to draw up a dose and inject it. Proactive education is needed. Nurses are ready, willing and able. Tto provide this education and training.

  62. This method worked for many years before and after the Epipen was invinted. It was invented in the 70’s for military use for another drug to combat nerve agents. Then it was introduced to the public in the 90s. The ANA Kit was basis what you have in this kit. Except it had a chlorpheniramine tablets also to help fight the allergic reaction. I have had an Epipen fail ans I would much rather have the ANA Kit, but they are no longer on the market.

  63. What you don’t mention and didn’t think about is that the syringes can be prefilled. The prefilled syringes maintain potency for 3 months and they can withstand exposure to temps as high as 38C (100F). So there is no fumbling for the vial, spending critical seconds drawing up the dose, taking up time trying to read the small numbers while sweat beads on your brow. There is open the pencil holder from Target, uncap the needle, slam it into the thigh, push the plunger, and count to 3. Extract. Apply pressure.

  64. are you kidding me. Prior to the use of Epi-Pen every one used the “old” self drawn dosage from a bottle. The pen was introduced for convince for traveling away from family who were trained by their doctor on how to use. It made it possible for kids to enjoy sleep overs, and camps. In a severe reaction there is no such thing as to much ! in that respect this is not insulin where the dosage has to be spot on, and yes I too have used both ways for my child who is now a grown with a family of his own. You are not worried about sanitizing the vial, phial, or flacon which ever term you want to use it is a IM injection not IV, you need to be speedy the reaction can kill them not the wiping of the top of the bottle.

  65. I am nurse and would love another doctor’s opinion to counter the previous post. I was trained to know Benadryl will act as an antihistamine but cannot counter airway inflammation and constriction…those being the life-ending problems.

  66. Oh Babe,

    I believe you have gone too far. While I agree it is a tense and nerve wracking experience, some of us are quite capable of dealing with that level of stress. In addition, perhaps a prepared person would have already filled a syringe or two with the appropriate amount of ‘epi’ and secured it properly. Just sayin’…

    • Oh Dick (as we’re shortening names),

      The meme said to deliver the medication in an incorrect method (subcutaneous vs intramuscular), in a way that studies show take way longer than is responsible to deprive a person of oxygen, and you need a filter syringe to go along with these vials to remove glass to ensure that you’re not injecting yourself with glass shards.

      So you can add all the “maybes” and the “some of us” that you want, but I was debunking this piece of shit meme and offering alternatives to the epipen that apply to current evidence. Just sayin’…

  67. *If* the diphenhydramine is injected immediately, one may and *just* may prevent a severe enough reaction to not need epinephrine.
    As in, for the handful of such events, I managed that precisely twice, on the same individual, within a minute of the service member receiving a bee sting.
    The rest of the time, they needed epi and even a steroid.

    Note the short time frame involved, where one’s interrupting a histamine cascade, plus likely, a cytokine cascade in general.

    As for expired epi, “The Pediatric Insider” had an excellent write-up just today on, “Some epi beats no epi”.
    https://pediatricinsider.wordpress.com/2016/08/29/expired-epipens-safe-to-use/

    Hell, I’ll trust a physician’s word over my own SF medic’s words any way. I always defer to a physician, save when it’s obvious that he’s wrong and that isn’t very common enough for me to act upon, as wrong encompasses delayed results or killing a patient.
    I’ve only overridden the physician once, as he was going to kill a patient and I quite literally, in a military environment, drew my weapon on him.
    His boss came in and defused the situation, relieving him for cause. Amazingly, I wasn’t sent to court martial for threatening a commissioned officer’s life.

  68. That’s bovine defecation!
    My wife had an anakit, a three step syringe that was prefilled with epinephrine, one rotated the plunger to add to the initial dose in three steps to give the entire ampule within.
    Steps, select the site, cleanse the site with the provided alcohol pad, uncap needle, jam it in, push and twist the plunger as needed.
    Also available, carpuject units.
    A phial, available then and now, not preferred. Having used the damned things myself many, many times while in the military, I still don’t recommend it today for civilian usage in an emergency.

    I carried phials in my drug kit inside of my primary treatment bag. I carried multi-use vials in my ambulance (when I had access to one), plus resupply of phials. I had multi-use and phials in our battalion aid station.

  69. First, sterility is not guaranteed.
    That said, PENCIL HOLDERS, Whiskey, Tango, Foxtrot, over?!
    Cigar tubes.
    Cheap, durable beyond a pencil holder, easily sanitized. Carried a bunch in my aid bag.
    But, prefilled can easily lose drug from jostling, isn’t assured of sterility, as the needle is open to the air, despite the non-airtight cap and overall isn’t preferred.

    That said, if that’s the only game in town, I’m playing it.
    Infections can be treated, dead can’t be treated.

  70. Thanks for the excellent memory, Amber3000! I had forgotten the antihistamine used!
    That said, limited civilian usage was present in the ’80’s, becoming far more popular in the 90’s.

    We had an original anakit, it expired, we replaced it, but it being already expired, was an item of curiosity for us. How long before sea monkeys sprouted in it?
    Between two and a half and three years, the stoppers degraded, leaving residue to accumulate as both color changes in solution and obvious particulates in the solution. At the end, particles accumulated in what was obviously growth and we destroyed the unit.
    I don’t know precisely what sea monkeys were growing in there, but just in case they actually were gorillas I incinerated the unit with a welding torch.

    Yes, I’m known for colorful idioms, useful when one wants infantry to learn an important point.
    I quite literally had a combat lifesaver come to me, during one of his refresher courses and relate how he identified contaminated IV fluid because he remembered the “sea monkey” crack. As the refresher in question was well over a decade later (I didn’t handle *all* refreshers), it’s notable.

  71. Benadryl will not reverse an anaphylaxis reaction nor will an inhaler regardless if it contains a small amt of epi. In fact Benadryl can mask symptoms of an allergic by calming itch and causing drowsiness.

  72. That’s actually the old formulary…. of course no medication can withstand extreme temperatures- be it hot or cold, but Epi-Pens don’t have to be kept as cautiously as before. And actually, even super expired Pens are better to use than nothing at all… like this dumb ass author suggests.

  73. @stanley kristiansen, their thought is, lousy epi vs no epi, no brainer, as we can’t fix dead.
    I’d advocate for a multi-use vial, to only be opened during an emergency.
    Phials are notoriously tricky, I’ve even had a case load that weren’t scored, creating an issue when trying to decant the medicine when needed at a battalion aid station. Said medication ended up being recalled for the lack of scoring, we retained them and filed the damned necks, sanitized them and put them in stock.
    But then, I’m nearing social security age. We knew those tricks, we were trained in them.

    Easy usage by those not conversant in daily usage is critical in survival, not tricks and traps of the trade and science.
    In short, not returning back 50 years, but keeping our advances.
    Or is your desired goal for this second world nation to become yet another developing nation?
    If it’s the latter, shouldn’t we re-introduce smallpox, so that 1/3 – 1/2 of children born should die in childhood, to Make America Great Again?

    If so, your father should’ve worn a rubber.

    Yeah, I got my own dirty jokes. They’re not as pleasant.

    • as medical advice it is not, but I thought I was quite clear that the meme was to draw attention to the price gouging by illustrating how inexpensive the drug is. so to repeat it is appropriate to illustrate a point.

  74. Stating something is science (based off of one study) does not mean the conclusions and real world applications are immutable. And it is privilege. People who can afford the Pen versus people who cannot. The vial and syringe method may not be good enough for you but for People who require Epi. And cannot afford the Pen it Will have to do until the price is reduced. The poor shouldn’t have to use what is admittedly an inferior method but that’s the way it is right now. Just like with most other things in this world you do what is necessary to survive.

    Instead Of instilling fear in People we should be giving them the knowledge and confidence to act courageously and competently in dire circumstances. Do you think ours easy for parents too perform CPR on their children? Feel their ribs crack twigs. Of course not but they do it because they have been taught correctly. Proper education is certainly key. Your entire dramatization of managing an anaphylactic reaction does not support, educate or uplift but rather instills fear and hopelessness in those whose only option maybe to use the vital and syringe. What is it you wish to accomplish? Start from there.

  75. “What’s criminal is scaring people into thinking they can’t do a simple injection on their own so that they have to pay the $600. Shame on you!!!!”

    You mewling quim, go away. Makes me feel better is superior to actual effective treatment is bad.

  76. Sorry, but I would have zero problem with this method. I am 100000% certain that I could administer properly and quickly enough. I am certain MOST could if shown property by pediatrician. Parents possess superhuman abilities when it comes to the life of their child. Makes me wonder who really wrote this? Someone who works for Mylan???

  77. Why, you’re absolutely correct, Kelly Murphy.
    That’s *why* the military abandoned the drugs.

    Oh wait, we didn’t.
    One of us is an idiot, one of us got to have a hell of a lot of damned fine men and women come home.
    You’re not part of that membership, kid.

  78. So people who have children with deadly allergies & can’t afford the EpiPen should just risk letting their kid die?
    Noone said to just go to the pharmacy & ask for some epinephrine & syringes. They said GO TO YOUR DOCTOR & have them show you how much to draw up & how to administer the shot. Just like diabetics.
    And using a needle isn’t that hard. I was a heroin addict for 8 years. When you’re dope sick you spasm & twitch & shiver & shake uncontrollably. But I always managed to hit a vein. And with a subcutaneous shot you don’t even need to aim for a vein so it’s not that tricky.
    I can understand wanting to warn of the risks of not talking to your doctor & taking it into your own hands. But shaming people, who have no other choice but to just let their kid die, is wrong.

    • I love that a former heroin addict is trying to give advice on epinephrine administration while you’re unable to breathe. This is priceless.

      Someone get me more popcorn.

  79. as medical advice it is not, but I thought I was quite clear that the meme was to draw attention to the price gouging by illustrating how inexpensive the drug is. so to repeat it is appropriate to illustrate a point.

  80. You are funny. The person above flat out says that years ago she did this. Your response is that years ago when people did this they died. I guess her ghost is writing. Why is it that you refuse to believe that there are competent people out there? Also, why do you refuse to believe that some people honestly cannot afford even the generics? Have you always been surrounded by rich incompetent idiots? Make do and hope for the best is real fact of life for a lot of people.

  81. If diabetics can get counseling and training by doctors, teen and adult allergic-persons can as well. They can tell us what dose for our weight/size/need. Show us how to use the syringe and vial and how to store it. A generic autoinjector would be great for travel and out of the house, but at home or with a travel-case if desires, why not? WE’re not idiots. If we’re trained, we can shoot ourselves. It would be BETTER to have inexpensive autoinjectors. But with the greed of these companies (Mylan exhibit #1), how long will it take to get one that’s $100 or so? That generic EpiPen is $300. Still overpriced for something most of us never use and throw away in a year. And does it actually expire in a year or is that part of the $ scam?

    For poor patients for whome $300 is out of the question, training and subsidies for vials and syringes might make sense. Doctors can gauge if there is a maturity level and understanding and know to offer an alternative if there is not. My uneducated (never graduated high school) mom who didn’t speak English got a syringe and steroids from my doc in the 60s, when I was constantly having bad asthma attacks and pneumonia. She administered it safely and properly at home and STERILIZED those reusable syringes. I never got an infection or an overdose. If a woman with a fourth grade education can learn, shoot, anyone with a functioning brain and motivatrion can. Diabetics prove that in the country: EVERY DAY. I’d prefer cheap autoinjectors for convenience. When they appear, great. But if they don’t, we have to consider syringes.

    • So people who go into anaphylactic shock can be trained on how to administer a dosage in a real life situation by having a doctor cut off their oxygen supply while they’re attempting to handle a filter syringe?

  82. Primatene stopped being OTC years ago. I know. I used Primatene for years in my youth for asthma prior to Rx albuterol puffers.

    Can Primatene still be gotten? I think it’s stupid to have removed it from OTC. People should be able to get these things OTC as needed. Barriers to proper, mature self-medication are dumbass.

  83. stanley kristiansen, The danger here is that I can picture people taking the meme as serious medical advice… or at least giving it more weight than just, “huh, I wondered why it was so expensive.”

  84. What ever happened to the 80’s era Ana Kit? A pre-filled syringe with 3 doses of epi & a cammed plunger to guarantee correct dosing.

  85. isnt it terrible when people have to decide to pay for food for a month or 3 or buy one epi pen. guess what before epi pens were invented the syringe and vial was what people had to do. This is the drug companies trying to scare people out of a cheaper way to get the medicine. they got so greedy that now people cant pay for the drug. yes is is harder to draw medicine up in a syringe than use an epi pen , but like i said it was done before and could be done again. also even if you drew it up every day ahead of time and threw it out if you didnt need it you would only pay 300$ a month instead of the almost 700$. its about time the government makes an affordable drug act and stop taking all those campaine donations from the drug companies. if these companies can sell thier drugs in other countries for a very small amount of what they are charging here then its about time we try to get something done about it.
    it doesnt help if you can now go to the doctor because you have insurance but cant pay for the medicine – might as well not even go to a doctor.

  86. I did not read everyone’s
    comments, but why not spend $30 on one of these and preload it each year with the appropriate dosage (since epinephrine expires annually): Owen Mumford Autoject 2 Fixed Needle Injection Aid Device – AJ1300. Thats what I would do…maybe cost 40 bucks total without fighting with insurance to pay for it.

  87. I been there there done that and had a very serious reaction. My previous dumbass nurse practitioner told me to take benedryl instead as it had worked before my most recent anaphlaxis. I got a food with clear very hard to read label. I felt an immediate reaction. I was Driving!! I took 3 benedryl as she told me to. By some miracle I made it home and then 10 minutes later had the mother of all reactions. Had tachycardia plummeting bp. Heart pounding so hard I felt it in my mouth. ER called but luckily I vomited it all up stopping the reaction. The jerkoff paramedic told my hubbyit was a panic attack and refused to transport me.
    I was fine thanks to my rebellious digestive system. If I weren’t lucky that night my kids could have lost their mother. It certainly was not due to the smarts of the medical professionals around me. I no longer go to that NP. Now I carry an epipen everywhere. No food goes into my mouth without me looking at the label. I even bring my own dinner to parties at friends homes. Going out to eat is just plain scary as I’m allergic to sunflower seeds and avoid the oil for safety, although I’ve never reacted to it strongly. Good bye potato chips, I miss you but just not worth the risk.

  88. @Mitch, while I conditionally agree with the transient hypertension bit, it’s conditional.
    I’m highly adverse to considering even transitory hypertension, aortic dilation and all, no need to risk it turning into an aneurysm.
    Crap! That reminds me, doctor forgot to order a repeat ultrasound on the damned thing.
    Excuse me while I go visit the patient portal…

  89. Referral requested for abdominal utrasound to follow up on that aortic dilation, well post six months after discovery.

    My abdomen moved like a scene out of Alien…

  90. I just realized, by reading this post, that the US does not have a generic drug law, what the hell, how do you people stay alive?

    • What do you think of the autoinjectors that people can store pre-filled syringes in?

      I’ve seen a few videos with those and they seem to administer a pre-filled syringe similarly to an epipen after being filled (one button press, done). It takes out the guess work, pushes the plunger all the way down, and gets the “holy shit I’m administering a syringe and I’m scared and it’s a needle haaaalp” mentality out of someone’s brain because they don’t see the syringe or the needle.

      I like the concept a lot, but I wanted to ask a doctor. I’m considering writing a follow up to this blog with just some alternatives. Because there’s been a bit of yelling this week. :-p

      What worries me is the thought of someone who doesn’t use syringes regularly trying to fill the syringe when they’re seeing someone going into anaphylaxis in front of them OR going into it for their own anaphylaxis. That scares the crap out of me.

  91. What is with the filthy language?? I wouldn’t trust anyone’s explanation if the only way they explain it is with a four letter filthy word in every sentence, sounds like there is not too much upstairs… with proper instructions they will do fine..

  92. Nice try on scaring people. You make the argument for difficulty getting the right dose. EpiPen doesn’t have dose options. They are all the same. All the person has to do is have the needle preloaded, ready to go

  93. My child with life-threatening allergies also has Type 1 Diabetes. No surprise there considering both conditions are caused by an infuriating overreaction of their messed up immune system.

    So, with that said, we give a LOT of injections in my house. I’ve seen them have a severe allergic reaction once, before we were prescribed an epi-pen, and let me tell you – it was a horrific experience. Wheezing, swelling throat and tongue, eyes turning as red as a cherry popsicle. I was able to remain calm(ish) and get help, but even being as confident as I am now in drawing up a syringe, making sure there’s no bubbles and confidently giving injections there’s no way I would ever trust myself to be able to draw up a syringe of epinephrine and administer it as fast as it needed to be in such a crisis as that.

    • I’m so sorry you went through that. So, so sorry. That sounds horrifying.

      And thank you for pointing out that there’s a big difference between administering a syringe in a controlled setting for diabetes (which is still unpleasant) and during the “HOLY SHIT MY CHILD CAN’T BREATHE” setting of anaphylaxis. Everyone saying they’d be the parent who could remain calm is… well, who knows. Maybe they’d miraculously suddenly be able to work a syringe, measure the medication just perfectly despite not using it regularly, their hands wouldn’t shake, their child would be just fine, and I would be proven wrong. I GENUINELY hope their child would be fine.

      But I wrote this blog entry because I thought you, Type1DMom, were the rule of how they’d handle the situation, not the exception, especially given that you’re familiar with administering it in both situations.

      Thanks for your input. Is it okay with you if I screenshot your comment and add it into the blog entry?

  94. To the people talking about inhalers, the problem with an inhaler is you con not breath. I have asthma and my daughter needs epi, when a severe reaction hits you can not breath to use the inhaler. Yes in an emergency I did hand her my inhaler and no she could not use it. That is how we found out she needed epi.

    She is an uninsured adult and 600 dollars id cost prohibitive so I will be suggesting she ask her doctor about the generic pen. I can guarantee you that neither she nor anyone she knows would be able to use the 10 dollar alternative in an emergency situation.

  95. At least we haven’t seen a Jude Law look-a-like selling homeopathic treatments for severe life threatening allergic reactions as a result of the price hike.

    I hope not anyway.

    A very important and responsible piece from the always engaging Science babe. Thank you.

  96. People in real life are more than a study.

    Lay people do surpringly well in caringfor anaphylactic reactions in others.

    Not every country has access to alternate administration devices.
    Nor do the public pay rude prices yet for their autoinjectors.

    Should the time come for our lay people to nut up, I’m sure they will.

  97. Let’s be honest. The only reason “this is a horrible idea” is that the American people are intensely stupid. Did you think I was kidding when I kept saying (in places like Salon.com) that only ten percent of the population here knows how to read? If I were more cynical, I would call this a Darwinian solution to making America smarter again. But in all honesty, how hard is it to make a limited-dispensing injector that you could fill from an ampule of medicine? Why isn’t someone working a way to get around the Epipen copyright? Oh, yeah…because even among the ten percent of Americans that have reading ability, there’s still a LOT of stupidity out there.

  98. I did not see one comment here about what is called “the middle man” in all of this and it is important. While we excoriate Mylan endlessly let us not forget the “pharmacy benefit managers”. Raise your hand if you’ve heard of them. I thought not. Mylan’s price for the twin pack is reported as $274 and, according to Chris Fleisher of the Pittsburgh Tribune-Review, “middlemen tack on charges that boost the list price to $608. There is no further details about just who these middlemen are and who they are working for. I intend to find out and suspect that they are hidden and bear as much retribution and anger as Mylan.

  99. I was going to share until all the foul language started. What does that bring to the conversation? You are angry and outraged? Say that.

  100. @Thomas Reed, why indeed, I must concur, there is a great deal of idiocy and a profound lack of reading comprehension going right here.

    For one, it was mentioned, here and in multiple other sources, the patent has expired and devices aren’t copyrighted, they’re patented.
    Other devices do exist, in highly limited numbers, others actually exist but aren’t approved by the FDA.

    So, all that you’ve proven is that you have a significant reading comprehension problem.

    Ideally, what would be of greater effect is if the FDA would have binding agreements, preferably under a ratified treaty, wherein specific nation approval agency testing is automatically accepted by the US FDA. That way, we’d not begin to reinvent the wheel with each and every new drug or device that is approved in other advanced markets.

  101. One problem that I’d love to see professional input on, how long is the solution to be trusted in a prefilled syringe, which would likely not be stored in entirely aseptic conditions, merely clean(ish) conditions and variable environmental conditions?
    How long before the plunger degrades? How long before bacteria proliferate within the needle and from there, into the syringe itself?

    Prefill in a clinical practice is one thing, I’ve done that many times in military clinics. But, we had studies that supported how long we retained our preloaded syringes, by drug type and conditions. In a field environment, we discarded preload at COB each day, in a full clinic, it varied by drug.

  102. @Daniela, I’ll not speak for all of my countrymen, but we do manage to barely (at times) make it work or we substitute to a less preferred drug.
    Case in point, my wife was prescribed Tresiba autoinjector for her diabetes, our insurance company wouldn’t cover the newer drug (despite less cases thus far of hypoglycemic episodes with it over Lantus), so she was switched to Lantus and I paied $50 for 5 autoinjectors.

    Initially, I was somewhat dreading her taking insulin, as I have to remind her of best practices (such as a patient care handwash, sanitizing the site, etc and short steps could potentially result in infection) and with her dyslexia, a dosage error could create a condition where I’d come home from work to find her comatose on the floor.
    Fortunately, autoinjectors are the norm today, reducing the number of potential errors.

  103. Well, considering one pediatrician was ranting on Twitter about a colleague prescribing azithromycin entirely inappropriately (in short, for an infection that wouldn’t be treated by any antibiotic), the standard of care isn’t very tightly conserved throughout the land.
    Some physicians prescribe a drug, be it antibiotic or epinephrine injector due to patient expectation.
    Others, due to patient expectation and a concern for physician reviews on one of the many testimonial physician review sites out there.

    We started with a new physician at the beginning of this year, as we had just relocated. The first thing that I did was explain to doctor, my only expectation is best quality of care with evidence based medicine and that we’re a team.
    That was received with considerable relief. His alarm began when he began reviewing vitals and later, labs and ECG findings.

  104. First of all, how can it be emphasized enough that the likelihood of the need for pharmaceutical intervention is statistically remote. Pre-filled syringes of epinephrine are perfectly sufficient for emergency kits, and there is absolutely no reason to be forced to break vials or measure a specific dose from a vial for administration in an actual emergency. Ask yourself: how were we managing anaphylaxis in the field – for children or adults – before the Epipen? They are charging these outrageous fees by playing on fears that it is impossible for a non-medical patient, parent, or caregiver to deliver a correct [adequate] dosage in the event of an emergency. An IM administration of epinephrine does not to be perfect, it needs to be efficient and adequate to intervene in an emergency. Modest training & practice allows anyone to halt the reaction, stabilize the individual, and call for emergency care. Before the Epipen, it HAD to be done; there was no choice and no other option, and the literature reflects the fact that, in the overwhelming majority of cases, it was done effectively and adequately in the field by parents and others, with minimal instruction and practice. The analogy of diabetics administering insulin or men self-administering testosterone – both IM injections – is perfectly reasonable: even in a crisis, it is not that difficult. And most pertinent to this discussion, the cost is ridiculously low.

  105. As a Registered Nurse trained in administration of medications under emergency situations, I can attest to having personally drawn and administered epinephrine both to my own children and to myself during emergent situations. It can be done. I will admit that when self-administering I was shaky and started second guessing the dosage, however successfully completed the injection and recovered. While it is possible to efficiently draw and administer the correct dose to another person, even your own child, it was difficult to self administer. I do in fact carry EpiPens in my first aid kit because they are reliable and easy to use. BTW, epi does not have to be injected to work. Anyone trained in emergency medicine knows epi can be administered orally and is absorbed readily by oral mucosa.

  106. As soon as I saw your comment I had to voice my support as your description is obviously that of Addisons Disease. My wife and I are both nurses (I was also a medic for 12yrs before becoming a nurse l). My wife has EpiPens due to severe food allergy issue due to milk (we still believe it’s a cross issue with her severe allergy to cephalosporins). She’d been fighting with her endocrinologist due to chronic low cortisol issues we thought were due to her long term use of inhaled corticosteroids to Tx her asthma. After a Stim test the bad news came out she too has Addisons Disease according to her Endocrinoligist. She’d had signs of borderline adrenal crisis a few times with hypotension among other things and we assumed the fatigue issue was due to her mixed thyroiditis turns out Addisons was more likely to blame. She’s on PO Hydrocortisone now but of course getting dosage aligned isn’t always easy as well as timing it out and of course the known fear of a severe stomach bug could now lead to adrenal crisis if her meds can’t be kept down. Guess it’s just one more thing that we have to deal with.

  107. I got a pretty good laugh from your article. It contains some fairly accurate info delivered in a humorous way. I am a veterinarian who had to pull up Epi & give it to am employee – after the hospital manager accidentally tried using the epi-pen & injected her own thumb instead of the person who needed it. I saw first hand what can happen when someone panics, & that was with an Epi-pen. Well done article! 🙂

  108. I agree with this article. My mother died from anaphylatic shock from a shellfish allergy that she was not aware that could be fatal. No one, not even her doctors mentioned that little fact. I was with her when she went into shock and there was no way either one of us could have administered a regular syringe at the time. At the same time, there has to be competition for EpiPen. A monopoly for a life saving medication is ridiculous.

  109. Actually, it was never done with pre-filled syringes, as one cannot ensure adequate thermal control or even maintaining a clean environment for what is a decanted solution in an open syringe.
    What was used was an ana-kit, I know, we kept a pair available at all times for my wife and youngest daughter.
    In the field, I did use a phial for epi, in our BAS, I used phials and multi-use vials for ancillary medications to provide more definitive treatments to halt the reaction cascade (epi works for a short term palliative, but if the antigen is still present, mast cells are still going to release their histamine.
    You know, things like antihistamines and steroids.

  110. I’ve been known to utilize some profanity laced metaphors in my education of service members, where a point had to be remembered clearly.
    It wasn’t a harangue, but instead, a humorous turn of profane phrase.

  111. I responded to a similar question – regarding sustained potency and the potential for contamination, particularly when one “cannot ensure adequate thermal control or even maintaining a clean environment for what is a decanted solution in an open syringe.” My phone whacked so I don’t know what arrived. SciBabe, please discard the other! There is, in fact, an excellent, convincing body of research compiled by the Asia Medical Society, from India, Pakistan, Thailand, and the Sub-Sahara that demonstrates that epinephrine in glass vials and in pre-filled vials of modern materials are relatively impervious to heat, cold, and other extreme conditions, as well as are resistant to contamination comparable with the epipen or its competitors.

    The kits we distribute in our practice contain a pre-filled, sterile-sealed plastic syringe containing epinephrine; a glass vile with a single dose of diphenhydramine & and a sterile syringe for its administration; alcohol-prep wipes; and an instruction sheet with diagrams. These are contained in a heat-sealed plastic bag; on one side is a prescription label with “quick instructions”; on the back side is a label with detailed, step-by-step instructions. The kits are warranted for one year, and are indicated to be destroyed after that period. Again, they cost next to nothing.

  112. I dunno, I could go with these:
    http://www.bemedsupply.com/product-p/1-823388.htm
    Carpuject units would be even nicer.

    Both would also be good for about a year before the stopper would degrade.
    In my experience in some very similar environments, the stopper was what degraded, rather than the solution.

    The only real advantage in an epipen system is that of needle avoidance, as one doesn’t see the needle until after use. That’s less of a big deal in many environments, where the fear of dying is much higher than the fear of using a needle. The latter, being more of a biggie in the west, as we’ve so sanitized medicine and life experiences.

  113. @dave, because Clinton’s currently in that highly powerful office of… Candidate?
    Or are you saying that the Clinton Foundation has some magical mind control power over Congress?
    It’d take Congressional action to institute price regulation regulations and we’ve saw examples aplenty of Congressional inertia, save when action benefits big business.

    • The dems in Congress and the White House have circled the wagons around hillary protecting her.

      On an unrelated note… since we have an army of lawyers ready to sue anyone for anything (Trial Lawyers Association supports dems), I am curious how much of the price represents litigation reserve.

  114. I understand the warnings here, and they do make some sense, however, if you can by a syringe and a vial of epinephrine for $10 (and throw in an Inject-Ease auto injector for another couple of bucks) how the hell do the companies selling these auto injectors get to $400 to $650 bucks?? And why isn’t there a drug company that wants to steal the ENTIRE FRIGGIN EPIPEN MARKET by selling one for say $40 or $50??

  115. After much discussion with emergency room staff and our PCP, we recently purchased the vials and syringes as an alternative for my husband. HOWEVER, what wasn’t mentioned in your article is that you can pre-draw the epinephrine into the syringe, cap it and store it for at least 3 months in the syringe ready to go. For each vial we can get 3 full doses. For under $12 we received 2 vials, 6 syringes and 6 filtered needles. That means we can have 3 doses ready to go for 6 months for $12.

    I fully agree that drawing it up in the event is too much to ask, but having it pre drawn, no. Maybe for the most severe reactions that instantly prevent the affected person from injecting themselves, but in our situation, we have enough of a window that he is able to function and recognize early symptoms

  116. I just note, if no one else has, that syringes can be PRE-FILLED with the correct dosage and safely stored or carried in plastic cases designed for that purpose. And any doctor, nurse or pharmacist can teach you to administer an injection properly. If you can buy Epi-Pens, great; but if you can’t afford them, a pre-filled syringe is far superior to not having anything in an emergency, and for too many people, that’s their only choice..

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