Epinephrine for severe allergic reactions

What is epinephrine?

Epinephrine is used to treat a very bad allergic reaction, such as anaphylaxis.

You may hear epinephrine called by its brand names, EpiPen, EpiPen Jr or Neffy. Epinephrine comes in an injectable form or nasal spray.

Before giving epinephrine to your child

Talk with your child's health-care provider if your child has any of the following conditions. Precautions may need to be taken with this medication if your child:

• has diabetes
• has heart disease
• is taking a beta-blocker medication

How should you give your child epinephrine?

Follow these instructions when you give your child epinephrine:

• Read how to use the device when you first get it, before an emergency happens. All injectable forms of epinephrine can be injected through clothing.
• Use this drug for emergencies, which may include allergic reactions to insect stings or bites, food, drugs and latex.
• Keep this medication with you and your child at all times. Your child may want to keep extra ones at school, home and work (if applicable).
• Never put your fingers or hand over the tip.
• Do not take off the safety release until you are ready to use it.
• Do not use if the solution is not clear or if the red flag is in the window.

When ready to use epinephrine

How to give EpiPen or EpiPen Junior to your child:

1. Take the pen out of the case, hold the pen with the orange tip down, and make a fist around the pen.
2. Remove the blue safety cap by pulling straight up. Do not bend or twist.
3. Swing your arm and push the orange tip firmly into the mid-outer thigh until you hear a "click". Hold for 3 seconds.
4. Get help immediately. Call 911 or emergency local services. Do not drive your child to the hospital yourself.
5. Put the injection device back in the storage case. Take it with you to the hospital.
6. If symptoms do not improve within 5 minutes after the first dose, give a second dose using another EpiPen or EpiPen Junior autoinjector.

How to give Neffy to your child:

1. Open the package and remove the nasal spray.
2. Hold the nasal spray with your thumb on the bottom of the plunger and your fingers on either side of the nozzle.
3. Insert the nozzle straight into the nostril. Do not angle the nasal spray towards the inner or outer sides of the nose.
4. Press the plunger firmly until it snaps and sprays the medication into the nostril. Ask your child not to sniff while the medication is being given and after it is given.
5. Get help immediately. Call 911 or emergency local services. Do not drive your child to the hospital yourself.
6. If symptoms do not improve within 5 minutes after the first dose, give a second dose with another Neffy nasal spray into the same nostril as the first dose.

How long does epinephrine take to work?

• It starts working as soon as it is given.

What are the possible side effects of epinephrine?

Your child may have some of these side effects while they take epinephrine. Check with your child's health-care provider if your child continues to have any of these side effects, if they do not go away or if they bother your child:

• irritation where the injection was given
• flushing
• upset stomach or throwing up
• feeling dizzy. Have your child get up slowly over a few minutes when sitting or lying down.
• nervous and/or excitable
• dry mouth
• throat irritation or tingling nose if epinephrine nasal spray was used

What safety measures should you take when your child is using epinephrine?

If your child has an allergy that can lead to anaphylaxis, they should wear an allergy ID band (e.g., MedicAlert bracelet) at all times.

There are some medications that should not be taken together with epinephrine; the dose of epinephrine or the other medication may need to be adjusted. It is important that you tell your child's health-care providers if your child takes any other medications (prescription, over the counter or herbal). These may include beta-blockers, digoxin, diuretics and other heart medications.

What other important information should you know about epinephrine?

• Keep a list of all your child's medications (prescription, natural products, vitamins, over the counter) with you and show this list to your child's health-care provider or pharmacist.
• Do not share your child's medication with others and do not give anyone else's medication to your child.
• Make sure you always have enough epinephrine to last through weekends, holidays and vacations. Call your pharmacy at least two days before your child runs out of medication to order refills.
• Keep epinephrine at room temperature in a cool, dry place away from sunlight, heat or an open flame. Do NOT store it in the bathroom or kitchen.
• Do not keep any medications that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medications.
  

Keep epinephrine out of your child’s sight and reach and locked up in a safe place. If your child takes too much epinephrine, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.