Why prescriptions for epinephrine autoinjector should be marked “do not substitute"

There are 4 epinephrine auto-injectors available in the US as of June 2013: Adrenaclick, Auvi-Q, EpiPen, Generic "Adrenaclick".

Here is a timely Update on Generic Epinephrine Autoinjector from the AAAAI President:

I wanted to provide some further information in regards to the authorized generic version of Adrenaclick® called epinephrine injection, USP auto-injector that was recently launched by Lineage Therapeutics, Inc.
Since the availability of this product may result in substitution for other epinephrine autoinjectors at the pharmacy, it is recommended that prescribers mark prescriptions “do not substitute” or the state’s convention that legally requires a pharmacist to call the prescriber before substituting (e.g., “medically necessary”).
This is an important issue, so I hope this information gives practitioners more specific direction on what to write when prescribing.
Remember that you can view each type of epinephrine autoinjector and the instructions for administration at their respective product websites:

www.auvi-q.com
www.epipen.com.
www.epinephrineautoinject.com
www.adrenaclick.com

Linda Cox, MD, FAAAAI
AAAAI President

Real life approach

The two most commonly prescribed epinephrine autoinjectors are EpiPen and Auvi-Q. Make sure your patients know how to use them. In our allergy clinic, we give the patients the opportunity to practice with the trainer devices (no needle) of both brands. A prescription is then given for the device the patient and family feel more comfortable with. Currently, most (but not all) patients prefer the voice-guided instructions and the compact size of Auvi-Q.

Videos: How To Use Epinephrine Autoinjector - Auvi-Q or EpiPen

This 2-minute video shows the Sanofi's new voice guided Auvi-Q epinephrine injector in action:



Start here: How to use EpiPen. Self-injectable epinephrine (SIE) in the form of a device (EpiPen) was first introduced in 1980.

Video instructions on use of the EpiPen (epinephrine/adrenaline) autoinjector for anaphylaxis from the Australasian Society of Clinical Immunology and Allergy (ASCIA):



How To Use an EpiPen video from Nationwide Children's Hospital in Columbus, Ohio:



Action Plan

All patients prescribed an epinephrine autoinjector should have either a food allergy action plan or an anaphylaxis action plant, depending on their diagnosis.

The Food Allergy Action Plan by FAAN is available here (adapted by Dr. Dimov):



The generic version is available from FAAN website: FAAN's Food Allergy Action Plan is available for download in several languages. You may copy these documents and distribute them freely.

Click here for the Anaphylaxis Action Plan (adapted by Dr. Dimov):



The generic version of the Anaphylaxis Action Plan is available from the AAAAI website (PDF).

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