Given the growing national shortage of epinephrine auto-injectors it behooves school nurses to start making plans regarding how their districts will address and respond not only now, but if the shortage continues into the next school year.
The American Society of Health-System Pharmacists (ASHP) posted a notice on its website, detailing which epinephrine devices are affected. The list includes: Mylan’s EpiPen and EpiPen Jr. and identical generic devices, all of which are made by Pfizer Inc., as well as the Impax Therapeutics generic epinephrine auto-injector in the adult and child sizes.
Before determining to use an expired epinephrine auto-injector or not, it is recommended school nurses have a conversation with their medical director. Together you can determine what will be the practice as far as using parent provided patient specific expired auto-injectors, and what will be the practice for any expired stocked auto-injectors.
I would recommend you communicate this to your parents in the form of a letter or possibly a post on your Health Services school district webpage. After discussion your district may determine that in an emergency, your school staff will administer an epinephrine auto-injector XX number of months past its expiration date. The expiration date is the last day of the month listed, not the first day of the month.
The following information on the use of expired epinephrine auto-injectors is from the Australasian Society of Clinical Immunology and Allergy website. https://www.allergy.org.au/health-professionals/anaphylaxis- resources/adrenaline-autoinjector-storage-expiry-and-disposal
The shelf life of adrenaline auto-injectors is normally around 1 to 2 years from date of manufacture. The expiry date on the side of the device needs to be marked on a calendar and the device must be replaced prior to this date.
It is important that the expiry date on the adrenaline auto-injector device is checked and noted, rather than the expiry date on the box.
Expired adrenaline auto-injectors are not as effective when used for treating allergic reactions and should not be relied upon to treat anaphylaxis. However, the most recently expired adrenaline auto-injector available should be used if no in-date device is available.
EpiPen contains a clear window near the tip where you can check if the adrenaline is discoloured or contains sediment. If this is the case, the device should be replaced as the adrenaline may be less effective.
Adrenaline auto-injectors cannot be reused even if some adrenaline remains inside the device.
After using an adrenaline aut0injector, an ambulance should be called immediately to take the individual to hospital, so they can be given further treatment and remain under observation for at least 4 hours.
As noted there are two brands of epinephrine auto-injectors currently experiencing shortages. The national advocacy organization FARE (Food Allergy Research & Education) is advising patients who are finding it difficult to obtain epinephrine to speak to their physician about getting a different epinephrine auto-injector prescription. Aside from the branded EpiPen or Mylan generic auto-injectors there is another epinephrine option in the United States. Information regarding Auvi-Q is below.
The compact device is known for its voice-guided instructions that help those using the device through the process of injection. Manufacturer Kaléo has an affordability program that allows consumers with insurance to pay zero out-of-pocket costs, even if the device is not included under your insurer’s plan.
“Auvi-Q market share continues to expand,” said Spencer Williamson, Kaléo’s president and CEO. Williamson notes that Kaléo’s high-tech robotic production line has over 100 automated quality checks on each device. “This production line has the capacity to expand should the need develop in the market.” As well, the brand launches a new 0.1 mg dose auto-injector for infants and small children on May 1.