Can you provide the prescription directions (sig) and duration for a 2‑pack of EpiPen (epinephrine) 0.3 mg/0.3 mL auto‑injectors?

EpiPen 2-Pak 0.3 mg/0.3 mL Prescription Instructions

Inject 0.3 mL (0.3 mg) intramuscularly into the mid-outer thigh at the first sign of anaphylaxis; may repeat once after 5-15 minutes if symptoms persist or recur; always carry 2 auto-injectors; seek emergency care immediately after use; no expiration on duration—replace when expired or used.

Sig (Prescription Directions)

"Inject 0.3 mL into outer thigh muscle at first sign of severe allergic reaction. May repeat once after 5-15 minutes if needed. Call 911 immediately after first dose. Always carry both auto-injectors."

Duration

• No time-limited duration: Prescribe for ongoing use as long as the patient remains at risk for anaphylaxis 1
• Replace immediately after use or when solution becomes discolored (pinkish/brown) or cloudy 1
• Storage: Room temperature 68-77°F; protect from light in carrier tube provided 1

Critical Prescribing Details

Dosing Specifications

• 0.3 mg dose is appropriate for patients weighing >30 kg (approximately >66 lbs) 2
• The recommended dose is 0.01 mg/kg (maximum 0.3-0.5 mg in adults, 0.3 mg in children) 3
• Always prescribe 2-Pak (two auto-injectors): 6-19% of pediatric patients require a second dose 2, and one device may be accidentally activated 1

Administration Instructions to Emphasize

• Inject into anterolateral mid-thigh (outer thigh muscle)—this is the first-line route 3, 2
• Can inject through clothing if necessary
• Hold firmly in place for 3 seconds after activation
• Second dose timing: Give 5-15 minutes after first dose if symptoms continue, worsen, or return 2, 1

When to Use (Patient Counseling Points)

Anaphylaxis symptoms requiring immediate injection include 2:

• Respiratory: Difficulty breathing, wheezing, throat tightness, hoarseness
• Cardiovascular: Dizziness, weak pulse, chest pain, collapse
• Skin: Hives, severe itching, swelling of face/lips/tongue
• GI: Persistent vomiting, severe cramping, diarrhea
• Do not delay—inject at first sign of anaphylaxis, even if uncertain 3

Emergency Response Protocol

• Inject epinephrine first, then call 911 2, 1
• Position patient: Lying down with legs elevated (unless respiratory distress/vomiting) 2
• Never allow standing or walking after injection 2
• Transport to emergency department even after epinephrine use—observation required for potential biphasic reactions 3

Common Pitfalls to Avoid

1. Underprescribing: Always prescribe the 2-Pak, not single units—patients need backup for repeat dosing or accidental activation 1

2. Delayed use: Emphasize immediate injection at symptom onset—fatal anaphylaxis correlates with delayed epinephrine administration 3

3. Wrong injection site: Subcutaneous or other routes are inferior; intramuscular thigh injection is essential 3

4. Expired devices: Patients must check expiration dates regularly and replace promptly 1

5. Single location storage: Counsel patients to keep auto-injectors at multiple locations (home, school, work) if needed 1

Safety Considerations

• No absolute contraindications to epinephrine in anaphylaxis 3, 2
• Expected pharmacologic effects (pallor, tremor, anxiety, palpitations) are transient and acceptable given life-threatening nature of anaphylaxis 2
• Serious adverse effects are rare in appropriate dosing 2

Storage and Replacement

• Store at room temperature (68-77°F) in provided carrier tube 1
• Do not refrigerate 1
• Replace if solution is discolored, cloudy, or contains particles 1
• Replace immediately after any use to maintain 2-device supply 1