Is it safe to administer an EpiPen (epinephrine auto-injector) to individuals of any age?

From the Guidelines

It is not safe to provide an EpiPen for any age without consideration of appropriate dosing. EpiPens come in two main doses: EpiPen Jr (0.15 mg) for children weighing 15-30 kg (approximately 33-66 pounds), and standard EpiPen (0.3 mg) for individuals weighing more than 30 kg (66 pounds) 1. For infants and very small children under 15 kg, epinephrine administration should be discussed with a healthcare provider as they may need a different dosing approach 1. When administering an EpiPen, inject it into the outer thigh and hold for 3 seconds, even through clothing if necessary. After use, seek immediate medical attention as the effects are temporary (typically 10-20 minutes) 1. Some key points to consider when deciding on the use of an EpiPen include:

• The patient's weight and the corresponding recommended dose of epinephrine
• The potential risks and benefits of using an EpiPen, including the risk of overdose or underdose
• The availability of alternative forms of epinephrine, such as ampule/syringe/needle
• The individual's medical history and any underlying conditions that may affect the use of an EpiPen 1 Side effects can include increased heart rate, anxiety, dizziness, and headache, but these risks are outweighed by the benefit in true anaphylaxis 1. The medication works by constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing hives and swelling. For very young children, elderly patients, or those with certain medical conditions like heart disease, the risk-benefit assessment may differ, so individual medical guidance is essential 1.

From the FDA Drug Label

Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 mL to 0. 5 mL) of undiluted Adrenalin® administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.5 mg (0.5 mL) per injection, repeated every 5 to 10 minutes as necessary. Children less than 30 kg (66 lbs): 0.01 mg/kg (0. 01 mL/kg) of undiluted Adrenalin® administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.3 mg (0.3 mL) per injection, repeated every 5 to 10 minutes as necessary.

It is safe to administer an EpiPen to individuals of any age, but the dosage varies based on the patient's weight.

• For adults and children 30 kg (66 lbs) or more, the recommended dose is 0.3 to 0.5 mg.
• For children less than 30 kg (66 lbs), the recommended dose is 0.01 mg/kg, up to a maximum of 0.3 mg per injection. Administration should be done with caution in certain patients, such as those with heart disease, hyperthyroidism, or pregnant women 2.

From the Research

Safety of EpiPen Administration

The safety of administering an EpiPen to individuals of any age is a topic of discussion among medical professionals.

• The standard approved doses of epinephrine administered intramuscularly in the lateral thigh have a long track record for safe and effective use 3.
• However, more information is needed on epinephrine pharmacokinetics and pharmacodynamics to ensure that current dosing strategies are optimal 4, 3.
• When epinephrine auto-injectors (EAIs) are used in infants, the dose increasingly exceeds the recommended dose as weight decreases, although the clinical significance of this is unclear 4.

Age-Specific Considerations

• For young children weighing 15 to 30 kg, the EpiPen Jr (0.15 mg) and EpiPen (0.3 mg) auto-injectors have been compared prospectively, with the EpiPen Jr achieving a maximum plasma concentration of 2037 +/- 541 pg/mL at 16 +/- 3 minutes, and the EpiPen achieving a maximum plasma concentration of 2289 +/- 405 pg/mL at 15 +/- 3 minutes 5.
• A newly available 0.1 mg EAI has a lower dose and shorter needle, which may be better suited to patients weighing 7.5 to 15 kg 4.
• For infants and small children, the ideal means for storing and delivering epinephrine in prehospital and hospital environments warrants further study, to determine how to best balance efficiency, safety, and costs 4, 3.

Alternative Options

• Epinephrine prefilled syringes may be a safe and viable option for the self-administration of epinephrine, especially for patients who cannot afford or do not have access to EAIs 6.
• However, inhalation of epinephrine from a pressurized metered-dose inhaler is not a recommended substitute for epinephrine injection in children at risk for systemic anaphylaxis, due to the difficulty in administering an adequate dose and the potential for adverse effects 7.