What is the recommended dose of Epipen (epinephrine) for pediatric patients?

From the Guidelines

The recommended dose of EpiPen for pediatric patients depends on the child's weight, with 0.15 mg of epinephrine using the EpiPen Jr auto-injector for children weighing 15-30 kg (33-66 pounds) and the adult dose of 0.3 mg using the regular EpiPen for children weighing more than 30 kg (66 pounds). The injection should be administered into the outer thigh muscle and can be given through clothing if necessary. After administration, seek immediate medical attention as the effects of epinephrine are short-acting (typically 10-20 minutes), and a second dose may be needed if symptoms persist or recur 1. Epinephrine works by constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing hives and swelling that may occur during severe allergic reactions. Side effects may include increased heart rate, tremors, anxiety, and dizziness, but these are generally outweighed by the life-saving benefits in anaphylaxis.

Some key points to consider when administering epinephrine to pediatric patients include:

• The dose of epinephrine should be based on the child's weight, with the goal of administering 0.01 mg/kg of epinephrine up to a maximum dose of 0.3 mg 1.
• The EpiPen Jr auto-injector is designed for children weighing 15-30 kg (33-66 pounds) and delivers a dose of 0.15 mg of epinephrine.
• For children weighing more than 30 kg (66 pounds), the adult dose of 0.3 mg using the regular EpiPen is recommended.
• The injection should be administered into the outer thigh muscle, which is the preferred site for intramuscular injection of epinephrine in pediatric patients 1.
• After administration, the child should be monitored closely for signs of anaphylaxis and receive immediate medical attention if symptoms persist or recur.

It's also important to note that while there are potential risks associated with epinephrine administration, including increased heart rate, tremors, anxiety, and dizziness, these risks are generally outweighed by the life-saving benefits of epinephrine in anaphylaxis 1. Additionally, the use of epinephrine auto-injectors has been shown to be safe and effective in pediatric patients, with a low risk of serious adverse effects 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0. 5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary ( 2) Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0. 3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary ( 2)

The recommended dose of Epipen (epinephrine) for pediatric patients is:

• For children 30 kg (66 lbs) or more: 0.3 to 0.5 mg intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary.
• For children 30 kg (66 lbs) or less: 0.01 mg/kg (up to 0.3 mg) intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2.

From the Research

Epipen Dose for Pediatrics

The recommended dose of Epipen (epinephrine) for pediatric patients can vary depending on the child's weight.

• According to a study published in 2003 3, the recommended dose for children is 0.01 mg/kg, given intramuscularly in the lateral thigh.
• A study published in 2002 4 compared the EpiPen Jr (0.15 mg) and EpiPen (0.3 mg) auto-injectors in children weighing 15 to 30 kg and found that both devices achieved similar maximum plasma concentrations of epinephrine.
• Another study published in 2018 5 evaluated the sublingual bioavailability of epinephrine 30 mg as a potential pediatric dose and found that it had a similar maximum plasma concentration to intramuscular epinephrine 0.15 mg from an EpiPen Jr.

Administration Methods

Different administration methods have been studied for pediatric use, including:

• Intramuscular injection: This is the most common method of administration and is recommended for children 3.
• Sublingual tablets: A study published in 2018 5 found that sublingual tablets of epinephrine 30 mg had a similar maximum plasma concentration to intramuscular epinephrine 0.15 mg from an EpiPen Jr.
• Inhalation: A study published in 2000 6 found that inhalation of epinephrine from a pressurized metered-dose inhaler was not a reliable method of administration for children, as it was difficult for them to inhale sufficient epinephrine to increase their plasma epinephrine concentrations promptly and significantly.

Important Considerations

• It is essential to note that the dose and administration method of epinephrine for pediatric patients should be determined by a healthcare professional, taking into account the child's weight, medical history, and other factors 7, 3, 4.
• Education of the patient or parent regarding the proper use of epinephrine auto-injectors is crucial to ensure timely and effective treatment of anaphylaxis 3.