What is the proper administration and dosage of an EpiPen (epinephrine) in the event of a severe allergic reaction?

Proper Administration and Dosage of EpiPen for Severe Allergic Reactions

For severe allergic reactions (anaphylaxis), administer EpiPen immediately into the anterolateral aspect of the thigh, holding it in place for 10 seconds, with dosing based on patient weight: 0.15 mg for children weighing 10-25 kg (22-55 lbs) and 0.3 mg for individuals weighing ≥25 kg (≥55 lbs). 1, 2

Correct EpiPen Administration Technique

• Remove the EpiPen from its plastic carrying case 1
• Pull off the blue safety release cap 1
• Hold the orange tip near the outer thigh (always apply to thigh) 1
• Swing and firmly push the orange tip against the outer thigh, holding it in place for approximately 10 seconds 1
• Remove the EpiPen and massage the area for 10 more seconds 1
• Call emergency services (911) immediately after administration 1

Appropriate Dosing Guidelines

• Adults and children weighing ≥30 kg (66 lbs): Use 0.3 mg EpiPen 2
• Children weighing <30 kg (66 lbs): Use 0.15 mg EpiPen Jr 2
• For children weighing 10-25 kg (22-55 lbs): 0.15 mg is the recommended dose 1
• For individuals weighing approximately 25 kg (55 lbs) or more: 0.3 mg is recommended 1

Timing and Additional Doses

• Administer immediately when symptoms of anaphylaxis appear 1
• A second dose may be administered after 5-10 minutes if symptoms persist or recur 1, 2
• Delayed use of epinephrine may be ineffective and is associated with fatal outcomes 1
• Always carry at least two epinephrine autoinjectors 1, 3

Post-Administration Care

• Monitor the patient continuously after epinephrine administration 1
• Transfer to an emergency facility for observation and further treatment 1
• Observe for at least 4-6 hours or longer based on reaction severity 1
• Additional medications may be administered after epinephrine:
  • Antihistamines (H1: diphenhydramine; H2: ranitidine) 1
  • Inhaled bronchodilators if asthma is present 1
  • Corticosteroids (prednisone for 2-3 days) 1

Common Pitfalls to Avoid

• Do not inject into buttocks, digits, hands, or feet 2
• Do not delay administration while waiting for additional symptoms to develop 1, 3
• Do not substitute antihistamines or corticosteroids for epinephrine in anaphylaxis 1
• Do not hesitate to use epinephrine in patients with cardiovascular disease when experiencing anaphylaxis - the risk of untreated anaphylaxis exceeds the risk of epinephrine administration 1
• Avoid storing EpiPens in extreme temperatures which may reduce effectiveness 3

Special Considerations

• Patients with certain conditions require careful monitoring but should still receive epinephrine for anaphylaxis:
  • Cardiovascular disease 1
  • Patients taking monoamine oxidase inhibitors or tricyclic antidepressants 1
  • Patients with hyperthyroidism, Parkinson's disease, diabetes, or pheochromocytoma 2
• Intramuscular injection in the anterolateral thigh achieves more rapid and higher plasma concentration than subcutaneous or intramuscular injection in the arm 1

Remember that epinephrine is the first-line treatment for anaphylaxis, and prompt administration is critical for preventing mortality. The benefits of timely epinephrine administration far outweigh the risks in cases of severe allergic reactions 1, 3.