How to Order an EpiPen for a Patient
All patients with a history of severe allergic reactions should be prescribed two epinephrine auto-injectors at discharge or during their clinic visit, with hands-on training provided at the time of prescription. 1, 2
Who Should Receive an EpiPen Prescription
Mandatory prescriptions for epinephrine auto-injectors include:
- Any patient who has experienced anaphylaxis (regardless of trigger) 1
- Patients with food allergy and concurrent asthma (higher risk for fatal reactions) 1
- Patients with known allergy to peanuts, tree nuts, fish, or crustacean shellfish 1
- Patients with a history of any prior systemic allergic reaction 1
Strong consideration should be given to prescribing for all patients with IgE-mediated food allergies, even without prior anaphylaxis 1
Dosing Based on Weight
The prescription should specify the appropriate dose based on patient weight 2, 3:
- Children 10-25 kg (22-55 lbs): EpiPen Jr 0.15 mg 1, 2
- Children and adults ≥25 kg (≥55 lbs): EpiPen 0.3 mg 1, 2
- Alternative dosing: 0.01 mg/kg per dose (maximum 0.5 mg) if using epinephrine 1:1000 solution 2, 3
Critical Prescription Details
Always prescribe TWO auto-injectors because 1, 2:
- Symptoms may recur or persist after the first dose
- A second dose may be needed every 5-15 minutes if symptoms continue 2, 3
- One device may malfunction or be unavailable when needed
The prescription must include 1:
- Two epinephrine auto-injectors (specify correct dose)
- Written anaphylaxis emergency action plan
- Instructions for monitoring expiration dates (devices expire after 1 year)
- Plan for follow-up evaluation
Patient Education at Time of Prescription
Hands-on training is mandatory and should cover 1, 2:
- When to use: Immediately for any severe symptoms including difficulty breathing, wheezing, throat tightness, widespread hives with systemic symptoms, dizziness, or hypotension 2, 4
- How to administer: Inject into anterolateral thigh (vastus lateralis muscle) through clothing if necessary, hold firmly for 10 seconds 1, 3
- After injection: Call 911 immediately and proceed to emergency department even if symptoms improve 1
- Storage: Keep at room temperature; check that liquid remains clear 1
Common Pitfalls to Avoid
Do not delay prescribing while waiting for allergy testing or specialist referral—primary care providers should prescribe immediately upon suspicion of severe allergy 1
Do not prescribe only one auto-injector—this is inadequate and potentially dangerous if a second dose is needed 1, 2
Do not rely on antihistamines as a substitute—epinephrine is the only first-line treatment for anaphylaxis 1, 5
Avoid the misconception that epinephrine is dangerous—there are no absolute contraindications to epinephrine use in anaphylaxis, even in patients with cardiac disease or on beta-blockers 2, 3
Follow-Up Management
Schedule follow-up within 1-2 weeks after any anaphylactic event 1
Refer to allergist/immunologist for definitive testing, trigger identification, and long-term management 1
Establish annual renewal system through office reminders or automated pharmacy notifications to ensure patients never have expired devices 1
Provide medical identification jewelry information so patients can be easily identified in emergencies 1