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Self-Injectable Epinephrine: how to do it right.


Epinephrine is the most important medication used to stop or lessen severe allergic reactions (called anaphylaxis).  Such reactions triggered by allergies to foods, medications, yellow jackets and other stinging insects, or latex may be life threatening.

EpiPen Auvi-Q are auto-injectors that will inject the medication (epinephrine) into the body when it is used as directed.  EpiPen and Auvi-Q both come in a two pack in the event a second dose is needed.  This is estimated to be about 20% of the time.  They also are both available in 2 doses based on weight (less than 66 lbs and more than 66 lbs).

Although your doctor, nurse, medical assistant or pharmacist may have already instructed you on the proper technique of the self-injectable epinephrine, here is a quick review!

How to administer EpiPen:

  1. Remove safety cap and place orange tip against the fleshy outer part of the thigh at a 90 degree angle to the leg (Do not administer into the buttocks or a vein). It may be given through clothing.
  2. Use a quick motion to press the orange tip hard into the thigh for auto-injection.
  3. Leave the device in place for 10 seconds then remove.
  4. Seek medical attention at once or call “911”
  5. If allergic reaction progresses, a second dose from a NEW EpiPen may be given after 5-15 minutes.
  6. Dispose used device at pharmacy, ER or physician’s office.

How to administer Auvi-Q:

  1. Remove grey outer case.  Listen and follow the devices verbal instructions or the written instructions on the case to:
    1. Pull off the red safety guard
    2. Place black end against outer thigh, then press firmly and hold for 5 seconds (it may be given through clothing). Although the 5 second hold is recommended, the needle will automatically retract back into the device in 1 second.
    3. Seek medical attention at once or call “911”
    4. If allergic reaction progresses, a second dose from a NEW Auvi-Q may be given after 5-15 minutes.
    5. Dispose used device at pharmacy, ER or physician’s office.

Special tips to remember about EpiPen & Auvi-Q

  • Do not expose to direct sunlight (store at room temperature).
  • Check the expiration date (Register your EpiPen at for expiration date alerts via e-mail). If you are given a device that expires in less than 1 year, give it back and politely ask for one that will not expire for at least a year.
  • The solution should be clear and colorless.
  • Do not remove safety cap until ready for use.
  • Do not put thumb or finger over the orange (EpiPen) or black (Auvi-Q) tip.
  • EpiPen and Auvi-Q are bio-equivalent–that is, they have a similar peak and epinephrine exposure.
  • Auvi-Q has less injection site pain and bleeding compared to EpiPen.

Other important aspects of anaphylaxis treatment:

  • Wear your medical ID bracelet and have your written Anaphylaxis Action Plan.  What?  You don’t have such a plan?  Visit with Dr. Zacharisen and he will develop a detailed, common sense plan to deal with severe allergies.
  • If you have school-aged children have your physician fill out a school epinephrine authorization –OR- if you plan on flying have your physician fill out a form that enables you to carry your epinephrine with you on board.
  • Give babysitters, relatives, mature siblings or anyone you leave your child with directions on how to use the epinephrine auto-injector and the symptoms that would indicate the need for an injection.
  • Carry your self-injectable epinephrine with you everywhere!
  • Remember, even if you have an expired Epi-Pen/Auvi-Q injector, and need it in a life threatening situation ALWAYS inject it!! It could save your life!

Epinephrine Side Effects:

  • As with any medications, there are short-term side effects of epinephrine (fast heart rate, sweating, nausea, vomiting, weakness, tremor, nervousness, anxiety, dizziness, headache, and pale skin).  These side effects are usually mild and not long lasting; a small price to pay for the life-saving benefits.

At Family Allergy & Asthma Care of Montana, we want our patients to know how and when to use their medications.   A miss-step in treating anaphylaxis can have dire consequences.

If your community group or school desires an educational, hands-on presentation on anaphylaxis including how and when to use self-injectable epinephrine, contact Dr. Zacharisen at 406-451-7017.  As an ACE (Anaphylaxis Community Expert), he and his team will, at no cost to you, present to your group.   For more information, or an ACE team near you, go to:

This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.



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