Expired Epinephrine Still Delivers!
With the incredible price increases in some self-injectable epinephrine auto-injectors, I commonly hear patients ask whether they can use them after the expiration date. Scientific studies have addressed this question.
A study of 31 unused, expired EpiPens and 9 EpiPen, Jr devices was published by Cantrell and Cantrell in the Annals of Internal Medicine in 2017. http://annals.org/aim/article/2625390/epinephrine-concentrations-epipens-after-expiration-date. The devices were 1 to 50 months (over 4 years) past the expiration date and none were discolored. Using liquid chromatography-tandem mass spectrometry, the epinephrine concentration was measured.
Results: The epinephrine content was 90% of the stated concentration for 2/3 of the EpiPens and over half (56%) of the EpiPen, Jrs. All EpiPen auto- injectors contained at least 80% of the labeled concentration which is a substantial amount.
A study of 28 unused, expired EpiPens and 6 EpiPen, Jr auto-injectors was studied by Dr. Simon (national expert in anaphylaxis) and published in the Journal of Allergy and Clinical Immunology in 2000. https://www.ncbi.nlm.nih.gov/pubmed/10808186. The devices were 1 to 90 months (7.5 years) past the expiration date. The epinephrine content was measured by spectrophotometry with an HPLC-UV method. The epinephrine bioavailability was significantly reduced in the expired devices compared to the un-expired devices. The inverse correlation between the decreased epinephrine content and the number of months past the expiration date was 0.63. This means that as the time past expiration continues the epinephrine concentration gradually decreases. For example, 80% of the labeled dose is still present at 30 months (2.5 years) past the expiration date.
These reports do not lead me to recommending anything other than refilling epinephrine in accordance with the expiration date. However, outdated EpiPens may have a use in an emergency when it is the only alternative available and the epinephrine is not discolored or contains precipitates. The benefits appear to outweigh the risks of suboptimal doses of epinephrine when an individual is experiencing an anaphylactic reaction.
As more data becomes available in larger studies, perhaps the expiration dating for epinephrine should be reconsidered. On a practical note: when you pick up your self-injectable epinephrine, double check to make sure the expiration date on the device is at least 1 year out. If it’s not—hand it back and ask for another.
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This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.