Monday, January 25, 2010

Choosing an Epinephrine Auto-Injector

by Kelley Lindberg

In the first part of January, the pharmaceutical company Sciele Pharma announced that it is now offering a new epinephrine auto-injector, called Adrenaclick.

This makes three companies I know of that offer epinephrine auto-injectors in the United States, plus one more in Europe, Australia, Asia, and Canada.

The three brands of auto-injectors that I know are available in the United States are EpiPen, Twinject, and now Adrenaclick. The additional brand available in Europe is called Anapen.

I am not a doctor, so don’t accept what I say as medical advice. But I’m going to describe what I’ve learned from my pharmacist, allergist, and my own online research about these, in case you’re wondering, like I am, what the differences are between these auto-injectors.

All of the brands appear to use the same medicine, adrenaline (also called epinephrine), to treat anaphylaxis caused by allergic reactions to foods, insect stings, or other allergens. The three brands in the United States all seem to offer two dosages: 0.15 mg for smaller body sizes (younger kids) and 0.30 mg for larger kids and adults. The Anapen appears to come in 3 dosages (0.15 mg, 0.30 mg, and 0.50 mg).

So if the medicine is the same, what’s the difference between them?

As far as I can tell, the only significant differences are in how the auto-injectors work and whether your insurance has a preferred brand (which can mean some cost savings for you).

The new Adrenaclick appears to work almost identically to the EipPen – a single injection of a pre-measured dose in a pen-shaped injector, which you administer by pressing the injector against the outer thigh and leaving it there for 10 seconds. To administer a second dose, you use a second auto-injector. (The EpiPen instructions require more of a “jabbing” motion, while the Adrenaclick instructions say to place the auto-injector against the thigh, then press it firmly to inject the needle.)

The Twinject contains two doses in a single pen-shaped injector, so it is more compact to carry. However, only the first dose is administered automatically through the pen. To administer the second dose, the Twinject instructions tell you to remove a syringe from the container, stick the needle into the thigh, and press the plunger to administer the pre-measured dose. It doesn’t look difficult, but for people with needle phobias, it could be a little harder to see and use. But the space savings in having both doses in a single container make the Twinject more attractive to some users.

The Anapen looks most similar to the EpiPen and the Adrenaclick – a single dose auto-injector. However, instead of jabbing the pen against the thigh, the Anapen instructions tell you to press it to the thigh, then press the red button at the top of the pen to inject the needle.

Beyond the mechanical differences of how the auto-injectors are administered, there doesn’t seem to be a significant difference between them. So check with your insurance company to see if they have a preferred brand. If they do, they will sometimes cover that brand at a lower co-pay, so it’s worth it to ask.


Asia said...

I am new to your blog, so thanks for providing such helpful info. for those suffering from allergies. I wish I could make it to the meetings at the Barnes and Noble, but I have a conflict on Wednesdays. My son (almost 3yrs) has allergies to peanuts, tree nuts, milk and eggs. I have a 10 month old I plan to have tested soon and I am thinking of going to a different allergist for a comparison to my son's allergist. I would love any recommendations you might have. I feel that my son's allergist is not as involved as I think they should be, but maybe that is how they all are. It takes forever. The allergist never looks at his skin during the skin test and the medical assistants do all of the skin test and I am not that confident in their abilities. They seemed kind of careless and only half paying attention to what they were doing. She even had to retest part of it on his arm after the skin test on the back. Sorry about the long comment, I just wanted to let you know my concern and would love any feedback you have. Thanks, Asia

Kelley J. P. Lindberg said...

Hi Asia, glad you found my blog and that it's helpful! The only board-certified allergist working full-time in Davis County is Dr. Douglas Jones in Layton. His website is Write to me privately and we can talk