Epinephrine for severe allergic reactions

What is epinephrine?

Epinephrine is used to treat a very bad allergic reaction.

You may hear epinephrine called by its brand names, EpiPen, EpiPen Jr or Twinject. Epinephrine comes in an injectable form.

Before giving epinephrine to your child

Tell your child's health care provider if your child has:

• an allergy to epinephrine or any other part of the injection

Talk with your child's health care provider if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• diabetes
• heart disease
• thyroid disease

How should you give your child epinephrine?

Follow these instructions when you give your child epinephrine:

• Read how to use the device when you first get it, before an emergency happens. All devices can be injected through clothing.
• Use this drug for emergencies which may include insect stings or bites, food, drug and latex allergies.
• Keep this drug with you and your child at all times. Your child may want to keep extra ones at school, home and work (if applicable).
  
• Never put your fingers or hand over the tip.
• Do not take off the safety release until you are ready to use it.
• Do not use if solution is not clear or if red flag is in window.

When ready to use epinephrine

How to give EpiPen or EpiPen Junior to your child:

1. Take the pen out of the case, hold the pen with the orange tip down, and make a fist around the pen.
2. Remove the blue safety cap by pulling straight up. Do not bend or twist.
3. Swing and push the orange tip firmly into mid-outer thigh until you hear a "click". Hold for 10 seconds.
4. Get help immediately. Call 911 or emergency local services. Do not drive your child to the hospital yourself.
5. Put the injection device back in the storage case. Take it with you to the hospital.

How to give Twinject to your child:

1. Pull off the green end cap marked [1] to reveal a red tip. Never put your thumb, finger or hand on the red tip.
2. Pull off green end cap marked [2].
3. Swing and push the red tip firmly into mid-outer thigh until you hear a "click". Hold for 10 seconds.
4. Remove auto-injector and check red tip. If the needle is exposed, the dose has been given. If not, repeat step 3.
5. Get help immediately. Call 911 or emergency local services. Do not drive your child to the hospital yourself.
6. If symptoms have not improved in 10 minutes of the first dose, inject the second dose:
• Unscrew and remove the red tip.
• Hold the blue hub at needle base and remove syringe from barrel.
• Slide yellow collar off plunger.
• Put needle into the thigh and push the plunger all the way down.
7. Put the injection device back in the storage case. Take it with you to the hospital.
   

How do I use an Epinephrine autoinjector?

For more videos from SickKids experts in collaboration with Youngster, visit Youngster on YouTube.

How long does epinephrine take to work?

• It starts working as soon as it is given.

What are the possible side effects of epinephrine?

Your child may have some of these side effects while they take epinephrine. Check with your child's health provider if your child continues to have any of these side effects, if they do not go away, or if they bother your child:

• irritation where the shot is given
• flushing
• upset stomach or throwing up
• feeling dizzy. Have your child get up slowly over a few minutes when sitting or lying down.
• nervous and/or excitable
• dry mouth

What safety measures should you take when your child is using epinephrine?

If your child has a very bad allergy, they need to wear an allergy ID band (e.g., MedicAlert bracelet) at all times.

There are some medicines that should not be taken together with epinephrine; the dose of epinephrine or the other medicine may need to be adjusted. It is important that you tell your child's health care providers if your child takes any other medications (prescription, over the counter or herbal). These may include beta-blockers, digoxin, diuretics and other heart medications.

What other important information should you know about epinephrine?

• Keep a list of all your child's medications (prescription, natural products, vitamins, over the counter) with you and show this list to your child's doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Make sure you always have enough epinephrine to last through weekends, holidays and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills.
• Keep epinephrine at room temperature in a cool, dry place away from sunlight, heat or an open flame. Do NOT store it in the bathroom or kitchen.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep epinephrine out of your child’s sight and reach and locked up in a safe place. If your child takes too much epinephrine, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.