Patient education: How to give epinephrine (The Basics)

What is epinephrine? — 

This is the same as the hormone adrenaline. Your body makes its own adrenaline when you are scared, stressed, or having an allergic reaction. You might need extra epinephrine to treat a severe allergic reaction, called "anaphylaxis." A severe allergic reaction can happen after you eat a food, take a medicine, or are stung by an insect you are allergic to.

What are the symptoms of an allergic reaction? — 

Symptoms can include:

●Hives – These are raised patches of skin that are very itchy (picture 1).

●Puffiness of the face, eyelids, ears, mouth, hands, or feet

●Redness or itching of the skin (without hives)

●Runny nose, or swelling of the tongue or throat

●Wheezing or trouble breathing

●Vomiting or diarrhea

●Feeling dizzy or passing out

●Death (although this is rare)

When should I use epinephrine? — 

Your doctor or nurse will tell you when to use epinephrine. Most doctors recommend you use it right away when you have an allergic reaction and:

●Have trouble breathing, or feel like your throat is tight

●Feel dizzy or like you are going to pass out

If your doctor prescribed epinephrine for your child, use it right away when your child has an allergic reaction and:

●Seems groggy, or passes out

●Vomits a lot

●Coughs a lot

●Has hives all over their body

What should I do if someone needs epinephrine? — 

If you think someone is having a severe allergic reaction, give epinephrine immediately if you have it. Then, call for an ambulance (in the US and Canada, call 9-1-1) or have someone drive them to the emergency department. This is because epinephrine doesn't last very long in the body, and symptoms can sometimes come back as the medicine wears off. In the hospital, doctors can watch the person and give them more medicine if needed.

Epinephrine comes with directions. It's important to read the directions so you know what to do before you actually need to use it. Epinephrine comes in 2 forms: an autoinjector (sample brand names: EpiPen, Auvi-Q) and a nose spray (sample brand name: neffy).

In general, to use an epinephrine autoinjector:

●Take the autoinjector out of the case.

●Hold it in your hand. Make sure your fingers are not covering either end.

●Take off the safety cap (or caps).

●If you're giving the injection to a child or someone who might have trouble staying still, hold their leg so they can't move.

●Press the tip firmly into the outer thigh – The needle in the autoinjector can go through clothes (figure 1).

●Hold it in place for at least 2 to 3 seconds.

In general, to use an epinephrine nose spray:

●Take the nose spray out of the package. Hold it with 2 fingers, with your thumb on the plunger.

●Place the tip of the nozzle into 1 nostril until your fingers touch the person's nose (figure 2).

●Press the plunger with your thumb firmly to give the dose.

What if the epinephrine doesn't stop my symptoms? — 

The epinephrine should stop your symptoms within a few minutes. But if they don't improve within 5 minutes, get worse, or return before you reach the hospital, you need another dose.

●Some autoinjectors have 2 doses of medicine in them, but most have only 1. If your autoinjector has only 1 dose, you need to use a second autoinjector.

●Epinephrine nose sprays only have 1 dose. If a second dose is needed, use a new epinephrine nose spray in the same nostril as the first dose.

What are the side effects of epinephrine? — 

Epinephrine can cause short-term side effects, such as:

●Fast or pounding heartbeat

●Feeling nervous, shaky, or dizzy

●Headache

It is best to sit down. If you feel dizzy, lie down. If you pass out, another person should lower you to the ground and raise your legs up. This helps blood flow to your heart and brain.

What else should I know? — 

Know where to keep the epinephrine:

●It's important to keep it at room temperature. Do not leave it in places that could get too hot or cold, like your car. You can buy small cases, bags, or belts meant for carrying epinephrine.

●Carry at least 1 dose of epinephrine with you at all times in case of an allergic reaction. Tell your family members where you keep it. That way, if you have an allergic reaction but can't get your epinephrine, another person can get it and give it to you.

●If your child was prescribed epinephrine, bring it wherever they go. You should also keep at least 1 at your child's school or day care, and with other regular caregivers.

Know when the epinephrine expires:

●Check the dates on your medicine. It is best to use one that has not expired. Over time, the epinephrine might not work as well. Check the dates on all your medicines regularly. Call your doctor, nurse, or pharmacist if they have expired and you need a new prescription.

●In an emergency, using an expired dose of epinephrine is better than not using one at all.

Learn more about cost:

●Some brands can be expensive. The cost depends on where you live, which device you have, and your health insurance.

●If you are worried about the cost, talk to your doctor or nurse. You might be able to get a less expensive type of epinephrine.

More on this topic

Patient education: How to use an autoinjector (The Basics)
Patient education: Anaphylaxis (The Basics)
Patient education: Food allergy (The Basics)
Patient education: Insect bites and stings (The Basics)
Patient education: Peanut, tree nut, and seed allergy (The Basics)
Patient education: How to dispose of needles and other sharps (The Basics)

Patient education: Using an epinephrine autoinjector (Beyond the Basics)
Patient education: Anaphylaxis symptoms and diagnosis (Beyond the Basics)
Patient education: Anaphylaxis treatment and prevention of recurrences (Beyond the Basics)