Are Expired EpiPens Still Viable?

Patadia, Deepa D.; Stukus, David R.

doi:10.1016/j.jaip.2017.06.026

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Although both of these approaches are better than not delivering any epinephrine, they raise concerns. 10 , 12 Pre-filled syringes require more training, are more likely to be associated with handling or dosing errors, are more sensitive to ultraviolet light and temperature extremes, and must be replaced every 2–3 months. 10 Expired EAIs have been shown to deliver a lower dose of epinephrine.…”

Section: Patient Barriersmentioning

confidence: 99%

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Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities

Prince¹,

Mikhail²,

Stukus³

2018

JAA

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Epinephrine is the only effective treatment for anaphylaxis but studies routinely show underutilization. This is especially troubling given the fact that fatal anaphylaxis has been associated with delayed administration of epinephrine. Many potential barriers exist to the proper use of epinephrine during an anaphylactic reaction. This article will explore both patient-and physician-related factors, as well as misconceptions that all contribute to the underuse of epinephrine for the treatment of anaphylaxis.

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Section: Patient Barriersmentioning

confidence: 99%

“…However, the exact amount of viable epinephrine remaining in expired devises ranges from 51–90%, depending upon time since expiration and study methodology used. 12 – 14 …”

Section: Patient Barriersmentioning

confidence: 99%

Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities

Prince¹,

Mikhail²,

Stukus³

2018

JAA

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“…A study on patient compliance reported that even patients with high awareness of EAI expiration date may still carry expired EAIs and delay replacement [14,15]. Several studies have found 50-90% active ingredient still available in EAIs from 1 to 90 months after their expiration dates [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…The oxidized derivative of epinephrine is melanin-like adrenochrome [23,28], and the resulting discoloration of the eye is tolerated as a side effect of ocular epinephrine drugs [27]. Although it is advised to not use discolored EAIs [11,16,18], the prevalence of expired EAIs due to cost pressures, and the nature of epinephrine as a drug of first aid, presents the possibility that expired and discolored EAIs can be the only option available in emergency and remote settings.…”

Section: Introductionmentioning

confidence: 99%

Estimation of available epinephrine dose in expired and discolored autoinjectors via quantitative smartphone imaging

et al. 2020

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Epinephrine autoinjectors (EAIs) are important first aid medications for treating anaphylaxis. A 10-fold price increase over the past 12 years and evidence that expired EAIs may still contain significant doses of available epinephrine have motivated interest in the efficacy of expired EAIs as treatments of last resort. Degradation of expired EAIs, which can be caused by improper storage conditions, results in various degrees of discoloration of the epinephrine solution. Previous studies have determined that significant epinephrine remains available in expired EAIs, but these have only considered EAIs that show no discoloration. Here, we investigate the potential for colorimetric estimation of available epinephrine dose based on the degree of discoloration in expired EAIs. The correlation of available epinephrine dose and time since expiration date was poor (r = − 0.37), as determined by an industry standard UHPLC protocol. Visible absorbance of the samples integrated across the range 430-475 nm correlated well with available epinephrine dose (r = − 0.71). This wavelength corresponds to the blue channel of a typical smartphone camera Bayer filter. Smartphone camera images of the EAI solutions in various illumination conditions were analyzed to assign color indices representing the degree of discoloration. Color index of the samples showed similar correlation (|r| > 0.7) with available epinephrine dose as that of visible spectrophotometry. Smartphone imaging colorimetry is proposed as a potential point-of-use epinephrine dose estimator for expired and degraded EAIs.

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