Epinephrine doses contained in outdated epinephrine auto-injectors collected in a Florida allergy practice

Rachid, Ousama; Simons, F. Estelle R.; Wein, Michael; Rawas-Qalaji, Mutasem; Simons, Keith J.

doi:10.1016/j.anai.2015.01.015

Cited by 26 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Accordingly, EAIs have a relatively short shelf-life, and prescribing information states that they should be stored at 20°C–25°C (68°F–77°F) 59,60. Once the expiration date has passed, the concentration and bioavailability of epinephrine in an EAI decrease over time 69,71. Similarly, epinephrine stored outside the recommended temperature range may not provide the labeled dose 72…”

Section: Use Of Expired Epinephrinementioning

confidence: 99%

Update on the usage and safety of epinephrine auto-injectors, 2017

Posner

Camargo

2017

DHPS

View full text Add to dashboard Cite

Anaphylaxis is a serious, potentially fatal allergic reaction. Guidelines recommend prompt intramuscular injections of epinephrine as the first-line therapy for anaphylaxis. Delayed epinephrine treatment may cause undesirable clinical outcomes, including death. In the community, epinephrine auto-injectors (EAIs) are commonly used to treat anaphylaxis. This literature review examines several recent concerns regarding the safety of EAIs that may prevent the timely administration of epinephrine. Reports of cardiovascular complications are linked with epinephrine administration, although recent studies suggest that these events are much more commonly associated with intravenous epinephrine rather than with EAIs. Recent studies have also highlighted accidental injections of EAIs in patients’ or caregivers’ fingers and lacerations associated with the use of EAI in children. However, the data suggest that both accidental injections and lacerations are rare and require limited medical intervention. In addition, patients may receive conflicting information on the safety and efficacy of using expired EAIs. Overall, it is believed that the benefits of using EAIs far outweigh the potential risks of not administering an EAI. Although legitimate safety concerns are associated with EAIs, adverse events are rare. Continued training of medical providers, caregivers, and patients may be beneficial to address these concerns and reduce EAI-associated injuries while ensuring that patients receive necessary medical care.

show abstract

Section: Use Of Expired Epinephrinementioning

confidence: 99%

Update on the usage and safety of epinephrine auto-injectors, 2017

Posner

Camargo

2017

DHPS

View full text Add to dashboard Cite

show abstract

“…However, manufacturers’ recommendations are similar for all EAIs with regard to storage: keep at 20° to 25 °C (excursions permitted from 15° to 30 °C) to protect the epinephrine solution from degradation and ensure mechanical integrity of the device. In a warm climate, the degradation of epinephrine solution in EAIs is potentially accelerated [ 109 ]. If EAIs are subjected to freezing temperatures for a few days, no degradation of epinephrine solution occurs; however, they must be completely thawed before use [ 110 ].…”

Section: Introductionmentioning

confidence: 99%

2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines

Simons

Ebisawa

Sánchez‐Borges

et al. 2015

World Allergy Organization Journal

Self Cite

461

344

View full text Add to dashboard Cite

The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized. Advances in epidemiology, diagnosis, and management in healthcare and community settings are highlighted. Additionally, new information about patient factors that increase the risk of severe and/or fatal anaphylaxis and patient co-factors that amplify anaphylactic episodes is presented and new information about anaphylaxis triggers and confirmation of triggers to facilitate specific trigger avoidance and immunomodulation is reviewed. The update includes tables summarizing important advances in anaphylaxis research.

show abstract

“…EAIs contain epinephrine in a sealed container that protects the drug from exposure to oxygen and light, allowing the epinephrine to remain pharmacologically stable for at least 1 year after the device is produced. Some studies have indicated that epinephrine stored in EAIs may remain stable and clinically usable for much longer than 1 year, although results vary by device and between studies [35–37]. Auto-injector devices reduce errors by eliminating some of the variables of administering the drug, such as determining the correct dose [12, 38].…”

Section: Discussionmentioning

confidence: 99%

A systematic review of epinephrine stability and sterility with storage in a syringe

Parish

Morton

Brown

2019

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

Background Epinephrine is a lifesaving medication in the treatment of anaphylaxis. Epinephrine auto-injectors are the preferred method of epinephrine administration, but are not universally available or affordable. Little is known about the effects on epinephrine when it is drawn up in advance and stored as prefilled syringes. Objective To study the stability and sterility of epinephrine when stored in syringes. Methods We searched Embase, Medline, and Web of Science in June 2016 for all studies of epinephrine stored in syringes in concentrations between 0.1 and 1 mg/mL that measured epinephrine stability and/or sterility over time, regardless of date published or language. Results Three studies were included, one testing two concentrations of epinephrine. Only one study tested epinephrine 1 mg/mL, the concentration clinically relevant for intramuscular use during anaphylaxis. Neither this study nor the one study testing 0.7 mg/mL epinephrine found significant degradation after 56 and 90 days, respectively. One of the two studies testing epinephrine at a concentration of 0.1 mg/mL found significant degradation by 14 days; the other found no degradation up to 168 days. Two studies tested for bacterial growth, with none detected after 28 and 90 days, respectively. One study tested for fungal growth, with none detected after 90 days. Conclusions Limited evidence suggests that syringes filled with 1 mg/mL epinephrine are stable and sterile for 90 days. More research is needed testing the duration of stability and sterility of prefilled syringes with the 1 mg/mL concentration most commonly used in anaphylaxis, testing more extensively in different storage conditions and across a wider range of marketed syringe brands.

show abstract

Epinephrine doses contained in outdated epinephrine auto-injectors collected in a Florida allergy practice

Cited by 26 publications

References 7 publications

Update on the usage and safety of epinephrine auto-injectors, 2017

Update on the usage and safety of epinephrine auto-injectors, 2017

2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines

A systematic review of epinephrine stability and sterility with storage in a syringe

Contact Info

Product

Resources

About