# Alternatives to Epi-pen???



## wowmulewow (Jan 17, 2014)

I'm looking for an alternative brand to Epi-pen in an auto-injector form.  Epi-Pen prices are outrageous and our department has an extremely small budget.  An ampule IM would do, but due to the "circumstances" of most of our calls, auto-injectors are much safer for my crew and the patient.  Anyone ever heard of Adrenaclick and thoughts on that device?  Thanks for the help!


----------



## wowmulewow (Jan 17, 2014)

Is anyone aware of a cheaper auto-injector alternative to the Epi-Pen?  As we all know they are pricey and my department has a very limited budget.  I would use Epi 1ml ampules and a syringe, but the "circumstances" of most of our calls make it a greater safety risk for our personnel and patients.  Thanks for all your input and help.  Fair Winds and Following Seas.


----------



## PotatoMedic (Jan 17, 2014)

Well the syringe and ampule is your only other choice.  You could just remove it all together and not have epi at all.  Unless your state requires it.  And can you explain why the "circumstances" make the draw-up epi more dangerous?


----------



## wowmulewow (Jan 17, 2014)

Epi is required per our State and DHS/ USCG Protocols.  When I say my department, Im refering to our Coast Guard Station.  Most of my calls occur on water, unless I am fortunate enough to trudge back through some marshes or an island.  The movement of our vessels makes it difficult to do anything let alone break open a vial, and then draw epi and administer it. :/  Thanks for your response!


----------



## PotatoMedic (Jan 18, 2014)

Yeah I don't know of any other option.  Practice with normal saline till you stop sticking yourself with the needle when you try to draw up the drug?

Also I thought the coast guard did not have any sort of EMT.


----------



## TransportJockey (Jan 18, 2014)

Get a 30ml vial of Epi 1:1000. Much easier than those damned amps (which I hate with a passion).


----------



## wowmulewow (Jan 18, 2014)

Yes, the Coast Guard does have EMT's, its just not a primary job function such as a Nsvy Corpsman or an Army Combat Medic.  Aside from some of us being EMT's we are boat drivers, Law Enforcement Officers, Fire Fighters, etc.  The NYPD actually has more members than the entire Coast Guard. (fun Fact).  This being said, most of us have our primary job, but then are cross trained, and even specialize in other areas as well.    As for the vial, I might give that a shot.  Less of a breaking/ spilling factor, though still not as convenient as an auto injector!!


----------



## DesertMedic66 (Jan 18, 2014)

TransportJockey said:


> Get a 30ml vial of Epi 1:1000. Much easier than those damned amps (which I hate with a passion).



Heck, I just learned you can turn the amp upside down and not spill the Epi haha


----------



## unleashedfury (Jan 18, 2014)

if carrying EPI is a requirement. the previously stated carrying of a ampule of Epi and a filtered straw for draw up is less expensive. 

The nice thing about Epi Pens is if they are rarely used they have quite the shelf life and may only need to be repurchased once a year. 

How many are you required to carry one per provider?


----------



## sinus (Jan 18, 2014)

Are Epi-pens still under patent? Surely there are generic epinephrine autoinjectors that are built to similar standards are tend to be much cheaper.


----------



## TransportJockey (Jan 18, 2014)

sinus said:


> Are Epi-pens still under patent? Surely there are generic epinephrine autoinjectors that are built to similar standards are tend to be much cheaper.


My copay for a 2 pack was damn near a hundred dollars. If there are cheaper alternatives out there I haven't seen them


----------



## sinus (Jan 18, 2014)

TransportJockey said:


> My copay for a 2 pack was damn near a hundred dollars. If there are cheaper alternatives out there I haven't seen them



I looked and there isn't an FDA approved generic yet, but some generic manufactures are in court disputing the patent. Generics are definitely in the pipeline.


----------



## unleashedfury (Jan 18, 2014)

TransportJockey said:


> My copay for a 2 pack was damn near a hundred dollars. If there are cheaper alternatives out there I haven't seen them



according to boundtree roughly 500 bucks for 2 epi pens. 

https://www.boundtree.com/epipen--0-3-mg--1-1-000-auto-injector--2-pack-pharm-11675-302.aspx

a ampule of Epi 1:1000 costs around 4 dollars, you can get the syringes with needle for less than a dollar. 

so a significant cost savings of about 490 dollars.


----------



## wowmulewow (Jan 18, 2014)

Thanks for the replies.   Does anyone know of a place that will sell a single epi pen rather than a two pack?   I figure I could have 1 pen (well 2, .3 and .15) in our jump bag with ampule/ vial and syringe as back up.   That way at minimum I can get some epi in my anaphalyxis Pts.  Any thoughts one one epi pen and amp/ vial as second go round?


----------



## NomadicMedic (Jan 18, 2014)

A pharmacy? Do you have medial control to write you a scrip for these? They're not OTC items.

If so, ask the doc where to get them.


----------



## wowmulewow (Jan 18, 2014)

I have a PDA from Med. Director, but all the sources we have found only sell Epi in the twin packs,  sounds like this might be my only option :/   thanks for all the help!


----------



## medicdan (Jan 18, 2014)

wowmulewow said:


> Is anyone aware of a cheaper auto-injector alternative to the Epi-Pen?  As we all know they are pricey and my department has a very limited budget.  I would use Epi 1ml ampules and a syringe, but the "circumstances" of most of our calls make it a greater safety risk for our personnel and patients.  Thanks for all your input and help.  Fair Winds and Following Seas.



Yes, there are actually several available.

--Auvi-q, looks like a pack of cigarettes or deck if cards, but is also equipped with a speaker and gives audio instructions. (~$40 less than Epi-Pen brand.)
--although manufacturing has stopped, Greenstone medical has a generic epinephrine auto injector, floating around. Downside: exposed needle after admin.(~$60less than Epi-pen brand. )
-- Amedra/Shionogi Pharmaceutical’s “AdrenaClick”:censored:http://www.adrenaclick.com/index.php
:censored:http://www.acaai.org/allergist/Resources/letters/Pages/letters-to-web-editor-6.aspx
--:censored: Lineage Therapeutics’ generic AdrenaClick auto-injector (I believe manufactured by Amedra):censored:http://www.epinephrineautoinject.com/


----------



## Carlos Danger (Jan 18, 2014)

wowmulewow said:


> Epi is required per our State and DHS/ USCG Protocols.  When I say my department, Im refering to our Coast Guard Station.  Most of my calls occur on water, unless I am fortunate enough to trudge back through some marshes or an island.  *The movement of our vessels makes it difficult to do anything let alone break open a vial*, and then draw epi and administer it. :/  Thanks for your response!



Drawing up from a vial isn't that hard at all, even in a moving vehicle. Many on this forum have done it routinely on moving ambulances and helicopters. Hold the vial between your thumb and index finger, and stabilize the syringe against the thenar eminence as you carefully push the needle into the vial. I would avoid the glass ampules, though.

If you do need the auto-injectors, the high price is kind of mitigated by the fact that epi is rarely needed. A single purchase should last a a long time.

Since when does the federal government balk at spending money, anyway?


----------



## mycrofft (Jan 18, 2014)

Adamis has brought back the pre filled syringe, 0.3 ml of 1:1000 epi:: 

http://runway-research.blogspot.com/2013/12/adamis-pharmaceuticals-admp.html






Resembles the older ones where you can give 0.3, then have to give the plunger a 90 degree twist to give a second remeasured 0.3 ml. I cannot find those via google.

Greenstone (generic arm of Pfizer) is selling a generic epi auto-injector. 





A thought: once you start stocking, using, disposing and rotating drugs, you have to accept a significantly higher level of budgeting. No way to do it on the cheap in a legal and responsible manner.

Besides, if you're a Coastie, then you have to buy off the GSA catalog, no??h34r:


----------



## mycrofft (Jan 18, 2014)

DesertEMT66 said:


> Heck, I just learned you can turn the amp upside down and not spill the Epi haha



Until you really need it not to. I think shaky hands cause them to dump.

And you'r supposed to use a filter needle. Yeah, I'll trade a small sterile SQ or IM sterile abscess for life anyway.


----------



## wowmulewow (Jan 19, 2014)

mycrofft said:


> Adamis has brought back the pre filled syringe, 0.3 ml of 1:1000 epi::
> 
> http://runway-research.blogspot.com/2013/12/adamis-pharmaceuticals-admp.html
> 
> ...



We rarely utilize drugs, _most_ of our calls are trauma related, but occasionally get AMI, Anaphylaxis, Diabetic emergencies, a rare overdose (people do all kinds of things on boats apparently), etc.  We only carry enough of each drug to stabilize the patient and transfer them to our local agencies who then transport to the ER.   You are correct on GSA catalog for most products, but GSA does not stock pharmaceuticals namely because of expiration and shelf-life of products, and PDA issues.  (They were the first place I checked, and that is the answer I received).  Thanks for the Greenhouse Generic, I will look into that!


----------



## jpregulman (Jan 19, 2014)

Try twin-ject (i think thats the spelling). They are a auto injector that can be taken apart to give a second dose of Epi.


----------



## Tigger (Jan 19, 2014)

jpregulman said:


> Try twin-ject (i think thats the spelling). They are a auto injector that can be taken apart to give a second dose of Epi.



I don't believe those are manufactured anymore.


----------



## MMiz (Jan 19, 2014)

Of the ones available on the market, the Adrenaclick is the cheapest at around $200. I haven't used it.


----------



## medicdan (Jan 19, 2014)

Auvi-Q seems to be the new, vogue version, for consumers. At the pricepoint it is advertised at, it may also be useful for EMS.


----------



## MMiz (Jan 19, 2014)

Threads merged.


----------



## mycrofft (Jan 26, 2014)

Twinject dead.http://foodallergysupport.olicentra...SID=a0671352b2c4cdb8f5d60fa650fa6902#msg57606

Shinogi Pharm sold it in 2008 and the new owner D/C'ed it.


----------



## mycrofft (Jan 26, 2014)

I know, I know… but that clear plastic structure on the plunger between the barrel and the finger pad looks like the old .3 ml limiter on the two-dose  pre filled syringes. You would depress the plunger to the stop, withdraw and recap (!) the needle, and wait. If a second dose was called for, twist the plunger (was it 1/4 or 1/2 turn?), which would clear that structure and allow a second 0.3 ml of 1:1,000 epi to be administered. Used to come in a little red kit like the glucagon does, but with the syringe, a thin tourniquet (!!!), and a CTM oral tab (useless).


----------

