Mythbuster: Why homemade Epinephrine kits should not be used
EpiPen (Epinephrine Auto Injector) and Mylan Corporation are hot topics in the news. EpiPen cost has increased 400% since Mylan bought the rights to manufacture and distribute it. Patients and families are looking for alternatives at a more reasonable cost. An Emergency Room doctor in Ohio suggested to a local television station that a cheap alternative to an expensive EpiPen could be done for less than $10. His comments are making the rounds on social media and the $10 cost verses over $600 for EpiPen is very appealing to families that need it.
However, there are several comments in the article that can be misunderstood by a parent or patient. First, the less than $10 price may have been the cost quoted to this physician for his practice, but the cost to patients is closer to $20. Secondly, the article suggests that parents can make and store their own kit in an Altoids can and take it to their school nurse. But school nurses are not allowed to store or to give unlabeled medications, thus a homemade kit would not meet this requirement. The physician also states that drawing up a little too much epinephrine should not be an issue. The standard doses for anaphylaxis are 0.3 and 0.15mg, based on age of the patient. If by a little bit more he means 0.33 or 0.18mg, then so be it. But there is the potential for the entire 1mg of epinephrine to be drawn up and given as dose. Furthermore, while it is true that the office or provider can teach the patient and/or family how to give the shot, the family would then be responsible for training everyone else involved with the patient on how to give the shot as well. This has the potential to not happen as planned and to cause serious adverse consequences. Moreover, there is no guarantee that the insulin syringe used to give the injection will penetrate the clothes and deliver the required dose. Lastly, nurses and parents on social media have stated that they plan on drawing up doses ahead of time so the dose is ready to give. This should not be done because of the chance of contamination and/or degradation of the drug to a non-usable state.
It is reasonable to expect parents to ask providers for this alternative, and it is very tempting to give in to a request from a parent for a cheaper alternative to EpiPen. Because of the above reasons, this should not be done. If a parent or guardian cannot afford an EpiPen, our Outpatient Pharmacy can work with them to find a more affordable solution to this problem.
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