How to Safely Use an EpiPen

Administer epinephrine to stop anaphylaxis

With food allergies so common in children today, many doctors recommend that parents carry automatic epinephrine injectors to use if their child develops anaphylaxis, a severe type of allergic reaction. Similarly, allergists recommend that adults with severe allergies also carry epinephrine injectors at all times.

You may never need to use an epinephrine auto-injector on yourself or your child, but it's critical to be prepared just in case. Allergic reactions are unpredictable and can progress to life-threatening anaphylaxis rapidly. Knowing how and when to administer epinephrine can mean the difference between life and death.

This article covers what epinephrine is and the symptoms of anaphylaxis to look out for. It also includes step-by-step instructions on how to use an EpiPen epinephrine auto-injector, as well as several safety tips for anyone with severe allergies.

How to Use an EpiPen on Yourself

Remove the EpiPen From Its Package

Taking out an EpiPen
Melanie Martinez

Unscrew the yellow cap from the container and slide out the EpiPen.

Remove the Gray Safety Cap

Remove the gray safety cap from the back of the EpiPen
Melanie Martinez

Take off the gray safety cap from the back of the EpiPen. It won't work unless this cap is removed.

Inject the Epinephrine

Woman administers EpiPen into thigh

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Grasp the EpiPen in your fist. Do not put your fingers on either end of the EpiPen. Position the black, rounded tip of the EpiPen against the middle of the outer thigh (upper leg).

To deliver the medicine, swing your hand outward then jab the EpiPen into the thigh. Push it into the thigh firmly. Listen for a click. The click signals that the epinephrine is being delivered.

Hold the EpiPen in place while slowly counting to three. After three seconds, the injection is complete and you can remove the EpiPen from your thigh.

You don't need to remove your clothing to use an EpiPen. The auto-injector can deliver the medicine through your clothes.

If you do not hear a click, the EpiPen may have failed to deliver epinephrine. All people with severe allergies should carry two EpiPens at all times. This way, if an EpiPen fails to deliver medicine, you will have a backup ready.

Call 911 and Discard the EpiPen

Throw a used EpiPen away in a sharps container
Melanie Martinez

Once the EpiPen is used, call 911. Anaphylaxis is a life-threatening condition, and using epinephrine is only a temporary fix.

It may be necessary to take a second dose of epinephrine. However, you must wait at least five minutes before taking a second dose. Taking two doses back-to-back can lead to dangerously high blood pressure, stroke, or death.

Do not attempt to reuse the EpiPen. The used EpiPen must now be properly discarded. The ambulance crew will be able to throw the used EpiPen away in their sharps container, or you may need to discard it in its original container.

How to Use an EpiPen on a Child

Remove the EpiPen From Its Package

Child holding EpiPen

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Remove the cap from the container and slide out the EpiPen.

Remove the Gray Safety Cap

Removing gray cap from EpiPen

Peter Dazeley / Getty Images

Remove the gray safety cap from the EpiPen. It won't work unless the cap is removed.

Position the Child to Receive the Injection

Woman administers EpiPen to child

Peter Dazeley / Getty Images

If the child is older, you can have them sit or lie on the ground. If the child is younger, you can seat them in your lap. You will be injecting the EpiPen into the outer part of their upper thigh, so you need to position the child in a way that allows you to jab their thigh.

Inject the Epinephrine

Injecting an EpiPen

miriam-doerr / Getty Images

Grasp the EpiPen in a fist. Do not put your fingers on either end of the EpiPen. Position the rounded tip of the EpiPen against the middle of the child's outer thigh (upper leg).

Hold the child's leg firmly in place, then deliver the medicine by jabbing the EpiPen into their thigh. Push it into the thigh firmly. Listen for a click. The click signals that the epinephrine is being delivered.

Hold the EpiPen in place while slowly counting to three. After three seconds, the injection is complete and you can remove the EpiPen from their thigh.

Again, you do not need to remove the child's clothes to administer the EpiPen. The EpiPen's needle can penetrate clothing.

Call 911 and Discard the EpiPen

Woman holding EpiPen

Ana Maria Serrano / Getty Images

Once the EpiPen is used, call 911. Do your best to keep the child calm while you wait for the ambulance. To prevent shock, you can have the child lay on the ground with their feet elevated.

Anaphylaxis is a life-threatening condition, and using epinephrine is only a temporary fix. It may be necessary to give a second dose of epinephrine. However, you must wait at least five minutes before giving a second dose.

Do not attempt the reuse the EpiPen. The used EpiPen must now be properly discarded. The ambulance crew will be able to throw the used EpiPen away in their sharps container, or you may need to discard it in its original container.

Symptoms of Anaphylaxis

Anaphylaxis is a severe allergy. Symptoms can begin suddenly and progress rapidly. If the victim is unconscious, call 911 immediately. Look for several telltale signs that indicate anaphylaxis:

  • Difficulty breathing
  • Swelling of the face, throat, or lips
  • Hives or itching
  • Clammy skin
  • Rapid heart rate
  • Lightheadedness
  • Low blood pressure
  • Nausea or vomiting
  • Shock

It is not necessary to have all of the signs for it to be anaphylaxis. If you suspect an allergic reaction and the victim has trouble breathing or dizziness, it is probably anaphylaxis. Call 911 immediately and administer an epinephrine injector.

EpiPen vs Antihistamines

Antihistamines will not prevent, relieve, or stop anaphylaxis symptoms and are not a substitute for epinephrine.

Epinephrine is the only first-line treatment for anaphylaxis, and the only medicine that can prevent a potentially fatal outcome.

Antihistamines are drugs that relieve mild allergy symptoms caused by hay fever (seasonal allergies), indoor allergies (such as house dust and dog dander), and mild food allergies. Common brands of over-the-counter antihistamines include Benadryl, Zyrtec, Claritin, and Allegra.

Antihistamines work by blocking your body's response to histamine—a substance your body normally releases when it detects something harmful.

Although histamines are involved in anaphylaxis, antihistamines cannot relieve or prevent the life-threatening symptoms of anaphylaxis, such as difficulty breathing, low blood pressure, and shock.

Furthermore, antihistamine tablets can take at least 30 to 60 minutes before their effects set in, whereas epinephrine begins to work immediately.

Antihistamines can be taken for very mild allergy symptoms, such as mild itching, hives, or sneezing. When you or your child has any signs of anaphylaxis, epinephrine is essential and should be given immediately.

If you or your child has made contact with an allergen that you know will trigger a severe reaction, you should administer the EpiPen even if symptoms seem mild at first.

Allergy Safety Tips

Unfortunately, you can't always prevent anaphylaxis, and a day may come when you or your child needs to use their epinephrine auto-injector.

Epinephrine saves lives when it is used properly and in a timely manner. That said, once you or your child has been prescribed an epinephrine auto-injector, you still need to be active and consistent with it in order to stay safe.

Be active by checking your auto-injectors regularly, staying on top of your refills, and avoiding known allergens. Be consistent by doing these things routinely, because anaphylaxis usually happens unexpectedly.

Stay prepared for an anaphylactic event by following these safety tips:

  • Always carry your epinephrine injector with you or ensure that your child keeps theirs on them at all times.
  • Many schools require that EpiPens be kept with the nurse, in the classroom, or at the front desk. But if possible, children should keep their EpiPen on their person throughout the school day. If they play sports, the EpiPen should be kept in a bag on the sidelines.
  • You or your child should also keep a spare epinephrine injector close by as well. Keep a backup where you or your child can quickly access it in case the first EpiPen malfunctions or a second dose is needed.
  • The most common cause of death during an allergic reaction is waiting too long to administer epinephrine or not having the auto-injector with you. Have an action plan in place. If you are unsure about when to use your EpiPen, talk to your healthcare provider.
  • Auto-injectors must be kept at room temperature. Do not keep it in your refrigerator, or in your car on an especially hot or cold day.
  • Check your auto-injectors regularly. The liquid inside of them should be clear. If they are cloudy, discolored, or have floating specks, they need to be replaced.
  • Check the expiration date on all your auto-injectors. Set a notification in your phone or write the expiration date in your calendar so that you can have them replaced before they expire.
  • Children who have had a severe allergic reaction should wear a medical ID bracelet or necklace, which you can buy at most pharmacies.
  • Each EpiPen comes with a Trainer auto-injector that contains no needle or medication. Use it to practice and encourage your child to practice too.
  • Last but not least, avoid known allergens as much as possible. Teach your children about the dangers of those allergens. Make sure their teachers, coaches, and other caretakers are informed, and encourage your child to speak up about their allergies whenever they feel they are at risk.

In 2020, the FDA received reports of EpiPens that injected too early or not at all. While EpiPen failure is unlikely, it can happen. If you notice any problem with your epinephrine auto-injector, let your pharmacist know. You can also contact the EpiPen manufacturer, Mylan, for a free replacement at 1-800-796-9526.

Summary

Epinephrine auto-injectors, such as the EpiPen, should be used at the first sign of anaphylaxis. The medicine works immediately to reverse the symptoms of this life-threatening allergic reaction. However, it must be used properly and without delay in order for it to work.

Because anaphylaxis can be very unpredictable, you (or your child) should have at least one EpiPen on your person at all times. Be sure to check your EpiPens regularly to ensure they are not expired and that the liquid in them is clear. Refill your auto-injectors before they expire, and practice with your trainer auto-injector as often as necessary to stay prepared.

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2 Sources
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  1. Nationwide Children's. Epinephrine auto-injectors for severe allergic reaction (Adrenaclick, Auvi-Q, EpiPen, Symjepi). Updated 2021.

  2. U.S. Food and Drug Administration. FDA alerts patients and healthcare professionals of EpiPen auto-injector errors related to device malfunctions and user administration.