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How to use an EpiPen

(epinephrine injection, USP) Auto-Injector

1 PREPARE
Remove the EpiPen or EpiPen Jr
Auto-Injector from the clear carrier tube.
Flip open the yellow cap of your EpiPen or
the green cap of your EpiPen Jr carrier tube.
Tip and slide the auto-injector out of the
carrier tube.

Hold the auto-injector in your fist with


the orange tip pointing downward.
NEVER-SEE-NEEDLE helps with protection. Protects against needle
Blue to the sky, orange to the thigh.
exposure before and after use.
With your other hand, remove the blue NOTE:
safety release by pulling straight up The needle comes out of the orange tip.
without bending or twisting it. To avoid an accidental injection, never put your thumb, fingers or hand over the
orange tip. If an accidental injection happens, get medical help right away.

2 ADMINISTER
If you are administering EpiPen or EpiPen Jr to a young child, hold the leg
firmly in place while administering an injection.

Place the orange tip against the middle of the outer thigh (upper leg) at a right
angle (perpendicular) to the thigh.

Swing and push the auto-injector firmly until it clicks. The click signals that
the injection has started.

Hold firmly in place for 3 seconds (count slowly 1, 2, 3).

Remove the auto-injector from the thigh. The orange tip will extend
to cover the needle. If the needle is still visible, do not attempt to reuse it.

Massage the injection area for 10 seconds.

3 GET EMERGENCY MEDICAL HELP RIGHT AWAY


You may need further medical attention.
If symptoms continue or recur, you may need to use a second EpiPen or EpiPen Jr Auto-Injector.

INDICATIONS
EpiPen and EpiPen Jr Auto-Injectors are for the emergency treatment of life-threatening allergic reactions (anaphylaxis) caused by allergens, exercise,
or unknown triggers; and for people who are at increased risk for these reactions. EpiPen and EpiPen Jr are intended for immediate administration as
emergency supportive therapy only. Seek immediate emergency medical help right away.

IMPORTANT SAFETY INFORMATION


Use EpiPen (epinephrine injection, USP) 0.3 mg or EpiPen Jr (epinephrine injection, USP) 0.15 mg Auto-Injectors right away when you have an allergic
emergency (anaphylaxis). Get emergency medical help right away. You may need further medical attention. Only a healthcare professional should give
additional doses of epinephrine if you need more than two injections for a single anaphylactic episode.
Not actual patient.
Please see additional Important Safety Information and Indications on the back.
Please see accompanying full Prescribing Information and Patient Information.
Every EpiPen 2-Pak (epinephrine injection, USP)


comes with an EpiPen Trainer
Practice with your Trainer repeatedly
to become familiar with it.

The EpiPen Auto-Injector



The EpiPen Trainer

Identify the EpiPen Trainer by:


Label
The EpiPen Trainer is clearly labeled
TRAINER or TRAINING DEVICE.

Color
or or
The EpiPen Trainer is shaded grey

EpiPen is yellow & EpiPen Jr is green

No Window or Liquid

Reset after each use


Always have access to two EpiPen Auto-Injectors The grey EpiPen Trainer contains no
in all the places you may need them because some medicine and no needle, and SHOULD NOT
people require a second dose. More than two BE USED during an anaphylactic reaction.
sequential doses of EpiPen Auto-Injector should be
administered only under direct medical supervision.

Visit epipen.com to watch our How to Use video and more.

IMPORTANT SAFETY INFORMATION (Continued)


EpiPen or EpiPen Jr should only be injected into the middle of your outer thigh (upper leg), through clothing if necessary. Do not inject into your veins, buttocks, fingers, toes, hands
or feet. Hold the leg of young children firmly in place before and during injection to prevent injuries. In case of accidental injection, please seek immediate medical treatment.

Rarely, patients who have used EpiPen or EpiPen Jr may develop an infection at the injection site within a few days. Some of these infections can be serious. Call your healthcare
professional right away if you have any of the following at an injection site: redness that does not go away, swelling, tenderness, or the area feels warm to the touch.

Tell your healthcare professional about all of your medical conditions, especially if you have asthma, a history of depression, thyroid problems, Parkinsons disease, diabetes, high
blood pressure or heart problems, have any other medical conditions, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. Be sure to also tell your
healthcare professional all the medicines you take, especially medicines for asthma. If you have certain medical conditions, or take certain medicines, your condition may get
worse or you may have longer lasting side effects when you use EpiPen or EpiPen Jr .

Common side effects include fast, irregular or pounding heartbeat, sweating, nausea or vomiting, breathing problems, paleness, dizziness, weakness, shakiness, headache, feelings
of over excitement, nervousness or anxiety. These side effects usually go away quickly if you lie down and rest. Tell your healthcare professional if you have any side effect that
bothers you or that does not go away.

Please see the full Prescribing Information and Patient Information.


You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
For additional information, please contact us at 800-395-3376.

EpiPen, EpiPen Jr, EpiPen 2-Pak, EpiPen Jr 2-Pak, Blue to the Sky, Orange to the Thigh and Never-See-Needle are trademarks owned
by the Mylan companies. The Mylan logo is a registered trademark of Mylan Inc. All other trademarks and service marks are the property of their
respective owners. 2016 Mylan Specialty L.P. All rights reserved. 7/16 EPI-2016-0305 Mylan Specialty L.P., 1000 Mylan
Blvd., Canonsburg, PA 15317
HIGHLIGHTS OF PRESCRIBING INFORMATION 3 DOSAGE FORMS AND STRENGTHS should be stored in the carrier tube provided to protect it
These highlights do not include all the information 4 CONTRAINDICATIONS from light [see How Supplied/Storage and Handling (16.2)].
needed to use EPIPEN and EPIPEN Jr safely 3 DOSAGE FORMS AND STRENGTHS
5 WARNINGS AND PRECAUTIONS
and effectively. See full prescribing information for EpiPen: Injection, 0.3 mg/0.3 mL (0.3 mL, 1:1000)
EPIPEN and EPIPEN Jr. 5.1 Emergency Treatment epinephrine injection, USP, pre-filled auto-injector
EPIPEN (epinephrine injection, USP), Auto-Injector 0.3 mg, 5.2 Injection-Related Complications EpiPen Jr: Injection, 0.15 mg/0.3 mL, (0.3 mL 1:2000)
EPIPEN Jr (epinephrine injection, USP) Auto-Injector 5.3 Serious Infections at the Injection Site epinephrine injection, USP, pre-filled auto-injector
0.15 mg, for intramuscular or subcutaneous use 5.4 Allergic Reactions Associated with Sulfite 4 CONTRAINDICATIONS
Initial U.S. Approval: 1939 None
5.5 Disease Interactions
6 ADVERSE REACTIONS 5 WARNINGS AND PRECAUTIONS
RECENT MAJOR CHANGES
Dosage and Administration (2) 05/2016 5.1 Emergency Treatment
7 DRUG INTERACTIONS EpiPen and EpiPen Jr are intended for immediate
Warnings and Precautions (5.2, 5.3) 05/2016 8 USE IN SPECIFIC POPULATIONS administration as emergency supportive therapy and are
8.1 Pregnancy not intended as a substitute for immediate medical care.
INDICATIONS AND USAGE In conjunction with the administration of epinephrine,
EpiPen and EpiPen Jr contain epinephrine, a non-selective 8.3 Nursing Mothers
the patient should seek immediate medical or hospital
alpha and beta-adrenergic receptor agonist, indicated in the 8.4 Pediatric Use care. More than two sequential doses of epinephrine should
emergency treatment of allergic reactions (Type I) including 8.5 Geriatric Use only be administered under direct medical supervision [see
anaphylaxis. (1) Indications and Usage (1), Dosage and Administration (2)
10 OVERDOSAGE
DOSAGE AND ADMINISTRATION and Patient Counseling Information (17)].
Patients greater than or equal to 30 kg (66 lbs): 11 DESCRIPTION 5.2 Injection-Related Complications
EpiPen 0.3 mg (2) 12 CLINICAL PHARMACOLOGY EpiPen and EpiPen Jr should only be injected into
Patients 15 to 30 kg (33 lbs to 66 lbs): 12.1 Mechanism of Action the anterolateral aspect of the thigh [see Dosage and
EpiPen Jr 0.15 mg (2) Administration (2) and Patient Counseling Information (17)].
12.2 Pharmacodynamics
Inject EpiPen and EpiPen Jr intramuscularly or Do not inject intravenously. Large doses or accidental
13 NONCLINICAL TOXICOLOGY intravenous injection of epinephrine may result in
subcutaneously into the anterolateral aspect of the thigh,
through clothing if necessary. Each device is a single-use 13.1 Carcinogenesis, Mutagenesis, Impairment cerebral hemorrhage due to sharp rise in blood pressure.
injection. (2) of Fertility Rapidly acting vasodilators can counteract the marked
pressor effects of epinephrine if there is such inadvertent
DOSAGE FORMS AND STRENGTHS 16 HOW SUPPLIED/STORAGE AND HANDLING
administration.
EpiPen: Injection, 0.3 mg: 0.3 mg/0.3 mL epinephrine, 16.1 How Supplied Do not inject into buttock. Injection into the buttock may
USP, pre-filled auto-injector (3) 16.2 Storage and Handling not provide effective treatment of anaphylaxis. Advise the
EpiPen Jr: Injection, 0.15 mg: 0.15 mg/0.3 mL 17 PATIENT COUNSELING INFORMATION patient to go immediately to the nearest emergency room
epinephrine, USP, pre-filled auto-injector (3) for further treatment of anaphylaxis. Additionally, injection
*Sections or subsections omitted from the full prescribing into the buttock has been associated with Clostridial
CONTRAINDICATIONS information are not listed.
None (4) infections (gas gangrene). Cleansing with alcohol does not
kill bacterial spores, and therefore, does not lower this risk.
WARNINGS AND PRECAUTIONS FULL PRESCRIBING INFORMATION Do not inject into digits, hands or feet. Since
In conjunction with use, seek immediate medical 1 INDICATIONS AND USAGE epinephrine is a strong vasoconstrictor, accidental
or hospital care. (5.1) EpiPen and EpiPen Jr are indicated in the emergency injection into the digits, hands or feet may result in loss
Do not inject intravenously, into buttock, or into digits, treatment of allergic reactions (Type I) including anaphylaxis of blood flow to the affected area. Advise the patient to
hands, or feet. (5.2) to stinging insects (e.g., order Hymenoptera, which go immediately to the nearest emergency room and to
To minimize the risk of injection related injury, instruct include bees, wasps, hornets, yellow jackets and fire ants) inform the healthcare provider in the emergency room of
caregivers to hold the childs leg firmly in place and limit and biting insects (e.g., triatoma, mosquitoes), allergen the location of the accidental injection. Treatment of such
movement prior to and during injection when administering immunotherapy, foods, drugs, diagnostic testing substances inadvertent administration should consist of vasodilation,
to young children. (5.2) (e.g., radiocontrast media) and other allergens, as well as in addition to further appropriate treatment of anaphylaxis
idiopathic anaphylaxis or exercise-induced anaphylaxis. [see Adverse Reactions (6)].
Rare cases of serious skin and soft tissue infections have
EpiPen and EpiPen Jr are intended for immediate Hold leg firmly during injection. Lacerations, bent
been reported following epinephrine injection. Advise
administration in patients who are determined to be at needles, and embedded needles have been reported
patients to seek medical care if they develop signs or
increased risk for anaphylaxis, including individuals with a when EpiPen and EpiPen Jr have been injected into the
symptoms of infection. (5.3)
history of anaphylactic reactions. thigh of young children who are uncooperative and kick or
The presence of a sulfite in this product should Anaphylactic reactions may occur within minutes after move during an injection. To minimize the risk of injection
not deter use. (5.4) exposure and consist of flushing, apprehension, syncope, related injury when administering EpiPen to young
Administer with caution in patients with heart disease; tachycardia, thready or unobtainable pulse associated with children, instruct caregivers to hold the childs leg firmly in
may aggravate angina pectoris or produce ventricular a fall in blood pressure, convulsions, vomiting, diarrhea place and limit movement prior to and during injection.
arrhythmias. (5.5) and abdominal cramps, involuntary voiding, wheezing, 5.3 Serious Infections at the Injection Site
ADVERSE REACTIONS dyspnea due to laryngeal spasm, pruritus, rashes, urticaria Rare cases of serious skin and soft tissue infections,
Adverse reactions to epinephrine include anxiety, or angioedema. including necrotizing fasciitis and myonecrosis caused
apprehensiveness, restlessness, tremor, weakness, EpiPen and EpiPen Jr are intended for immediate by Clostridia (gas gangrene), have been reported at the
dizziness, sweating, palpitations, pallor, nausea and vomiting, administration as emergency supportive therapy only and injection site following epinephrine injection for anaphylaxis.
headache, and/or respiratory difficulties. (6) are not a substitute for immediate medical care. Clostridium spores can be present on the skin and
To report SUSPECTED ADVERSE REACTIONS, 2 DOSAGE AND ADMINISTRATION introduced into the deep tissue with subcutaneous or
contact Mylan Specialty, L.P. at 1-877-446-3679 Selection of the appropriate dosage strength (EpiPen intramuscular injection. While cleansing with alcohol may
(1-877-4-INFO-RX) or FDA at 1-800-FDA-1088 or 0.3 mg or EpiPen Jr 0.15 mg) is determined according reduce presence of bacteria on the skin, alcohol cleansing
www.fda.gov/medwatch. to patient body weight. does not kill Clostridium spores. To decrease the risk of
Patients greater than or equal to 30 kg (approximately Clostridium infection, do not inject EpiPen into the buttock
DRUG INTERACTIONS
66 pounds or more): EpiPen 0.3 mg [see Warnings and Precautions (5.2)]. Advise patients to seek
Cardiac glycosides or diuretics: observe for
Patients 15 to 30 kg (33 pounds to 66 pounds): medical care if they develop signs or symptoms of infection,
development of cardiac arrhythmias. (7)
EpiPen Jr 0.15 mg such as persistent redness, warmth, swelling,
Tricyclic antidepressants, monoamine oxidase inhibitors, Inject EpiPen or EpiPen Jr intramuscularly or or tenderness, at the epinephrine injection site.
levothyroxine sodium, and certain antihistamines: subcutaneously into the anterolateral aspect of the thigh, 5.4 Allergic Reactions Associated With Sulfite
potentiate effects of epinephrine. (7) through clothing if necessary. Instruct caregivers of young The presence of a sulfite in this product should not deter
Beta-adrenergic blocking drugs: antagonize children who are prescribed an EpiPen or EpiPen Jr and administration of the drug for treatment of serious allergic
cardiostimulating and bronchodilating effects of who may be uncooperative and kick or move during an or other emergency situations even if the patient is
epinephrine. (7) injection to hold the leg firmly in place and limit movement sulfite-sensitive.
Alpha-adrenergic blocking drugs: antagonize prior to and during an injection [see Warnings and Precautions Epinephrine is the preferred treatment for serious allergic
vasoconstricting and hypertensive effects of (5.2)]. reactions or other emergency situations even though this
epinephrine. (7) Each EpiPen or EpiPen Jr contains a single dose of product contains sodium metabisulfite, a sulfite that may,
epinephrine for single-use injection. Since the doses of in other products, cause allergic-type reactions including
Ergot alkaloids: may reverse the pressor effects
epinephrine delivered from EpiPen or EpiPen Jr are fixed, anaphylactic symptoms or life-threatening or less severe
of epinephrine. (7)
consider using other forms of injectable epinephrine if asthmatic episodes in certain susceptible persons.
USE IN SPECIFIC POPULATIONS doses lower than 0.15 mg are deemed necessary. The alternatives to using epinephrine in a life-threatening
Elderly patients may be at greater risk of developing The prescriber should carefully assess each patient to situation may not be satisfactory.
adverse reactions. (5.5, 8.5) determine the most appropriate dose of epinephrine, 5.5 Disease Interactions
See 17 for PATIENT COUNSELING INFORMATION recognizing the life-threatening nature of the reactions Some patients may be at greater risk for developing adverse
and FDA approved patient labeling for which this drug is indicated. With severe persistent reactions after epinephrine administration. Despite these
Revised: May 2016 anaphylaxis, repeat injections with an additional EpiPen concerns, it should be recognized that the presence of
or EpiPen Jr may be necessary. More than two sequential these conditions is not a contraindication to epinephrine
doses of epinephrine should only be administered under direct administration in an acute, life-threatening situation.
FULL PRESCRIBING INFORMATION: CONTENTS* medical supervision [see Warnings and Precautions (5.1)]. Therefore, patients with these conditions, and/or any other
1 INDICATIONS AND USAGE The epinephrine solution in the clear window of the EpiPen person who might be in a position to administer EpiPen
Auto-Injector should be inspected visually for particulate or EpiPen Jr to a patient experiencing anaphylaxis should
2 DOSAGE AND ADMINISTRATION matter and discoloration. Epinephrine is light sensitive and be carefully instructed in regard to the circumstances under
which epinephrine should be used. recommended daily subcutaneous or intramuscular dose EpiPen Jr if the epinephrine solution appears discolored
Patients with Heart Disease (on a mg/m2 basis at a maternal subcutaneous dose of (pinkish or brown color), cloudy, or contains particles.
Epinephrine should be administered with caution to patients 0.5 mg/kg/day for 4 days). Thoroughly review the patient instructions and operation of
who have heart disease, including patients with cardiac These effects were not seen in mice at approximately EpiPen or EpiPen Jr with patients and caregivers prior to
arrhythmias, coronary artery or organic heart disease, 3 times the maximum recommended daily subcutaneous use [see Patient Counseling Information (17)].
or hypertension. In such patients, or in patients who are or intramuscular dose (on a mg/m2 basis at a subcutaneous 12 CLINICAL PHARMACOLOGY
on drugs that may sensitize the heart to arrhythmias, maternal dose of 0.5 mg/kg/day for 10 days). 12.1 Mechanism of Action
epinephrine may precipitate or aggravate angina pectoris 8.3 Nursing Mothers Epinephrine acts on both alpha- and beta-adrenergic receptors.
as well as produce ventricular arrhythmias [see Drug It is not known whether epinephrine is excreted in human 12.2 Pharmacodynamics
Interactions (7) and Adverse Reactions (6)]. milk. Because many drugs are excreted in human milk, Through its action on alpha-adrenergic receptors,
Other Patients and Diseases caution should be exercised when EpiPen is administered epinephrine lessens the vasodilation and increased vascular
Epinephrine should be administered with caution to patients to a nursing woman. permeability that occurs during anaphylaxis, which can lead
with hyperthyroidism, diabetes, elderly individuals, and 8.4 Pediatric Use to loss of intravascular fluid volume and hypotension.
pregnant women. Patients with Parkinsons disease may EpiPen or EpiPen Jr may be administered to pediatric Through its action on beta-adrenergic receptors, epinephrine
notice a temporary worsening of symptoms. patients at a dosage appropriate to body weight [see causes bronchial smooth muscle relaxation and helps
6 ADVERSE REACTIONS Dosage and Administration (2)]. Clinical experience with alleviate bronchospasm, wheezing and dyspnea that may
Due to the lack of randomized, controlled clinical trials the use of epinephrine suggests that the adverse reactions occur during anaphylaxis.
of epinephrine for the treatment of anaphylaxis, the true seen in children are similar in nature and extent to those Epinephrine also alleviates pruritus, urticaria, and
incidence of adverse reactions associated with the systemic both expected and reported in adults. Since the doses of angioedema and may relieve gastrointestinal and
use of epinephrine is difficult to determine. Adverse epinephrine delivered from EpiPen and EpiPen Jr are genitourinary symptoms associated with anaphylaxis
reactions reported in observational trials, case reports, fixed, consider using other forms of injectable epinephrine because of its relaxer effects on the smooth muscle of the
and studies are listed below. if doses lower than 0.15 mg are deemed necessary. stomach, intestine, uterus and urinary bladder.
Common adverse reactions to systemically administered 8.5 Geriatric Use When given subcutaneously or intramuscularly, epinephrine
epinephrine include anxiety; apprehensiveness; Clinical studies for the treatment of anaphylaxis have not has a rapid onset and short duration of action.
restlessness; tremor; weakness; dizziness; sweating; been performed in subjects aged 65 and over to determine 13 NONCLINICAL TOXICOLOGY
palpitations; pallor; nausea and vomiting; headache; and/ whether they respond differently from younger subjects. 13.1 Carcinogenesis, Mutagenesis, Impairment
or respiratory difficulties. These symptoms occur in some However, other reported clinical experience with use of of Fertility
persons receiving therapeutic doses of epinephrine, but epinephrine for the treatment of anaphylaxis has identified Long-term studies to evaluate the carcinogenic potential
are more likely to occur in patients with hypertension or that geriatric patients may be particularly sensitive to of epinephrine have not been conducted.
hyperthyroidism [see Warnings and Precautions (5.5)]. the effects of epinephrine. Therefore, EpiPen should be Epinephrine and other catecholamines have been shown
Arrhythmias, including fatal ventricular fibrillation, have been administered with caution in elderly individuals, who may to have mutagenic potential in vitro and to be an oxidative
reported, particularly in patients with underlying cardiac be at greater risk for developing adverse reactions after mutagen in a WP2 bacterial reverse mutation assay.
disease or those receiving certain drugs [see Warnings and epinephrine administration [see Warnings and Precautions Epinephrine was positive in the DNA Repair test with
Precautions (5.5) and Drug Interactions (7)]. (5.5), Overdosage (10)]. B. subtilis (REC) assay, but was not mutagenic in the
Rapid rises in blood pressure have produced cerebral 10 OVERDOSAGE Salmonella bacterial reverse mutation assay.
hemorrhage, particularly in elderly patients with Overdosage of epinephrine may produce extremely elevated The potential for epinephrine to impair fertility has not been
cardiovascular disease [see Warnings and Precautions (5.5)]. arterial pressure, which may result in cerebrovascular evaluated.
Angina may occur in patients with coronary artery disease hemorrhage, particularly in elderly patients. Overdosage This should not prevent the use of epinephrine under the
[see Warnings and Precautions (5.5)]. may also result in pulmonary edema because of peripheral conditions noted under Indications and Usage (1).
Accidental injection into the digits, hands or feet may result vascular constriction together with cardiac stimulation. 16 HOW SUPPLIED/STORAGE AND HANDLING
in loss of blood flow to the affected area [see Warnings and Treatment consists of rapidly acting vasodilators or alpha- 16.1 How Supplied
Precautions (5.2)]. adrenergic blocking drugs and/or respiratory support. EpiPen Auto-Injectors (epinephrine injections, USP, 1:1000,
Adverse events experienced as a result of accidental Epinephrine overdosage can also cause transient 0.3 mL) are available as EpiPen 2-Pak, NDC 49502-
injections may include increased heart rate, local reactions bradycardia followed by tachycardia, and these may be 500-02, a pack that contains two EpiPen Auto-Injectors
including injection site pallor, coldness and hypoesthesia accompanied by potentially fatal cardiac arrhythmias. (epinephrine injections, USP, 1:1000, 0.3 mL) and one
or injury at the injection site resulting in bruising, bleeding, Premature ventricular contractions may appear within one EpiPen Auto-Injector trainer device.
discoloration, erythema or skeletal injury. minute after injection and may be followed by multifocal EpiPen Jr Auto-Injectors (epinephrine injections, USP,
Lacerations, bent needles, and embedded needles have ventricular tachycardia (prefibrillation rhythm). Subsidence 1:2000, 0.3 mL) are available as EpiPen Jr 2-Pak, NDC
been reported when EpiPen has been injected into the of the ventricular effects may be followed by atrial 49502-501-02, a pack that contains two EpiPen Jr Auto-
thigh of young children who are uncooperative and kick or tachycardia and occasionally by atrioventricular block. Injectors (epinephrine injections, USP, 1:2000, 0.3 mL) and
move during the injection [see Warning and Precautions (5.2)]. Treatment of arrhythmias consists of administration of one EpiPen Auto-Injector trainer device.
Injection into the buttock has resulted in cases of gas a beta-adrenergic blocking drug such as propranolol. EpiPen 2-Pak and EpiPen Jr 2-Pak also include an
gangrene [see Warnings and Precautions (5.2)]. Overdosage sometimes results in extreme pallor and S-clip to clip two carrier tubes together. Rx only
Rare cases of serious skin and soft tissue infections, coldness of the skin, metabolic acidosis, and kidney 16.2 Storage and Handling
including necrotizing fasciitis and myonecrosis caused by failure. Suitable corrective measures must be taken in Protect from light. Epinephrine is light sensitive and should
Clostridia (gas gangrene), have been reported following such situations. be stored in the carrier tube provided to protect it from light.
epinephrine injection, including EpiPen, in the thigh [see 11 DESCRIPTION Store at 20 to 25C (68 to 77F); excursions permitted
Warnings and Precautions (5.3)]. to 15 to 30C (59 to 86F) [See USP Controlled Room
EpiPen (epinephrine injection, USP) 0.3 mg and EpiPen Jr Temperature]. Do not refrigerate. Before using, check to make
7 DRUG INTERACTIONS (epinephrine injection, USP) 0.15 mg are auto-injectors sure the solution in the auto-injector is clear and colorless.
Patients who receive epinephrine while concomitantly and combination products containing drug and device Replace the auto-injector if the solution is discolored (pinkish
taking cardiac glycosides, diuretics, or anti-arrhythmics components. or brown color), cloudy, or contains particles.
should be observed carefully for the development of cardiac Each EpiPen Auto-Injector, 0.3 mg delivers a single dose of
arrhythmias [see Warnings and Precautions (5.5)]. 0.3 mg epinephrine from epinephrine injection, USP 1:1000 17 PATIENT COUNSELING INFORMATION
The effects of epinephrine may be potentiated by (0.3 mL) in a sterile solution. [See FDA-Approved Patient Labeling (Patient Information
tricyclic antidepressants, monoamine oxidase inhibitors, Each EpiPen Jr Auto-Injector, 0.15 mg delivers a single and Instructions for Use).]
levothyroxine sodium, and certain antihistamines, notably A healthcare provider should review the patient instructions
dose of 0.15 mg epinephrine from epinephrine injection,
chlorpheniramine, tripelennamine, and diphenhydramine. and operation of EpiPen and EpiPen Jr in detail, with the
USP 1:2000 (0.3 mL) in a sterile solution.
The cardiostimulating and bronchodilating effects of patient or caregiver.
The EpiPen and EpiPen Jr each contain 2 mL epinephrine
epinephrine are antagonized by beta-adrenergic blocking Epinephrine is essential for the treatment of anaphylaxis.
solution. Approximately 1.7 mL remains in the auto-injector
drugs, such as propranolol. Patients who are at risk of or with a history of severe allergic
after activation, but is not available for future use, and
The vasoconstricting and hypertensive effects of epinephrine reactions (anaphylaxis) to insect stings or bites, foods, drugs,
should be discarded.
are antagonized by alpha-adrenergic blocking drugs, such and other allergens, as well as idiopathic and exercise-
Each 0.3 mL in the EpiPen Auto-Injector contains 0.3
as phentolamine. induced anaphylaxis, should be carefully instructed about
mg epinephrine, 1.8 mg sodium chloride, 0.5 mg sodium
Ergot alkaloids may also reverse the pressor effects of the circumstances under which epinephrine should be used.
metabisulfite, hydrochloric acid to adjust pH, and Water for
epinephrine. Administration and Training
Injection. The pH range is 2.2-5.0.
Instruct patients and/or caregivers in the appropriate use
8 USE IN SPECIFIC POPULATIONS Each 0.3 mL in the EpiPen Jr Auto-Injector contains 0.15
of EpiPen and EpiPen Jr. EpiPen should be injected into
8.1 Pregnancy mg epinephrine, 1.8 mg sodium chloride, 0.5 mg sodium
the middle of the outer thigh (through clothing, if necessary).
Teratogenic Effects: Pregnancy Category C. metabisulfite, hydrochloric acid to adjust pH, and Water for
Each device is a single-use injection. Advise patients to seek
There are no adequate and well controlled studies of the Injection. The pH range is 2.2-5.0.
immediate medical care in conjunction with administration
acute effect of epinephrine in pregnant women. Epinephrine is a sympathomimetic catecholamine.
of EpiPen.
Epinephrine was teratogenic in rabbits, mice and hamsters. Chemically, epinephrine is (-)-3,4-Dihydroxy--
Instruct caregivers to hold the leg of young children firmly
Epinephrine should be used during pregnancy only if the [(methylamino)methyl]benzyl alcohol with the following
in place and limit movement prior to and during injection.
potential benefit justifies the potential risk to the fetus (fetal structure:
Lacerations, bent needles, and embedded needles
anoxia, spontaneous abortion, or both). have been reported when EpiPen and EpiPen Jr have
Epinephrine has been shown to have teratogenic been injected into the thigh of young children who are
effects when administered subcutaneously in rabbits at uncooperative and kick or move during an injection [see
approximately 30 times the maximum recommended Warnings and Precautions (5.2)].
daily subcutaneous or intramuscular dose (on a mg/m2 Complete patient information, including dosage, directions
basis at a maternal dose of 1.2 mg/kg/day for two to three for proper administration and precautions can be found
days), in mice at approximately 7 times the maximum daily inside each EpiPen or EpiPen Jr carton. A printed label
subcutaneous or intramuscular dose (on a mg/m2 basis at a Epinephrine solution deteriorates rapidly on exposure to air on the surface of EpiPen shows instructions for use and a
maternal subcutaneous dose of 1 mg/kg/day for 10 days), or light, turning pink from oxidation to adrenochrome and diagram depicting the injection process.
and in hamsters at approximately 5 times the maximum brown from the formation of melanin. Replace EpiPen and Instruct patients and/or caregivers to use and practice with
the Trainer device to familiarize themselves with the use of hoarseness (changes in the way your voice sounds) How should I use EpiPen and EpiPen Jr?
EpiPen in an allergic emergency. The Trainer may be used hives (raised reddened rash that may itch) Each EpiPen or EpiPen Jr Auto-Injector contains only 1
multiple times. A Trainer device is provided in 2-Pak cartons. dose of medicine.
severe itching
Adverse Reactions
swelling of your face, lips, mouth, or tongue EpiPen or EpiPen Jr should be injected into the middle
Epinephrine may produce symptoms and signs that include of your outer thigh (upper leg). It can be injected through
an increase in heart rate, the sensation of a more forceful skin rash, redness, or swelling
your clothing if needed.
heartbeat, palpitations, sweating, nausea and vomiting, fast heartbeat
Read the Instructions for Use at the end of this Patient
difficulty breathing, pallor, dizziness, weakness or shakiness, weak pulse Information Leaflet about the right way to use EpiPen
headache, apprehension, nervousness, or anxiety. These
feeling very anxious and EpiPen Jr.
signs and symptoms usually subside rapidly, especially with
rest, quiet and recumbency. Patients with hypertension or confusion Your healthcare provider will show you how to safely
hyperthyroidism may develop more severe or persistent stomach pain use the EpiPen or EpiPen Jr Auto-Injector.
effects, and patients with coronary artery disease could losing control of urine or bowel movements Use your EpiPen or EpiPen Jr exactly as your healthcare
experience angina. Patients with diabetes may develop (incontinence) provider tells you to use it. You may need to use a second
increased blood glucose levels following epinephrine EpiPen or EpiPen Jr if symptoms continue or recur.
diarrhea or stomach cramps
administration. Patients with Parkinsons disease may notice Only a healthcare provider should give additional doses of
a temporary worsening of symptoms [see Warnings and dizziness, fainting, or passing out (unconsciousness) epinephrine if you need more than 2 injections for a single
Precautions (5.5)]. 2. Always carry your EpiPen or EpiPen Jr with you anaphylaxis episode.
Accidental Injection because you may not know when anaphylaxis Caution: Never put your thumb, fingers, or hand over
Advise patients to seek immediate medical care in the may happen. the orange tip. Never press or push the orange tip with
case of accidental injection. Since epinephrine is a strong Talk to your healthcare provider if you need additional your thumb, fingers, or hand. The needle comes out of
vasoconstrictor when injected into the digits, hands, or feet, units to keep at work, school, or other locations. the orange tip. Accidental injection into finger, hands or
treatment should be directed at vasodilatation if there is Tell your family members, caregivers, and others where feet may cause a loss of blood flow to these areas. If this
such an accidental injection to these areas [see Warnings you keep your EpiPen or EpiPen Jr and how to use it happens, go immediately to the nearest emergency
and Precautions (5.2)]. before you need it. You may be unable to speak in an room. Tell the healthcare provider where on your body
allergic emergency. you received the accidental injection.
Serious Infections at the Injection Site
Your EpiPen and EpiPen Jr Auto-Injector may come
Rare cases of serious skin and soft tissue infections, 3. When you have an allergic emergency (anaphylaxis)
packaged with an EpiPen Trainer and separate Trainer
including necrotizing fasciitis and myonecrosis caused Use EpiPen or EpiPen Jr right away. Instructions for Use. The EpiPen Trainer has a grey
by Clostridia (gas gangrene), have been reported at the
Get emergency medical help right away. You may color. The grey EpiPen Trainer contains no medicine
injection site following epinephrine injection for anaphylaxis.
need further medical attention. You may need to use a and no needle. Periodically practice with your EpiPen
Advise patients to seek medical care if they develop signs or
second EpiPen or EpiPen Jr if symptoms continue or Trainer before an allergic emergency happens to make
symptoms of infection, such as persistent redness, warmth,
recur. Only a healthcare provider should give additional sure you are able to safely use the real EpiPen and
swelling, or tenderness, at the epinephrine injection site [see
doses of epinephrine if you need more than EpiPen Jr Auto-Injector in an emergency. Always carry
Warnings and Precautions (5.3)].
2 injections for a single anaphylaxis episode. your real EpiPen or EpiPen Jr Auto-Injector with you
Storage and Handling in case of an allergic emergency. Additional training
Instruct patients to inspect the epinephrine solution visually What are EpiPen and EpiPen Jr? resources are available at www.epipen.com.
through the clear window of the auto-injector periodically. EpiPen and EpiPen Jr are disposable, prefilled automatic Do not drop the carrier tube or auto-injector. If the carrier
Replace EpiPen and EpiPen Jr if the epinephrine solution injection devices (auto-injectors) used to treat life- tube or auto-injector is dropped, check for damage and
appears discolored (pinkish or brown color), cloudy, or threatening, allergic emergencies including anaphylaxis leakage. Dispose of the auto-injector and carrier tube, and
contains particles. Epinephrine is light sensitive and should in people who are at risk for or have a history of serious replace if damage or leakage is noticed or suspected.
be stored in the carrier tube provided to protect it from light. allergic emergencies. Each device contains a single dose
The carrier tube is not waterproof. Instruct patients that of epinephrine. What are the possible side effects of the EpiPen and
EpiPen and EpiPen Jr must be used or properly disposed EpiPen Jr?
EpiPen and EpiPen Jr are for immediate self (or
once the blue safety release is removed or after use [see caregiver) administration and do not take the place of EpiPen and EpiPen Jr may cause serious side effects.
Storage and Handling (16.2)]. emergency medical care. You should get emergency help The EpiPen or EpiPen Jr should only be injected into
Complete patient information, including dosage, directions right away after using EpiPen and EpiPen Jr. the middle of your outer thigh (upper leg). Do
for proper administration and precautions can be found EpiPen and EpiPen Jr are for people who have been not inject the EpiPen or EpiPen Jr into your:
inside each EpiPen Auto-Injector carton. prescribed this medicine by their healthcare provider. veins
Manufactured for Mylan Specialty L.P., Morgantown, WV The EpiPen Auto-Injector (0.3 mg) is for patients who buttocks
26505, U.S.A. by Meridian Medical Technologies, Inc., weigh 66 pounds or more (30 kilograms or more). fingers, toes, hands, or feet
Columbia, MD 21046, U.S.A., a Pfizer company
The EpiPen Jr Auto-Injector (0.15 mg) is for patients who If you accidentally inject EpiPen or EpiPen Jr into any
EpiPen and EpiPen Jr are registered trademarks of Mylan weigh about 33 to 66 pounds (15 to 30 kilograms). other part of your body, go to the nearest emergency room
Inc. licensed exclusively to its wholly-owned affiliate, Mylan
It is not known if EpiPen and EpiPen Jr are safe and right away. Tell the healthcare provider where on your body
Specialty L.P. of Morgantown, WV 26505, U.S.A.
effective in children who weigh less than 33 pounds you received the accidental injection.
Copyright 2016 Meridian Medical Technologies. All rights (15 kilograms). Rarely, patients who have used EpiPen or EpiPen Jr may
reserved.
What should I tell my healthcare provider before using develop infections at the injection site within a few days of
May 2016 MS:EPI:R2 0001928 the EpiPen or EpiPen Jr? an injection. Some of these infections can be serious. Call
Before you use EpiPen or EpiPen Jr, tell your your healthcare provider right away if you have any of the
PATIENT INFORMATION and INSTRUCTIONS FOR USE following at an injection site:
healthcare provider about all your medical conditions,

EPIPEN but especially if you: redness that does not go away
(epinephrine injection, USP) Auto-Injector 0.3 mg have heart problems or high blood pressure swelling
Epipen = one dose of 0.30 mg epinephrine (USP, 1:1000, 0.3 have diabetes tenderness
have thyroid problems the area feels warm to the touch
EPIPEN JR
(epinephrine injection, USP) Auto-Injector 0.15 mg have asthma Cuts on the skin, bent needles, and needles that remain
Epipen = one dose of 0.15 mg epinephrine (USP, 1:2000, 0.3 mL) have a history of depression in the skin after the injection, have happened in young
children who do not cooperate and kick or move during an
For allergic emergencies (anaphylaxis) have Parkinsons disease
injection. If you inject a young child with EpiPen or EpiPen Jr,
have any other medical conditions hold their leg firmly in place before and during the injection
Patient Information
are pregnant or plan to become pregnant. It is not known if to prevent injuries. Ask your healthcare provider to show
Read this Patient Information Leaflet carefully before using
epinephrine will harm your unborn baby. you how to properly hold the leg of a young child during
the EpiPen or EpiPen Jr Auto-Injector and each time you
are breastfeeding or plan to breastfeed. It is not known if injection.
get a refill. There may be new information. You, your parent,
caregiver, or others who may be in a position to administer epinephrine passes into your breast milk. If you have certain medical conditions, or take certain
EpiPen or EpiPen Jr Auto-Injector, should know how to medicines, your condition may get worse or you may
Tell your healthcare provider about all the medicines you
use it before you have an allergic emergency. have longer lasting side effects when you use your
take, including prescription and over-the-counter medicines,
This information does not take the place of talking with your EpiPen or EpiPen Jr. Talk to your healthcare provider
vitamins, and herbal supplements. Tell your healthcare
healthcare provider about your medical condition or your about all your medical conditions.
provider of all known allergies.
treatment. Common side effects of EpiPen and EpiPen Jr include:
Especially tell your healthcare provider if you take certain
asthma medicines. fast, irregular or pounding heartbeat
What is the most important information I should know sweating
about the EpiPen and EpiPen Jr? EpiPen or EpiPen Jr and other medicines may affect each
other, causing side effects. EpiPen or EpiPen Jr may affect headache
1. EpiPen and EpiPen Jr contain epinephrine, a medicine
the way other medicines work, and other medicines may weakness
used to treat allergic emergencies (anaphylaxis).
affect how EpiPen or EpiPen Jr work. shakiness
Anaphylaxis can be life threatening, can happen within
minutes, and can be caused by stinging and biting Know the medicines you take. Keep a list of them to show paleness
insects, allergy injections, foods, medicines, exercise, or your healthcare provider and pharmacist when you get a
new medicine. feelings of over excitement, nervousness or anxiety
unknown causes.
Use your EpiPen or EpiPen Jr for treatment of anaphylaxis dizziness
Symptoms of anaphylaxis may include:
as prescribed by your healthcare provider, regardless nausea or vomiting
trouble breathing
of your medical conditions or the medicines you take. breathing problems
wheezing
These side effects may go away with rest. Tell your Your EpiPen and EpiPen Jr Auto-Injector Remove the auto-injector from
healthcare provider if you have any side effect that the thigh. The orange tip will
bothers you or that does not go away. EpiPen Auto-Injector (yellow label) extend to cover the needle.
in Carrier Tube
These are not all the possible side effects of the EpiPen If the needle is still visible,
or EpiPen Jr. For more information, ask your healthcare do not attempt to reuse it.
provider or pharmacist.
Call your healthcare provider for medical advice about
side effects. You may report side effects to FDA at
1-800-FDA-1088.
How should I store EpiPen and EpiPen Jr? Massage the injection area
Store EpiPen and EpiPen Jr at room temperature EpiPen Auto-Injector (yellow label)
removed from Carrier Tube for 10 seconds.
between 68 to 77 F (20 to 25 C).
Protect from light.
Do not expose to extreme cold or heat. For example, do EpiPen Jr Auto-Injector (green label)
in Carrier Tube
not store in your vehicles glove box and do not store in
the refrigerator or freezer.
Examine the contents in the clear window of your auto-
injector periodically. The solution should be clear. If the
solution is discolored (pinkish or brown color) or contains
solid particles, replace the unit. Step 3. Get emergency medical help now.
Always keep your EpiPen or EpiPen Jr Auto-Injector in You may need further medical attention. You may need
the carrier tube to protect it from damage; however, the EpiPen Jr Auto-Injector (green label)

to use a second EpiPen or EpiPen Jr Auto-Injector if
removed from Carrier Tube
carrier tube is not waterproof. symptoms continue or recur.
The blue safety release helps to prevent accidental A dose of EpiPen or EpiPen Jr requires 3 simple steps: Take your used auto-injector with you when you go to
injection. Keep the blue safety release on until you need to Prepare, Administer and Get emergency medical help see a healthcare provider.
use EpiPen or EpiPen Jr. Tell the healthcare provider that you have received an
Your EpiPen or EpiPen Jr has an expiration date. injection of epinephrine. Show the healthcare provider
Replace it before the expiration date. Step 1. Prepare EpiPen or EpiPen Jr for injection
where you received the injection.
Keep EpiPen and EpiPen Jr and all medicines out of Give your used EpiPen or EpiPen Jr Auto-Injector to the
the reach of children. Remove the EpiPen or healthcare provider for inspection and proper disposal.
General information about the safe and effective use of EpiPen Jr from the clear
carrier tube. Ask for a refill, if needed.
EpiPen and EpiPen Jr
Flip open the yellow cap of your Note:
Medicines are sometimes prescribed for purposes other
than those listed in a Patient Information Leaflet. Do not EpiPen or the green cap of The used auto-injector with extended needle cover will
use the EpiPen or EpiPen Jr for a condition for which it your EpiPen Jr carrier tube. not fit in the carrier tube.
was not prescribed. Do not give your EpiPen or EpiPen Jr EpiPen and EpiPen Jr are single-use injectable devices
to other people. that deliver a fixed dose of epinephrine. The auto-injector
This Patient Information Leaflet summarizes the most cannot be reused. Do not attempt to reuse EpiPen after
important information about EpiPen and EpiPen Jr. If you the device has been activated. It is normal for most of the
would like more information, talk to your healthcare provider. medicine to remain in the auto-injector after the dose is
You can ask your pharmacist or healthcare provider injected. The correct dose has been administered if the
for information about EpiPen and EpiPen Jr orange needle tip is extended and the window is blocked.
that is written for health professionals. Tip and slide the auto-injector
Your EpiPen and EpiPen Jr Auto-Injector may come
out of the carrier tube.
For more information and video instructions on the use packaged with an EpiPen Trainer and separate Trainer
of EpiPen and EpiPen Jr, go to www.epipen.com or Instructions for Use. The EpiPen Trainer has a grey color.
call 1-800-395-3376. The grey EpiPen Trainer contains no medicine and no
What are the ingredients in EpiPen and EpiPen Jr? needle. Practice with your EpiPen Trainer, but always
carry your real EpiPen or EpiPen Jr Auto-Injector in case
Active Ingredients: Epinephrine Grasp the auto-injector in your
Inactive Ingredients: sodium chloride, sodium metabisulfite, fist with the orange tip (needle
of an allergic emergency.
If you will be administering EpiPen or EpiPen Jr to a
hydrochloric acid, and water. end) pointing downward. young child, ask your healthcare provider to show you how
Important Information With your other hand, remove the to properly hold the leg in place while administering a dose.
The EpiPen Auto-Injector has a yellow colored label. blue safety release by pulling Do not try to take the EpiPen or EpiPen Jr Auto-Injector apart.
straight up without bending or
The EpiPen Jr Auto-Injector has a green colored label.
twisting it. This Patient Information and Instructions for Use has been
The EpiPen Trainer has a grey color and contains no approved by the U.S. Food and Drug Administration.
medicine and no needle.
Manufactured for:
Your auto-injector is designed to work through clothing. Mylan Specialty L.P., Morgantown, WV 26505, U.S.A. by Meridian
The blue safety release on the EpiPen and EpiPen Jr Medical Technologies, Inc., Columbia, MD 21046, U.S.A., a Pfizer company
Auto-Injector helps to prevent accidental injection of EpiPen and EpiPen Jr are registered trademarks of Mylan Inc.
Note:
the device. Do not remove the blue safety release until licensed exclusively to its wholly-owned affiliate, Mylan Specialty L.P.
The needle comes out of the orange tip. of, Morgantown, WV 26505, U.S.A.
you are ready to use it.
To avoid an accidental injection, never put your thumb, Copyright 2016 Meridian Medical Technologies. All rights reserved.
Only inject into the middle of the outer thigh (upper Revised: May 2016
fingers or hand over the orange tip. If an accidental
leg). Never inject into any other part of the body. MS:PIL:EPI:R2
injection happens, get medical help right away
Never put your thumb, fingers, or your hand over the EPI-2016-0247
orange tip. The needle comes out of the orange tip. Register your EpiPen or EpiPen Jr Auto-Injector at
Step 2. Administer EpiPen or EpiPen Jr
If an accidental injection happens, get medical help If you are administering EpiPen or EpiPen Jr to
right away. a young child, hold the leg firmly in place while EPIPEN
administering an injection. (epinephrine injection, USP) Auto-Injector 0.3 mg
Do not place patient information or any other foreign Epipen = one dose of 0.30 mg epinephrine (USP, 1:1000, 0.3
objects in the carrier tube with the Auto-Injector, as
this may prevent you from removing the Auto-Injector Place the orange tip against the EPIPEN JR
for use. middle of the outer thigh (upper (epinephrine injection, USP) Auto-Injector 0.15 mg
Epipen = one dose of 0.15 mg epinephrine (USP, 1:2000, 0.3 mL)
INSTRUCTIONS FOR USE leg) at a right angle
(perpendicular) to the thigh.
EPIPEN Swing and push the auto-
(epinephrine injection, USP) Auto-Injector 0.3 mg injector firmly until it clicks.
Epipen = one dose of 0.30 mg epinephrine (USP, 1:1000, 0.3 mL) The click signals that the injection

EPIPEN JR has started. MyEpiPen.com and find out more about:
(epinephrine injection, USP) Auto-Injector 0.15 mg Free EpiPen Auto-Injector Refill Reminder Program.
Epipen = one dose of 0.15 mg epinephrine (USP, 1:2000, 0.3 mL) It is important to keep your auto-injector up-to-date.
Hold firmly in place for 3
For allergic emergencies (anaphylaxis) seconds (count slowly 1,2,3).
Register up to 6 EpiPen or EpiPen Jr Auto-Injectors and
receive automatic Refill Reminder Alerts.
The injection is now complete.
Read these Instructions for Use carefully before you Receive periodic information related to allergies
use EpiPen or EpiPen Jr. Before you need to use your and allergens.
EpiPen or EpiPen Jr, make sure your healthcare provider Instructional Video
shows you the right way to use it. Parents, caregivers, For more information about EpiPen or EpiPen Jr
and others who may be in a position to administer EpiPen Auto-Injectors and proper use of the product, call
or EpiPen Jr Auto-Injector should also understand how Mylan at 1-877-446-3679 or visit www.epipen.com.
to use it as well. If you have any questions, ask your
healthcare provider.