Consumer medicine information

What is in this leaflet

This leaflet answers some common questions about EpiPen Jr. Adrenaline Auto-Injector. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor or pharmacist has weighed the risks of your child receiving EpiPen Jr. against the benefits this medicine is expected to have for them.

If you have any concerns about your child receiving this medicine, talk to your doctor or pharmacist before there is a situation where EpiPen Jr. is needed.

Please read this leaflet carefully before an emergency arises.

Keep this leaflet safely, with the EpiPen Jr. Auto-Injector. You will probably want to read it again.

What EpiPen Jr. is used for

EpiPen Jr. is only to be used for the immediate EMERGENCY TREATMENT of a SEVERE ALLERGIC REACTION (also known as ANAPHYLAXIS). Your doctor or pharmacist will explain what this is like, so that you know when you must use EpiPen Jr.

EpiPen Jr. is used to treat children who have a severe allergic reaction caused by, for example, hypersensitivity to

• food
• medicines
• stinging insects
• insect bites
• latex or
• other allergens, possibly unidentified.

See Side effects for information regarding allergy to sodium metabisulfite.

Avoidance of known allergens is most important in preventing severe allergic reactions.

A severe allergic reaction, otherwise known as anaphylaxis, is overwhelming and life-threatening.

It affects the whole body, in particular the

• heart and blood circulation.
  This may cause, for example, low blood pressure and collapse, or abnormal heart beat or function.
• air passages and lungs.
  This causes difficulty in breathing, with noisy wheezing or gasping, possibly with sneezing and a very runny nose.
• stomach and bowels.
  This may cause nausea, vomiting, diarrhoea and abdominal cramps, often severe.
• skin (very common).
  This causes flushing, itching, skin rash, hives or swelling, which may be widespread or in one part of the body.
• brain.
  There may be fits or confusion due to lack of oxygen.

Usually several parts of the body are affected. The patient feels extremely unwell.

It is important to act quickly to treat a severe allergic reaction.

The adrenaline in EpiPen Jr. treats allergic emergencies. It

• shrinks abnormally wide blood vessels and
• makes the heart beat strongly.

This helps improve the very low blood pressure and poor circulation that occur in a severe allergic reaction.

Adrenaline also

• relaxes the lungs. This eases breathing and lessens wheezing.
• helps stop
  - swelling, for example, of the face and lips
  - skin rash and/or
  - itching.

The EpiPen Jr. Auto-Injector is intended for use in children who have been assessed and advised by their doctor or pharmacist as needing an EpiPen Jr. Auto-Injector to treat their severe allergic reaction and who

• weigh from 15 kg up to 30 kg, and
• are having a severe allergic reaction.

NOTE: Selection of the appropriate dosage is determined according to patient body weight.

For a child who weighs from 15kg up to 30kg, the doctor or pharmacist may assess their severe allergic reaction as needing the larger dosage of adrenaline as provided by an EpiPen Auto-Injector. (The EpiPen Jr. Auto-Injector delivers a smaller dosage of adrenaline). Similarly, there may be instances where the doctor or pharmacist will recommend the use of EpiPen Jr. in some adults, based on careful medical assessment.

If you have any questions about this, talk to your doctor or pharmacist.

EpiPen Jr.

• provides convenient first-aid
• may be self-administered or administered by a carer to the child
• has a spring-activated, hidden needle
• automatically injects one pre-measured dose of adrenaline
• is for single use only.

EpiPen Jr. may be prescribed by your doctor. You can also purchase it directly from a pharmacy.

Before you use EpiPen Jr.

The EpiPen Jr. Auto-Injector is simple to use. Please read and follow the step-by-step instructions.

Do not remove the blue safety release until you need to use EpiPen Jr. and are ready to use it. The safety release stops EpiPen Jr. from “firing” or working.

There is no visible needle. This helps overcome fear of injection. The hidden needle is very fine so that the injection does not usually hurt.

When you must not use it

EpiPen Jr. is a life-saving treatment in the emergency management of severe allergic reactions. Therefore, it should not be withheld from anyone who is considered to need it.

The EpiPen Jr. Auto-Injector has a clear “viewing window” so you can see the contents.

Do not use EpiPen Jr. if the contents

• are cloudy or
• are coloured or
• contain sediment or
• if the “viewing window” is obscured.

These changes indicate that the effectiveness of the drug product may be decreased.

When the “viewing window” is obscured, the auto-injector has already “fired” and cannot be used again.

Check your EpiPen Jr. regularly (see Things you must do).

Do not use EpiPen Jr.

• after the expiry date on the EpiPen Jr. Auto-Injector and carton or
• if the packaging is torn, doesn’t look quite right or shows signs of tampering.

If the EpiPen Jr. packaging is damaged or it is past the expiry date, return it to your pharmacist for disposal.

Help in using EpiPen Jr.

It is important to know how to use an EpiPen Jr. BEFORE a severe allergic reaction causes a medical emergency.

Ask your doctor or pharmacist how you can get an EpiPen Training Device for practice.

An EpiPen Training Device is similar to the real EpiPen Jr. However, the EpiPen Training Device has

• NO medicine (adrenaline) and
• NO needle and
• “fires” quietly and less forcefully.

Ask your doctor or pharmacist to show you how to practice with the EpiPen Training Device. If you practice using the EpiPen Training Device, it will help you to learn how to use the real EpiPen Jr.

It is important to regularly ask your doctor or pharmacist to demonstrate use with an EpiPen Training Device.

EpiPen Jr. is effective as emergency treatment of a severe allergic reaction ONLY when used according to the directions in this leaflet.

Give WITH CAUTION to those who have

• high blood pressure
• thyroid problems
• high pressure in the eye (narrow-angle glaucoma).

Take care also when giving EpiPen Jr. to those

• having an anaesthetic

or who have:

• diabetes
• heart disease
• allergy to EpiPen Jr.
• brain damage.

You should tell your doctor or pharmacist if your child has:

• depression, or is on medication for depression
• thyroid problems, or is on thyroid medication
• heart disease or high blood pressure
• diabetes
• high pressure in the eye (narrow angle glaucoma)
• asthma
• ever had an allergic reaction to sodium metabisulfite.

Taking other medicines

Tell your doctor or pharmacist if your child is taking other medicines, including any medicines that you buy without a prescription from your pharmacy, supermarket or health food shop. Some medicines may interfere with EpiPen Jr. including:

• medicines for high blood pressure, especially those known as “beta-blockers”, and other medicines for heart problems
• medicines for depression, especially “tricyclic antidepressants”
• thyroid hormone
• medicines for diabetes
• antihistamines.

These medicines may affect how well the adrenaline in EpiPen Jr. works. Your doctor or pharmacist can tell you what to do if your child is taking any of these medicines.

You should discuss any concerns you have with your doctor or pharmacist.

How to use EpiPen Jr.

It is important to know how to use your EpiPen Jr. in an emergency (see Help in using EpiPen Jr.).

Follow carefully all directions given to you by your doctor or pharmacist. They may differ from the information contained in this leaflet.

If you do not understand the instructions in this leaflet or on the EpiPen Jr. Auto-Injector, ask your doctor or pharmacist for help.

When to use it

Use EpiPen Jr. immediately if your child has signs and symptoms of a severe allergic reaction, as described by your doctor or pharmacist. Symptoms do vary. However, the symptoms are likely to include:

• collapse
• difficulty in breathing
• wheezing
• swelling, especially of the face, lips, tongue or throat
• flushing of the face
• irregular or faint pulse
• vomiting, diarrhoea, stomach cramps
• skin rash, hives
• itching.

How much to use

• EpiPen Jr. Auto-Injector delivers one measured dose of adrenaline. This dose is intended for a child who weighs 15 kg to 30 kg and has been assessed by their doctor or pharmacist as needing EpiPen Jr.

NOTE: Your child’s doctor or pharmacist may advise EpiPen Auto-Injector for the treatment of an anaphylactic attack in children who weigh from 15 kg up to 30 kg after careful assessment of their body weight and the severity of their symptoms.

Similarly, there may be instances where the doctor or pharmacist will recommend the use of EpiPen Jr. in some adults, based on careful medical assessment.

See also “What EpiPen Jr. is used for” above.

How to use it

General

• Grip only the mid-section of the EpiPen Jr. Auto-Injector. Avoid touching either end, except when you remove the blue safety release. The blue safety release stops the EpiPen Jr. from “firing” or working.
• Never place thumb, fingers or hand over the orange end as this contains the needle.
• Always point the orange end (which holds the needle) away from any part of any body, except the planned injection site. This is usually the thigh of the child who has the severe allergic reaction.
• Always hold the leg firmly during injection especially in children who are uncooperative and kick or move during an injection. This will reduce the risk of injection related injuries.
• Keep EpiPen Jr. away from the face and eyes.
• Never inject EpiPen Jr. into the buttock.

Carefully follow the step-by-step directions to make the EpiPen Jr. work properly.

Step 1

Flip open the green cap on the protective carry tube. Carefully tip and slide the EpiPen Jr. Auto-Injector out of the carry tube. Never place thumb, fingers or hand over the orange end as this contains the needle. Check the contents of the EpiPen Jr. Auto-Injector through the “viewing window”. Make sure the solution is clear, colourless and sediment-free. If the “viewing window” is obscured, the EpiPen Jr. has already “fired” and cannot be used again.

Step 2

Make a fist around the EpiPen Jr. Auto-Injector, with your thumb nearest to the blue safety release (see FIGURE 1).

Step 3

Activate the EpiPen Jr. Auto-Injector by removing the blue safety release with your other hand (also shown in FIGURE 1). This “triggers” the EpiPen Jr. It is now ready to

• “fire” the needle and
• inject the medicine through the needle into the child’s thigh muscle.

After you remove the blue safety release do not touch or place thumb, fingers or hand over the orange end as this contains the needle.

Step 4

Hold the EpiPen Jr. Auto-Injector at a 90° angle (right angle) to the outer part of the thigh. Hold the orange end about 5cm away from the thigh (see FIGURE 2).

Step 5

Hold the child’s leg firmly, especially if they are uncooperative or may kick or move during the injection.

Push the orange end FIRMLY into the child’s outer mid-thigh until a “click” is heard or felt. Keep pressing the EpiPen Jr. Auto-Injector firmly against the thigh for approximately 3 seconds (see FIGURE 3).

NOTE: EpiPen Jr. may be used either

• through clothing, as shown in FIGURE 3, or
• directly on to skin.

When you press the orange end of the EpiPen Jr. Auto-Injector firmly against the thigh, the hidden needle “fires”. It injects the measured dose of adrenaline into the child’s thigh muscle.

Step 6

Carefully take the EpiPen Jr. Auto-Injector away from the thigh.

The orange needle cover will extend to cover the needle. (see FIGURE 4).

Check the “viewing window” - it should now be obscured. If it isn’t, the EpiPen Jr. has not “fired” or worked. If the “viewing window” is not obscured, repeat steps 2-6 above.

Step 7

Record the time EpiPen Jr. was given.

Step 8

Seek further medical attention for your child immediately. Although the child has received adrenaline from EpiPen Jr., he/she may need more medical treatment.

Either

• Contact your doctor or
• Call an ambulance (telephone 000 in Australia or 111 in New Zealand). State that adrenaline treatment may be needed.

Step 9

With severe, persistent allergic reactions, repeat injections with an additional EpiPen Jr. may be necessary. The EpiPen Jr. dose may be repeated every 5 to 15 minutes if symptoms recur or have not subsided.

Do not inject more than two sequential doses of EpiPen Jr. unless under medical supervision.

Step 10

Explain to the doctor that your child has had EpiPen Jr. (intramuscular adrenaline).

Take your used EpiPen Jr. Auto-Injector with you.

To avoid injury, follow the used EpiPen Jr. disposal instructions below (see Disposal).

Additional information about treatment of insect sting allergy

Use EpiPen Jr. immediately if you or your child have been stung or bitten by the insect and experience the signs and symptoms as described by your doctor or pharmacist.

If the insect’s sting is easily accessible, remove the sting with your fingernails. Do not squeeze, pinch or push the sting deeper into the skin. If available, ice packs or sodium bicarbonate soaks may then be applied to the stung area.

Keep warm, calm, and as still as possible.

If you use too much(overdose)

Because each EpiPen Jr. contains only one dose, overdosage is unlikely. Overdosage may lead to a rise in blood pressure. This may cause bleeding in the brain or fluid in the lung.

If you think you or anyone else may have used too much of this medicine,

• consult your doctor immediately
  or
• telephone the Poisons Information Centre (telephone 13 11 26 in Australia or 0800 POISON (0800 764 766) in New Zealand) for advice, or
• go to Accident and Emergency at your nearest hospital. Do this even if there are no signs of discomfort or poisoning. Urgent medical attention may be required.

Things to note about EpiPen Jr.

Things you must do

Check what the expiry date is on your EpiPen Jr.

Mark this expiry date on your calendar or diary.

Replace your EpiPen Jr. prior to this expiry date.

Also note on your calendar or diary to check the contents of your EpiPen Jr. each month. Do this through the “viewing window”.

Make sure the solution is clear, colourless and sediment-free. If not, obtain a new EpiPen Jr. immediately.

If the “viewing window” is obscured this means the EpiPen Jr. has already “fired” or worked. It cannot be used again. Return it to your doctor or pharmacist for disposal. Obtain a new EpiPen Jr. immediately.

The EpiPen Jr. Auto-Injector can be damaged and made unusable if it is mishandled.

EpiPen Jr. is NOT a toy. Keep it out of reach of children.

Things you must not do

Do not use EpiPen Jr.

• to treat any other medical conditions including other types of shock unless your doctor tells you to.
• if the solution is brown or contains any particles or cloudiness.
• in a child who weighs more than 30 kg unless advised by your doctor or pharmacist. EpiPen is generally recommended for any adult or child who weighs more than 30 kg.
• in a child who weighs less than 15 kg. Talk to your doctor or pharmacist if this is the case so that a careful assessment can be made and the appropriate dose selected based on the individual’s weight and the life-threatening nature of the reaction(s) for which EpiPen Jr. is being prescribed.

Do not take off the blue safety release until you need to use EpiPen Jr. and are ready to use it. Remember that the EpiPen Jr. Auto-Injector is activated (“triggered”, ready to “fire”) as soon as you take off the blue safety release.

Do not touch the orange end on any person or object while you are taking off the blue safety release and/or after you have taken off the blue safety release. The orange end holds the hidden needle, ready to “fire” and inject the adrenaline.

After you take off the blue safety release

• Do not “click” on either end of the EpiPen Jr. Auto-Injector. The EpiPen Jr. Auto-Injector does not work like a retractable ball-point pen (see How to use it step 3).
• Do not bump the EpiPen Jr. Auto-Injector until you intentionally push the orange end firmly into the child’s thigh (see How to use it step 4). This will help prevent accidental activation of the EpiPen Jr. Auto-Injector prior to use.

Do not inject into hands, feet, ears, nose, buttocks, genital area or into a blood vessel. If this does happen accidentally you must immediately seek medical attention.

Do not inject into the buttock. Rare cases of serious skin infections have been reported following injection into the buttock. If you develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at the adrenaline injection site you must seek medical attention immediately.

Side effects

Like all medicines, EpiPen Jr. can cause some side effects. Side effects not listed in this leaflet may occur in some patients.

Tell your doctor or pharmacist if your child experiences any unpleasant side effects after using EpiPen Jr., even if you do not think the effect is connected with the medicine or is listed in this leaflet. Ask your doctor or pharmacist to answer any questions you may have.

Do not be alarmed by the following list of side effects. Your child may not experience any of them.

Adrenaline

Tell your doctor or pharmacist if your child has any of the following:

• fast or noticeable heart beat
• difficulty breathing
• chest pain
• shortness of breath
• dizziness
• pale skin colour
• weakness
• tremor
• headache
• throbbing
• sweating
• nausea or vomiting
• sleeplessness
• coldness
• hallucinations
• restlessness
• anxiety
• fear
• flushing or redness of face and skin.

These side effects are minor and short lasting.

Accidental injection into the hands, fingers or feet may result in the following:

• fast or noticeable heart beat
• pale skin colour at the site of accidental injection
• feeling of coldness at the site of accidental injection
• bruising or discolouration at the site of accidental injection
• bleeding

If an accidental injection occurs at one of these areas, seek medical attention immediately.

Injection related injuries, such as needle cuts and bent needles, have been reported in people who are uncooperative and kick or move during the injection.

Rare cases of serious skin infections have been reported following injection into the buttock.

More severe side effects can occur occasionally. They are caused by adrenaline stimulating the heart and increasing the blood pressure. Rarely, these side effects can cause, for example, a stroke, lung problems or severe irregular heartbeat.

Adrenaline may also cause disorientation and impaired memory.

Sodium metabisulfite

EpiPen Jr. contains a very small quantity of sodium metabisulfite as a preservative. In people who are allergic to sodium metabisulfite, this could cause, for example, severe allergic reactions (hypersensitivity) or breathing difficulty (bronchospasm) in certain groups of people, especially those with history of asthma. However, the active ingredient, adrenaline, in EpiPen Jr. is expected to overcome any allergic reaction to sodium metabisulfite. In an emergency, the risk of exposure to the very small amount of sodium metabisulfite is generally outweighed by the benefits of EpiPen Jr.

Storing EpiPen Jr. before use

Always handle the EpiPen Jr. Auto-Injector carefully, so as not to accidentally activate it or make it “fire” or work.

Storage

Keep EpiPen Jr. available with the child for whom it is intended.

Keep EpiPen Jr. in a cool dry place below 25°C. Temperature excursions between 15°C to 25°C permitted.

Do not place EpiPen Jr. in the fridge. Do not leave EpiPen Jr. in your car. Extreme temperatures may cause the auto-injector unit to malfunction.

Protect EpiPen Jr. from light. Keep EpiPen Jr. in the protective carry tube until required.

Do not store EpiPen Jr. or any other medicine in the bathroom or near a sink. Do not leave it on a windowsill or in the car. Heat and dampness can destroy some medicines.

Keep EpiPen Jr. where children cannot accidentally reach it.

After using EpiPen Jr.

Disposal

After the EpiPen Jr. Auto-Injector has “fired” or worked, the orange needle cover will extend to cover the exposed needle. After use, continue to handle the EpiPen Jr. Auto-Injector safely and with care. Do this even if you think the EpiPen Jr. Auto-Injector has not “triggered”, “fired” or worked properly.

You CANNOT RE-USE the EpiPen Jr. Auto-Injector even though some adrenaline is left inside it.

After use, do not just throw away the EpiPen Jr. Auto-Injector.

• Do not tamper with the orange needle cover.
• Do not replace the blue safety release.
• The used auto-injector with extended needle cover will not fit back into the carry tube.
• Give your used EpiPen Jr., to the doctor’s office or to a hospital. This is for inspection, if required, and also for safe disposal. The used EpiPen Jr. should be placed in a rigid sharps disposal unit.

Product description

Ingredients

EpiPen Jr. delivers one x 0.3 mL dose of adrenaline (epinephrine). This EpiPen Jr. dose provides 150 µg of adrenaline (epinephrine).

The EpiPen Jr. Auto-Injector holds 2 mL of adrenaline (epinephrine) 1:2,000 solution.

The injection also contains small amounts of

• sodium chloride
• sodium metabisulfite
• hydrochloric acid.

The EpiPen Jr. Auto-Injector is packed in a non-waterproof protective plastic carry tube. This carry tube has a green cap. The carry tube is supplied in a cardboard pack.

The Australian Registration Number is AUST R 42980.

This is not all the information available on EpiPen Jr. If you have any more questions or are unsure about anything, ask your doctor or pharmacist.

Supplier

EpiPen Jr. is distributed in Australia by:

Alphapharm Pty Ltd
Level 1, 30 The Bond
30-34 Hickson Road
Millers Point NSW 2000
www.mylan.com.au

Medical Information
Phone: 1800 274 276

This leaflet was prepared in January 1998, and last amended on 7 July 2021.

EpiPen® is a registered trademark of Mylan, Inc.

Made in USA

Epipen Jr_CMI/Jul21\00

Published by MIMS September 2021

1 Name of Medicine

Adrenaline (epinephrine)*.
* In some countries, adrenaline is known as epinephrine.

2 Qualitative and Quantitative Composition

Each EpiPen Jr adrenaline (epinephrine) injection contains adrenaline (epinephrine) 150 microgram (0.15 mg) in 0.3 mL as the active ingredient.

Excipients with known effect.

3 Pharmaceutical Form

Clear and colourless liquid.

4 Clinical Particulars

4.1 Therapeutic Indications

For the emergency treatment of anaphylaxis (acute severe allergic reactions) due to insect stings, or bites, foods, drugs or other allergens.

4.2 Dose and Method of Administration

Dosage.

Adults (≥ 30 kg).

Children (15 to 30 kg).

Use of adrenaline.

Important information - after use.

4.3 Contraindications

Contraindications are relative as this product is intended for use in life threatening emergencies.
Adrenaline should not be used in patients with certain types of arrhythmia, cerebral arteriosclerosis and where vasopressor drugs are contraindicated, e.g. thyrotoxicosis.
Adrenaline is also contraindicated in shock (other than anaphylactic shock) in patients or during general anaesthesia with halogenated hydrocarbons or cyclopropane.
Clinical conditions where special precautions are advised and interactions with other medicines are described in Section 4.4 Special Warnings and Precautions for Use.

4.4 Special Warnings and Precautions for Use

A severe anaphylactic reaction is a life threatening emergency and administration of EpiPen Jr is not intended as a substitute for immediate medical care. In conjunction with the administration of adrenaline, the patient should seek immediate medical or hospital care. More than two sequential doses of adrenaline should only be administered under direct medical supervision.
The presence of anaphylactic shock should be confirmed before administering EpiPen Jr, as EpiPen Jr is only indicated for the treatment of anaphylaxis. Anaphylaxis may occur within minutes after exposure and consist of flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with a fall in blood pressure, convulsions, vomiting, diarrhoea and abdominal cramps, involuntary voiding, wheezing, dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria or angioedema.
For these reasons, Auto-Injectors should always be carried by such persons in situations of potential risk.
The patient/carer should be informed about the possibility of biphasic anaphylaxis which is characterised by initial resolution followed by recurrence of symptoms some time later.
Do not inject intravenously as cerebral haemorrhage may occur due to a sharp rise in blood pressure. Rapidly acting vasodilators can counteract the marked pressor effects of adrenaline if there is such inadvertent administration.

Excipient warnings.

Concomitant diseases.

Use in the elderly.

Paediatric use.

Effects on laboratory tests.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Central nervous system and other medicines.

Other sympathomimetic agents.

Alpha-adrenergic blocking agents.

Beta-adrenergic blocking agents.

General anaesthetics.

Hypoglycaemic agents.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

4.7 Effects on Ability to Drive and Use Machines

The patients' ability to drive and use machinery may be affected by the anaphylactic reaction, as well as by possible adverse effects to adrenaline.

4.8 Adverse Effects (Undesirable Effects)

Common symptomatic adverse events include anxiety, apprehensiveness, restlessness, tachycardia, respiratory difficulty, tremor, weakness, dizziness, headache, dyspnoea, cold extremities, sweating, pallor, nausea, vomiting, sleeplessness, hallucinations, palpitations, fear and flushing or redness of face and skin. Psychomotor agitation, disorientation, impaired memory and psychosis may occur.
Potentially fatal ventricular arrhythmias, including ventricular fibrillation may occur and severe hypertension may lead to cerebral haemorrhage and pulmonary oedema.
Angina may occur in patients with coronary artery disease.
Cardiac arrhythmias may lead to ventricular fibrillation and death.
Rare cases of stress cardiomyopathy have been reported in patients treated with adrenaline.
The potential for adrenaline to produce these types of adverse effects does not contraindicate its use in an acute life threatening allergic reaction.
Accidental injection into the hands, fingers or feet may result in loss of blood flow to the affected area (see Section 4.4 Special Warnings and Precautions for Use). Adverse events experienced as a result may include increased heart rate, local reactions including injection site pallor, coldness or hypoaesthesia or injury at the injection site resulting in bruising, bleeding, discolouration, erythema or skeletal injury.
Lacerations, bent needles, and embedded needles have been reported when adrenaline has been injected into the thigh of young children who are uncooperative and kick or move during the injection (see Section 4.4 Special Warnings and Precautions for Use).
Rare cases of serious skin and soft tissue infections, including necrotising fasciitis and myonecrosis caused by Clostridia (gas gangrene), at the injection site have been reported from post-marketing experience. Injection into the buttock has resulted in cases of gas gangrene (see Section 4.4 Special Warnings and Precautions for Use).

Reporting suspected adverse effects.

4.9 Overdose

Effects.

Treatment.

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Clinical trials.

5.2 Pharmacokinetic Properties

Absorption.

Distribution.

Metabolism.

Excretion.

Clinical trials.

5.3 Preclinical Safety Data

Genotoxicity.

Carcinogenicity.

6 Pharmaceutical Particulars

6.1 List of Excipients

Hydrochloric acid (for pH adjustment), sodium chloride, sodium metabisulfite, water for injections.

6.2 Incompatibilities

Adrenaline and its salts are physically incompatible with alkalis, metals, oxidising agents, sodium warfarin, hyaluronidase and many other drugs; it forms polymers with sodium bicarbonate.
Oxidation can be inhibited by addition of anti-oxidants. The solution darkens in colour upon exposure to air or light.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Adrenaline is light sensitive and should be stored in the carrier tube provided. The carrier tube is not waterproof.
Store below 25°C. Temperature excursions between 15°C to 25°C permitted.
Do not refrigerate. Protect from light.
Before using, check periodically through the viewing window of the Auto-Injector to make sure the solution is not discoloured. Replace the Auto-Injector if the solution is discoloured or contains a precipitate.

6.5 Nature and Contents of Container

The EpiPen Jr Auto-Injector contains 2 mL Adrenaline Injection USP 0.15 mg/0.3 mL and delivers a single 150 microgram adrenaline dose.
EpiPen Jr Auto-Injector is available in a single pack or in a pack of 2.
Not all pack sizes may be marketed.

Australian register of therapeutic goods (ARTG).

6.6 Special Precautions for Disposal

Any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Chemical structure.

CAS number.

References

** Australasian Society of Clinical Immunology and Allergy Guidelines - Adrenaline (Epinephrine) Injector Prescription, ASCIA 2024 https://www.allergy.org.au/hp/anaphylaxis/adrenaline-injector-prescription.

7 Medicine Schedule (Poisons Standard)

S3 (Pharmacist Only Medicine).

Summary Table of Changes