Allergy emergency is no time to learn how to use your EpiPen


People who have a severe life-threatening allergic reaction to bee stings, peanuts, shellfish, or other causes must get help immediately. A medicine called epinephrine (adrenaline) slows down allergic reactions and can prevent a reaction from getting worse. Doctors often recommend that patients (or parents of young children) carry epinephrine injection with them in a prefilled syringe or at least keep one close by. EpiPen or one of its generic equivalents is then prescribed.

EpiPen is a single-dose pre-filled automatic injection device. It is injected into the thigh and can be used without removing clothing. There is a special one for kids who weigh less than 66 pounds. It is called EpiPen Jr.

Recently, the manufacture of the EpiPen redesigned the look and feel of the pen. However, the older version may still be in some homes if they have yet to expire. Both pens are easy to use but since this medicine will be used in an emergency situation, it is very important that the person responsible for using it becomes familiar with how the pen is supposed to work.


Older version:

EpiPen is shaped like a large pen or magic marker. It has a gray cap at one end that must be removed before use, and a black tip on the other end that holds the needle. The needle only comes out once the black tip is pushed forcefully against a person's leg.

It is very important to be aware of which end holds the needle before it is needed in an emergency. People have a natural tendency to hold the EpiPen upside down, put their thumb over the black tip, and press down, as they would a ballpoint pen. So they may accidentally inject the medicine into their thumb.

Newer version:

The newly designed version is supposed to make it less likely for anyone to accidentally inject their thumb or finger. The needle cover is now a bright orange color and labeled 'needle end' for quick and easy orientation. Initial use of the new device requires activation of a blue safety release at the end of the pen farthest from the needle. Once activated, the orange tip at the needle end of the syringe is placed firmly against the outer thigh for approximately 10 seconds while the drug is delivered into a thigh muscle. To prevent needle exposure when the injection is completed, a needle cover is automatically released. The new pen is larger which allows for better instructions for use on the pen. 

Unfortunately, even with these changes, the new version can also be used incorrectly. For example, a nurse injected her thumb using the new device. She was administering an EpiPen injection for the first time. She was not familiar with the device and apparently had not been taught how to use it properly. She was, however, familiar with the use of insulin pens, one of which has an orange push button that is pressed to inject the insulin. Although the orange end is clearly marked with the warning "Never put thumb, fingers, or hand over orange tip," the nurse incorrectly assumed that, since it was a pen and had an orange tip, it operated the same way as the insulin pen. She held her thumb against the orange tip at the EpiPen needle end, expecting the needle to exit the opposite end once she activated the safety release. But when she pushed down on the orange end, she drove the needle through her thumb.

While injecting EPINEPHrine into a thumb or finger may pose a risk to the individual attempting to administer the drug, the greater harm and risk is to the patient who needs the drug immediately in light of their severe allergic reaction. The situation could be quite serious if it is the only pen is available.

Created on May 18, 2011

Medication Safety Alerts

FDA Safety Alerts

Show Your Support!

ISMP needs your help to continue our life saving work