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Epi Pen Shortage

Adrenaline for anaphylaxis kits
Following the alert issued by MHRA on 28 September 2018 regarding the supply disruption to EpiPen and EpiPen Junior adrenaline auto-injectors (AAIs), the Chief Dental Officer has released an important reminder.

Dental professionals are expected to stock ampoules, needles and syringes (as well as dosing charts) when renewing adrenaline in anaphylaxis rather than EpiPens or AAIs. All healthcare professionals should be competent to administer adrenaline in this way.

This will help to preserve the essential EpiPen stocks for patients, parents, and carers who are unable to administer adrenaline via a needle and syringe.

Adrenaline doses, strength and administration

Adrenaline (epinephrine) 1:1000 (1mg/ml) solution should be administered immediately by IM injection.

A 25mm needle (blue 23G) is best and suitable for all ages.

The best site for IM injection is the anterolateral aspect of the middle third of the thigh. Injections can be given through clothing.

If there is no clinical improvement, the dose may be repeated after five minutes. Further doses of adrenaline can be given if needed.

Age dose of adrenaline (epinephrine) – Volumes stated are 1:1000 adrenaline

  • Under 6 months 150 micrograms IM (0.15ml)
  • Over 6 months but under 6 years 150 micrograms IM (0.15ml)
  • 6 to 12 years 300 micrograms IM (0.30ml)
  • Over 12 years including adults 500 micrograms IM (0.5ml)

Standard management includes keeping patients in a supine position with oxygen administration. Paramedics will decide on the use of chlorphenamine and corticosteroids. The timings and doses of drugs given should be communicated to the paramedics.

For further advice on the use of adrenaline in anaphylaxis, please visit the Resuscitation Council here.