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The EpiPen and you.

38K views 70 replies 36 participants last post by  dgrc 
#1 ·
Mike,

Would you be so good as to tell me anything you feel I should know about the EpiPen.

I just purchased 3 of them.
 
#27 ·
I too keep Epipens for safety sake. Our property is about 40 miles from the closest emergency room. The doctor had no problems on the prescription, paid for through my HMO ($20), but as stated previously, specified the used for "breathing problems." I am very allergic to most nuts (to food type, not the human type, although they give me a reaction too). When filling an order, I suggest having the pharmacy order a fresh package (good for a year).
 
#28 ·
I'll throw my two cents' worth in here. I do have an Epi-pen, although it's past its expiration date now. My wife thought it would be good "insurance." I agree to a point -- if I have someone else with me when I'm working bees, and they run into problems, an Epi-pen might be worthwhile. Mainly, though, that Epi-pen alleviates my wife's worrying, and that's worth the cost of it to me.

Having said all that, my 'pen (I covered virtually all the cost myself) cost me about $50. I'm sure you can get them less expensively if insurance kicks in on them, but sooner or later we all end up covering that cost, too. The expiration date on an Epi-pen is roughly one year from the date of prescription, so you should count on replacing any of them every year.

I would view an Epi-pen as a "last resort" measure. I hear about a lot of people who have "bad reactions" to bee stings, yet I wonder how many of these people would actually go into shock from a sting. One of my brothers-in-law, for example, swells up terribly from bee stings. Some of his family members are EMTs and push him to take epinephrine when he's been stung. So far he has never taken epinephrine (just benadryl), and so far he's never experienced anything approaching anaphylaxis. I think, in most instances, if someone with me was stung and began experiencing problems, I'd try to do what others have suggested -- get them to a medical facility as quickly as possible for treatment by professionals -- rather than using an Epi-pen.
 
#29 ·
In my experience the first sting of the season is the worst and then they get better until they are hardly noticable.

Sometimes a first sting is really bad. This last year I had my ankle swell up so much I couldn't walk on the first sting. The rest of the stings were nothing.

This, of course, is backwards from the concept that subsequent stings are worse.
 
#31 ·
"With several inhalations and a belt of liquid benadryl you'll get to the ER. Arguably safer than injectables."

Taking "several inhalations" isn't any safer than any other treatment suggested on this string. Taking any medications, OTC or not, beyond the recommended dosing on the label without consulting a physician is just as dangerous.

I, like J. McGuire, am a career firefigher/paramedic. As I said above, it's not good at all to take medications any way other than which they were intended. Likewise, using medications which were prescribed for somebody else is just as ill-advised.

Yes, Epi should be as clear as water, no discoloration and no "cloudiness". Would you use one that was discolored or out of date in an emergent situation if it was your best option at the time? The choice will be totally yours. It may beat the alternative, it may be a very risky maneuver.

I know that many people on this site live in rural areas and keep their bees in rural areas, but if you have a cell phone, many places such as these are still within range. Always keep yours with you to access emergency medical help and be able to provide ACCURATE information as to your location since obviously cell phones are unable to provide dispatchers with the location the call comes from as many enhanced 911 operations can on landlines.

Barry
 
#33 ·
Walter Kelley sells a product thats called "Denver's Sting Stopper" that works great on stings if you can apply it soon after the sting. Something in the stuff "neturalizes" the chemicals in the venom. Do a search on the net and you can find out about it. I've used it before and it stopped the hurt almost right away. But if your truly allergic to bee stings I won't rely on this alone.
 
#34 ·
"Taking "several inhalations" isn't any safer than any other treatment suggested on this string. "

I would argue that primatene mist is safer than injectable. Not as effective, but the danger aspect of an injectable is there.

Primatene mist coupled with liquid benadryl is safer than doing nothing when you are 20 miles from an ER.

[ March 31, 2006, 11:29 PM: Message edited by: Sundance ]
 
#35 ·
OK, I had 5 pages written on this and my computer dumped it. So, I will make it brief and summarize what everyone has already said.
Yes, in almost all (except in extremely rare cases which make it almost improbable) you need to be stung twice to become allergic. First sting the body identifies the poison (protein) then develops the antigens and histamines. Second sting it releases it.
If you have been stung more then twice by the same type of insect without an allergic reaction the chances of you having a severe reaction are extremely slim (In the area of lighting strike or asteroid strike to the head type chances). So, If you have been raising bees for a while you probably don’t need it.


The EpiPen is Epinephrine. Epinephrine is synthetic adrenalin. Adrenalin is a fight of flight hormone and is released by the body when its fighting or fleeing for its life.
Epinephrine is unstable and has a somewhat short shelf life and this is reflected by the expiration date on the box. Old Epi is weak Epi exponetionally. Keep in cool dry dark place blah blah says it all on the box.
Epinephrine can cause some severe side effects….heart attacks, death…other worse things. Remember the body only uses it when its fighting for its life and is in a do or die situation.
The EpiPen is a prescription medication and should only be given to the person prescribed to. I believe your box should have the name of the person prescribed on it. ONLY they can use that medication…and Yes you will (WILL) be held liable for giving your prescription medication to another person even in a life or death situation. You and I are not doctors and cannot make that decision, sorry. Consult the FDA on that one.
The EpiPen is not for mild allergic reactions. Your doctor should not have prescribed it to you. It is not a prophylactic medication…Meaning it should not be prescribed or taken because you “think you need it”. This crap is somewhat dangerous. And should be used only when your thinking “I cant breathe and I am going to die” or “I really need to go to the emergency room”. In fact, the manufacture recommends that if you use the EpiPen you go to the ER right away (30% of people have secondary allergic reactions once the initial dose of Epi wears off) for evaluation and another prescription for EpiPen
The EpiPen comes in 2 sizes Adult (gray tan box 0.3mg of Epinephrine) and Pedi (yellow? 0.15mg Epinephrine). The PediPen is for people under the weight of 50 pounds. Do not give the adult dose to kids. The EpiPen is a metered dose one time use injector designed from the military’s Mark 19 auto injector used for Biological and chemical warfare. You cannot give a “half dose”.
To use EpiPen remove from box, it will be in an amber tube, slide out from tube. Inspect it. (expiration date and for clarity in window) Hold in fist, remove gray safety cap from rear of injector.. The EpiPen is designed to be injected into the thigh only and can go thru clothes. (thigh area means take fist with thumb out…hold at side and press against leg naturally…right there) press black knob against this area firmly. You will hear a snap..hold for 5-10 seconds..remove. Take the Epipen bend the needle over on a hard surface( to protect others from accidentally being stuck) and return it to the amber tube…Take it with you to the hospital so they can make sure it worked properly and what dose was used. You can rub the injection site for more rapid absorption.
Remember the FIVE RIGHTS
RIGHT person (only the person the medication is prescribed to)
RIGHT Medication (Epi or not…easy one)
RIGHT Dose (Adult or Pedi…not interchangeable)
RIGHT Time (Life threatening situations only)
RIGHT Route (Mid Thigh area only)

Many healthcare professionals across the country have lost licenses for not following the above rules in the past, You as an untrained professional also have to follow them and cannot do anything your not trained to do. The Good Samaritan laws state you can do what any other person trained to the same level would do in good judgment in the same situation and not be held liable. Overstepping those bounds is when people get in trouble…mostly due to poor judgment.
Personally, I have issues with any physician who hands out prophylactic prescription medications for “just in case” situations to someone who has no proven allergic history as it shows bad judgment on their part. Should he also prescribe you Nitro in case of a heart attack because your in the optimum age category but never had cardiac problems in the past? NO!
Basically. Keep it simple.
First Identify the hazards…Go out and get stung a few times, find out if your allergic first! If you get stung…..
Non-Life threatening…use OTC medications others have discussed earlier. They should help. Also ice packs, elevation above the heart and a light constricting band (not a tourniquet) higher up on the limb to prevent further spreading also help
Life Threatening-Use your prescribed EpiPen
Somewhere in there you should be thinking “911” Almost all ambulances in the country (I can only speak for Nebraska..and all have them) should carry Allergic reaction kits containing both EpiPen and PediPen and the providers are trained in proper usage. They can also provide other life saving measures. IE oxygen, Cardiac monitoring, IV therapy, Other supplemental medications etc..and get to drive fast to the hospital Safer then you in your privately owned vehicle.
I have been around the EpiPen a while. Works great most of the time. But, I have seen it used in the wrong situation before with a detrimental outcome…The last I saw of that guy was when we where driving away in the ambulance with a really sick person and the police where pulling him to the side talking to him…Rules are in place for a reason.
 
#63 ·
OK, I had 5 pages written on this and my computer dumped it. So, I will make it brief and summarize what everyone has already said.
Yes, in almost all (except in extremely rare cases which make it almost improbable) you need to be stung twice to become allergic. First sting the body identifies the poison (protein) then develops the antigens and histamines. Second sting it releases it.
Wow... you nearly wrote a book. And I only got a couple of sentences into it before I found it to be wrong. Must be stung twice before you become allergic? Where did you come up with that nonsense? :scratch: I was stung by a honey bee when I was about ten. First sting in my life. Went into shock and nearly died. It was my first sting.

Please don't give medical advice on BeeSource. :no: Great place for beekeeping advice. Terrible place for medical advice.
 
#36 ·
I was in the Florida Keys cleaning up after hurricain Georges when I got bit by something, 2 holes in my leg about 1/2" apart. After about 15 minutes I got red rashes in my groin and armpits, 10 minutes later my lips started to get thick, my tongue started to get stiff. A few minutes later my throat started feeling tight. I high tailed it to the hospital. By the time I got there I could not speak proberly because of the stiff tongue and lips.
At triage a doc overheard and asked if I got bit. I pointed to the leg and she grabbed me off to a room and injected some epi.

I had never had an anaphalactic shock reaction before. I asked her, on a scale of 1 to 10 how severe was this. Oh about 9.99 she said. In another 15 minutes you would not have been able to breathe.

She told me to get an epi-pen and keep it on hand all the time. Furthermore she warned me to avoid using until I really felt I needed to and to try to get some help or contact with anyone before injecting with it. Epi can cause significant, even fatal drop in blood pressure, so someone should know what you've done. After injecting do not sit around by yourself. Get medical help and monitoring.

Lessons learned.
 
#37 ·
And not the other side.

Last summer I was working on my woodpile for the next winter's heating and overturned a wasp nest. Got 7 or so stings in close proximity around my face. Within a short few minutes my nose and lips swelled up. Ran to the house, took a few benadry tabs, got some ice and the epi pen and my wife to drive me to the hospital.

There the docs made and exam, laid me down and started and IV drip of ... not epi but benadryl.
Actually not benadryl but the generic drug, diphenhydramine HCL. Two bags of drip in 15 minutes.

So when everything was under control we asked the doc and his answers were:
Yes you did the right thing to come to the hospital.
Yes you did the right thing taking the benadryl before coming.
Yes you did the right thing NOT using the epi pen.

The reaction to the stings was all localized on my face. Not systemic. Never bothered my throat or breathing.

On the other hand at our cottage about 3 years ago a 45 year old woman who knew she had severe anaphalaxic reaction to wasps went for a walk in the woods with some friends. Stepped on a wasp nest. The husband ran home for the epi pen. He did not get back to her in time.

Lots to learn about when, where and how to use one if you get one.

When I got the dose my whole body felt like the tension was melting down within me.

It's powerful stuff. Use well ... use carefully

[ April 01, 2006, 07:05 PM: Message edited by: brent.roberts ]
 
#38 ·
Epipens are prescription medicine.
Just had a bad reaction, so spoke to my pharmacist about epipens. They are sold over the counter here in Nova Scotia at about $110 a pop. A drug plan will pay for them if you get a prescription.
As far as when to use it, a good first aid course should be a must for all beekeepers, because there are other things to do in an emergency other than the pen.
 
#40 ·
I’m one of those people whose heart did stop after having epinephrine; I was in a hospital and my surgery required cocaine. Following surgery I was given epinephrine to bring me down. Cocaine + epinephrine = heart attack; I was only 18 years old at the time.

These days I’m on fairly heavy doses of prescribed OxyContin, a form of cocaine. There’s no way I would chance another heart attack by using an epi-pen. I’ll stick to Benadryl thanks.
 
#41 ·
Oxyconton is nothing like cocaine...it contains a synthetic opiod. Much more like heroine than coke.

It is difficult to take this account as accurate given the obvious lack of understanding of what you are actually taking.

I'm no doctor, but epinephrine to "come down" from cocaine makes no sense to me.
 
#43 ·
When I first started I thought it would be a good idea to have an epi-pen around as well. My doctor prescribed without a problem, but my insurance company blocked it. Apparently, it's against policy to give synthetic adrenaline to someone with an internal cardiac defibrillator.:no:
 
#44 ·
"There are NO absolute contraindications to epinephrine use in anaphylaxis.
Patients with cardiovascular diseases: Reluctance to administer epinephrine due to fear of adverse cardiac effects should be countered by the awareness that the heart is a target organ in anaphylaxis. In the healthy human heart, mast cells are present throughout the myocardium and in the intima of coronary arteries. Anaphylaxis can unmask subclinical coronary artery disease, and myocardial infarction and/or arrhythmias can occur during anaphylaxis, even if epinephrine is not injected. Moreover, anaphylaxis itself can cause vasospasm, arrhythmias, and myocardial infarction in patients, including children, with healthy hearts as confirmed by normal electrocardiograms, echocardiograms, and coronary angiograms after resolution of anaphylaxis.
To reiterate, there are no absolute contraindications to the use of epinephrine in the treatment of anaphylaxis. The risk of death or serious neurologic sequelae from hypoxic-ischemic encephalopathy due to inadequately treated anaphylaxis usually outweighs other concerns. Existing evidence clearly favors the benefit of epinephrine administration in anaphylaxis."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C.

This does not mean there can not be dangerous side effects to the epinephrine, but if you truly are having an anaphylactic reaction (not just rash and itching) there is no reason not to use epinephrine to treat. If you have cocaine in your system or have a defibrillator and heart problems it would probably be best administered by trained professionals in a medical setting if possible.
 
#45 ·
"Agents that may be given as adjunctive therapies to epinephrine in the treatment of anaphylaxis include H1 antihistamines, H2 antihistamines, bronchodilators, and glucocorticoids (e.g. prednisone). None of these medications should be used as initial treatment or as sole treatment because they do not relieve upper or lower respiratory tract obstruction, hypotension, or shock and are not lifesaving.
Epinephrine is first-line treatment for anaphylaxis and there is no known equivalent substitute. A systematic review of the literature has failed to retrieve any randomized controlled trials that meet current standards and support the use of H1 antihistamines in anaphylaxis.
Despite this, H1 antihistamines are the most commonly administered medications in the treatment of anaphylaxis. This suggests overreliance on these agents, which should be considered adjunctive to epinephrine for the purpose of relieving itching and hives."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C.

"Other medicines that are used in the treatment of allergic reactions can help with some of the symptoms, but only epinephrine treats the entire reaction. Antihistamines (such as diphenhydramine and others) help with itching and hives, and asthma inhalers (such as albuterol) can help with coughing and wheezing, but these medications do not treat the dangerous symptoms of throat swelling and low blood pressure. In addition, antihistamines taken by mouth are too slow-acting to be effective in a rapidly-developing episode of anaphylaxis. In contrast, injected epinephrine works within a few minutes. In short, antihistamines and asthma inhalers are useful in the treatment of anaphylaxis, but they are NOT substitutes for epinephrine. There is no substitute for epinephrine in anaphylaxis."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C.
 
#47 ·
I repeat "There are NO absolute contraindications to epinephrine use in anaphylaxis."
I may not give a dose in the field, or I might choose to give a smaller dose but if a person is dying of true anaphylaxis the only thing that would save him might be epinephrine. The risks and benefits would need to be considered, sure. Would I send this gentleman out of my office with a prescription for self administered epinephrine- probably not. The advise I'm quoting is from respected experts in the medical field. I don't know of any better way of communicating true accepted medical facts but you are certainly entitled to your own opinion.

"Patients with cardiovascular diseases: Reluctance to administer epinephrine due to fear of adverse cardiac effects should be countered by the awareness that the heart is a target organ in anaphylaxis. In the healthy human heart, mast cells are present throughout the myocardium and in the intima of coronary arteries. Anaphylaxis can unmask subclinical coronary artery disease, and myocardial infarction and/or arrhythmias can occur during anaphylaxis, even if epinephrine is not injected. Moreover, anaphylaxis itself can cause vasospasm, arrhythmias, and myocardial infarction in patients, including children, with healthy hearts as confirmed by normal electrocardiograms, echocardiograms, and coronary angiograms after resolution of anaphylaxis.
To reiterate, there are no absolute contraindications to the use of epinephrine in the treatment of anaphylaxis. The risk of death or serious neurologic sequelae from hypoxic-ischemic encephalopathy due to inadequately treated anaphylaxis usually outweighs other concerns."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C
 
#48 ·
I repeat "There are NO absolute contraindications to epinephrine use in anaphylaxis."
So if I had ¼ of a kidney and was on dialysis, a failing liver, high blood pressure, multiple embolisms, and addicted to crack and PCP, you would have no problem giving me epinephrine? Because that is what you are saying. I mean no contradictions right?
 
#53 ·
If you want to discuss old ford guys situation (he brought it up), his words that the insurance company "blocked it".

In my experience, an insurance company might not pay for an epipen (which is what I expect happened in his case), but they can't really void the prescription.

The doctor could certainly have made an error...but the insurance company doesn't "fix" an error a doctor makes by "blocking" a prescribed treatment. My impression is that many people pay out of pocket for epipens.

My guess is that the insurance company doesnt want to pay for epipens for someone with no history of having a reaction. My guess is that the doctor made a judgement call...and probably wasn't unaware of the implanted device.

Regardless of what I guess, it would never be the insurance company that would correct such an error (if it were one).
 
#55 ·
If you want to discuss old ford guys situation (he brought it up), his words that the insurance company "blocked it".

Regardless of what I guess, it would never be the insurance company that would correct such an error (if it were one).
The insurance had to have some reason to deny it. It could have been as simple as his insurance plan does not cover epipens, period. Money? Who knows? Even if it turned out to be evil insurance profit mongering, dont you think it would be prudent to check with the cardiologist, before you tell an internet stranger that he should use an Epipen. I mean seriously, why wouldn't you check with your doctor?

Your tag line indicates searching for truth. Are we going to the subjective side now?
 
#57 ·
Using an epipen if your life isn't in danger from anaphylaxis is improper usage.

There are pluses and minuses, pros and cons, risks and benefits that all must be considered when prescribing or taking medication. Even asprin isnt universally recommended against heart disease anymore because of the risks vs the benefits.

The risks associated with using an epipen (which are considerable) vary with everyone's individual circumstance.

If old ford guy thinks that the epipen was (in his case) c9ntraindocated, then he certainly should seek another opinion...his cardiologist or otherwise.

The account, as related here (which I'm sure was posted with good intentions) makes no sense. The insurance company decides what to pay for, not what is medically advisable.

If it were really contraindicated or an obvious bad idea, it would be called malpractice, not 'blocked by insurance'.
 
#59 ·
I suppose I should have said something clear...like:
If old ford guy thinks that the epipen was (in his case) c9ntraindocated, then he certainly should seek another opinion...his cardiologist or otherwise.
...oh wait, I did.

He did consult his doctor. If he thinks he isn't getting good medical advice he should find medical advice he trusts.

...but if you want to talk nonsense have at it.
 
#60 ·
My wife just had a regular checkup and I asked her to talk with her doctor and see if she would give her a pen. She subscribed it and my wife asked "what about my high blood pressure" the doctor replied, " a stroke is better than death". So, I agree if you are going to absolutely die in the next minute, any body would keep you alive in that situation, even if death came from a heart attack 5 minutes later. That's 4 more minutes than you had before and who knows, you might live a few more years than that one minute.
 
#61 ·
Yes. No one is recommending recreational use of an epipen....if you aren't on your way to the emergency room or on the phone with medical personal, you should not even be thinking of injecting yourself.
 
#62 ·
It's also worth noting that it isn't easy to have an epipen.

You have to have it with you. You can't leave it in a hot car. You will probably never use it (especially if you are getting one just in case but have no reason to believe you are at risk)....which makes it easy to want to leave in the car and hard to actually have it with you when you end up needing it (like the recent post about a woman dying while her husband ran to get it).

It probably isnt worth having one if you don't jeep it closer than your smartphone.
 
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