Adrenaline auto-injectors

Adrenaline auto-injectors

Following the ceasing of the validation protocol at the end of 2018, the market supply of adrenaline auto-injectors continues to be closely monitored by the Department of Health and Social Care (DHSC).  We have collated the following information to be easily accessible and helpful in managing any current supply constraints.

The three products and their current supply arrangements are:

Emerade 150mcg, 300mcg and 500mcg available from AAH and Phoenix

Epipen 150mcg and 300mcg available from Alliance Healthcare

Jext 150mcg and 300mcg available from Alliance Healthcare

On 3rd October 2019, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a Class 4 drug alert for all strengths of Emerade auto-injectors following reports from the manufacturer, Bausch & Lomb UK Limited, of Emerade auto-injectors that have failed to activate. In this situation, the needle of the pen is not released from the auto-injector when used, and a dose of adrenaline cannot be delivered.

The issue makes it particularly important that users carry two adrenaline auto-injectors at all times. For further information see the MHRA alert here

DHSC advise that there are currently sufficient supplies overall to meet normal patient demand. However, due to the supply issues with some brands, patients may receive a prescription for a an alternative brand they are unfamiliar with. Links to training videos for each device are contained in the resources section below.

Overview of the current supply situation with all brands of adrenaline auto-injectors below:

* Sufficient supplies available to meet normal patient demand of 300 microgram and 500 microgram adrenaline auto-injectors during this time.

** Primary care: Pharmacies can place an order for up to a maximum of two devices per prescription. Anonymised prescriptions should be sent to Alliance Healthcare’s prescription validation service, either by fax (0330 332 8126) or email (scriptvalidation@alliance-healthcare.co.uk) and include the Alliance Healthcare account number. 

*** Please refer to the Central Alerting System (CAS) alert issued 1st August 2019 for advice on clinical management during this time.

To ease the supply situation, the MHRA has approved the extension of expiry dates for specific batches of EpiPen 300 micrograms and Jext 150 micrograms and 300 micrograms by four months beyond the labelled expiry date.

The expiry date means that the adrenaline auto-injectors should not be used after the end of the month This applies to the original expiry date or the extended expiry date.

The company websites list the specific batches that can have their original expiry date extended:

Epipen                    

Jext            

Clinicians should check with patients requesting new EpiPen 300 micrograms or Jext 150 micrograms and 300 micrograms to establish if they currently hold one of the batches that can be used beyond the listed expiry. If one of the listed batches is held, further supplies should be delayed until the extended expiry date, counselling the patient on the extended expiry.


Supply Disruption Alert: Emerade 500 microgram and 300 microgram adrenaline auto-injector devices

Supply Status Update: EpiPen® 0.3mg and 0.15mg Adrenaline Auto-Injectors

Adrenaline 150 microgram auto-injector validation process no longer required

Update to urgent action required by pharmacy teams – revised interim protocol

Urgent action required by pharmacy teams

Adrenaline 150mcg validation protocol 

Q&A for pharmacies

Extended expiry dates for Epipen 300mcg, Jext 150mcg and 300mcg

Epipen Junior shortage – patient letter – including guidelines to prescribe 300mcg dose for patients above 25kg (4 stone) 

Epipen 150mcg and 300mcg supply issue update September 2018 

Epipen 300mcg supply issues


Alerts:

Supply Disruption Alert (SDA/2019/004) 1st August 2019

CAS DHSC Supply Disruption Alert 15.10.2018

CAS DHSC Supply Disruption Alert 28.09.2018


Useful resources for community pharmacies

Adrenaline for anaphylaxis kits 

Anaphylaxis Campaign website

How to use Emerade

How to use Epipen

How to use Jext 

Summary of the key differences between the three presentations of adrenaline auto-injectors.

 



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