Guildford and Waverley CCG Medicines Management - update

on adrenaline autoinjectors

24th July 2014

Prescribing Clinical NetworkAdrenaline autoinjectors were discussed at the meeting in May 2014

• The PCN supports the prescribing of Jext®, EpiPen® or Emerade® as treatment options for patients requiring an adrenaline auto injector.

• All patients should receive training on a regular basis to ensure they know how to use their device (this could be done by practice nurse or community pharmacist).

• Jext®, EpiPen® or Emerade® are considered as GREEN on the traffic light system

Key Considerations• The potential for supply shortages if choice is restricted to a single

device.• Resuscitation Council UK guidelines on the Emergency Management

of Anaphylactic Reactions 2010 (These guidelines, written for HCP treatment of anaphylaxis rather than emergency self-administration of adrenaline by a patient or carer, recommend the use of a 500mcg dose)

• The importance of prescribing by brand and maintaining on one brand where possible for individuals

• The importance of training for both the HCPs and patients/carers

MHRA• Drug Safety Update – May 2014Summary People who have been prescribed an adrenaline auto-injector because of the risk of anaphylaxis should carry two with them at all times for emergency, on-the-spot use. After every use of an adrenaline auto-injector, an ambulance should be called (even if symptoms are improving), the individual should lie down with their legs raised and, if at all possible, should not be left alone.

MHRAAdrenaline auto-injectors: a review of clinical and quality considerations – reported June 2014MHRA has conducted a review of all adrenaline auto-injectors approved in the UK. This was in response to the death of an individual who had used an adrenaline auto-injector during an anaphylactic reaction.The recommendations include:• updating people with allergies, their carers, and healthcare professionals

on the correct use of adrenaline auto-injectors • informing people with allergies, their carers, and healthcare professionals

of measures to take to ease the symptoms of an anaphylactic reaction while awaiting emergency medical help

• requiring manufacturers to provide data on whether the adrenaline from an auto-injector is delivered into the muscle or fatty tissue

• requesting manufacturers to provide further technical information with the aim of improving the performance of adrenaline auto-injectors.

Epi-Pen • £26.45 for both 0.15mg and 0.3mg strengths• Swing and Jab method of admin• Shelf life – 18 months• The appropriate dosage may be 0.15mg (EpiPen Jr.) for children 15-30kg

body weight and 0.3mg (EpiPen) adrenaline for children >30kg body weight,

• Storage conditions – do not store above 25ᵒC and do not refrigerate or freeze.

• MEDA Pharmaceuticals Ltd - Tel: Jessika Housiaux 07795657974www.epipen.co.uk

• To watch an animated video of how to use an Epi-pen go to www.epipen.co.uk

Jext • £23.99 for both 0.15mg and 0.3mg strengths• Shelf life – 18 months• Place and press method of admin • Available as:

Jext 0.3mg (licensed for 30kg+) Jext 0.15mg (licensed for 15kg-30kg)

• ALK-Abello UK• www.jext.co.uk Tel: Duncan Fraser 07917 473038• To watch a video on how to use Jext go to

www.youtube.com/watch?v=CjgbwmQy2r8

Emerade• Cost

– 0.15mg - £26.94– 0.3mg - £26.94– 0.5mg - £28.74

• Shelf life 30 months• Place and press method of admin • Children between 15 kg and 30 kg - Emerade 0.150mg. Patients over

30 kg - Emerade 0.3mg or Emerade 0.5mg.•

iMed Systems Ltd.www.emerade.com - Tel: Alan Stern 07946 475705

• To watch a video on use of Emerade: http://www.emerade.com/instruction-video

Summary

• Currently in the UK there are 3 different adrenaline autoinjector devices• THEY ARE NOT INTERCHANGEABLE• Please prescribe adrenaline auto-injectors by brand e.g. Jext , Epipen,

Emerade• ANY change in device needs specific training for the patient (and their

carers)• All 3 brands of adrenaline autoinjector have been given equal status by

the Prescribing Clinical network (PCN)• All 3 manufacturers of adrenaline autoinjectors provide:

– Expiry date reminders for patients that register– Patient information / videos on how to administer– Training and dummy pens for Healthcare Professionals

Prescribing Advisory Database “PAD”

• Please visit the Prescribing Advisory Database "PAD" at its new website address http://pad.res360.net/

• Google – Prescribing Advisory database

• Download App from the website