Ask the Pharmacist

Q. What is the latest update on the EpiPen shortage?

A. The EpiPen is an injection that contains the medication epinephrine and is used to treat serious, potentially life-threating allergic reactions.

Epinephrine quickly narrows blood vessels and opens the airways in the lungs, thereby reversing the anaphylaxis reaction that someone is experiencing to an allergen (such as a bee sting, ingesting a peanut…).

The EpiPen shortage has been an ongoing concern for many months now and according to the manufacturer Pfizer, it was due to manufacturing problems and delays. It was thought that the issue might be resolved by August or September of this year but as we head into October, we are still seeing shortages of the EpiPens.

Up until a few weeks ago, EpiPen was the only product on the market in Canada providing a quick and simple to use epinephrine injection that can be used at a moment’s notice. As a result of this, Auvi-Q, another brand of epinephrine injection, has been temporarily approved for sale in Canada for the time being. This brand has been available in the United States for years now and is considered to be the equal of the Epipen.

Due to the continuing high demand for epinephrine injections, the supply of Auvi-Q is somewhat limited as well. The latest news that came from our Ontario Pharmacists Association over this past weekend was that the Auvi-Q 0.15mg (equivalent to the EpiPen Junior) is now also available to treat those who weigh less than 30kg (66 pounds). While the Auvi-Q is unfortunately more expensive, it is covered by the government drug plan for all its recipients (e.g. seniors, children, disability, social assistance…) who have a valid prescription as well as by many private insurance companies, including all the plans covering Bruce Energy employees, families and retirees.

The Auvi-Q is operated in the same manner as the Epipen with the only major difference being that the Auvi-Q has an audio recording that walks you through the steps when it is opened, making the device perhaps even easier to operate than the Epipen. Regardless, if you know how to use an Epipen, the Auvi-Q will not prove to be a challenge.

In other news, it has been reported that an extremely limited supply of EpiPens were shipped to some pharmacies that have a packaging defect. Pfizer has informed Health Canada that due to a labeling mishap, some of the EpiPens may not be easily removed from their protective carrier tube. This may result in a delay in receiving the epinephrine injection or possibly a missed dose altogether as a patient or family member wrestles with freeing the injection from the tube. Pfizer reports that this is due to the labels not fully adhering to the device and as such, in rare cases, the label might instead stick to the carrier tube on the inside. Pfizer reports that this affects only a small number of injectors (1 in every 14, 286 or 0.007%). The products affected by this could be either an EpiPen or an EpiPen Junior all having expiry dates in April 2018 or October 2019.

If you are in possession of an EpiPen or EpiPen Junior with the above expiry dates, check to ensure that the injector can be easily removed from the tube. If it cannot, it is suggested to bring it to your pharmacy and they will exchange it for a new one.

That being said, as mentioned earlier, the EpiPen and EpiPen Junior are still on a long-term backorder so you may have to wait to receive a new one. In the meantime, you can be provided with an Auvi-Q or Auvi-Q Junior until the EpiPen can be supplied.