By: Diana Gritsenko, Pharm D. Candidate c/o 2015
Most of us who work in a community pharmacy setting will usually get a few scripts a month for an Epi-pen™. An Epi-pen™ is a device that autoinjects epinephrine (also known as adrenaline) into a patient who is experiencing anaphylaxis. Anaphylaxis is a severe, whole-body allergic reaction to a foreign substance or an allergen. 1 This device can be life-saving as it can reverse or relieve some of the effects of anaphylaxis such as a dangerously low blood pressure, tightening of the lung muscles (which causes wheezing), and swelling of the throat and face.2 However, patients can put themselves in danger because they may not be aware of how to use the Epi-pen™ and may not even carry it around. A new autoinject device, the Auvi-Q™, has entered the market and promises to provide ease-of-use and better portability for patients.3
When the Epi-pen™ autoinjector is dispensed in a pharmacy, it is packaged in a box that contains two live Epi-pens and a practice dummy without a needle. When patients experience symptoms of anaphylaxis, they are instructed to grip the Epi-pen™ with the needle end (characterized by its orange tip) pointing downwards towards the floor, remove the blue safety cap on the top side of the pen, and stab the pen firmly into the muscle of their outer thigh. The force of the impact retracts the orange tip and exposes the needle which delivers the epinephrine into the muscle. In order to ensure that all of the epinephrine has been delivered, the patient has to hold the pen in place for approximately 10 seconds.4
Patients are counseled by their doctor or pharmacist on how to use this device. However, in stressful emergency situations, patients commonly forget the counseling points they might have received some time ago. The directions are written on the back of the pen itself, but it is unlikely that a patient will read them when in a state of panic. Furthermore, patients are supposed to carry this device with themeverywhere in case of an emergency. Unfortunately, the size of the Epi-pen™ may discourage patients; the device resembles a large felt-tip marker, and as of September 2012, each one comes in its own carrying case.5 These are the issues that the Auvi-Q™ was built to address.
The Auvi-Q™ was the brainchild of Eric and Evan Edwards. The twins grew up with serious food allergies and were instructed by their doctor to always carry the Epi-pen™ around. As they grew older, they found this advice increasingly hard to follow. After college, Eric Edwards pursued a career in Pharmaceutical Sciences and Evan Edwards received a degree in Engineering; they combined their talents to create the new device which hit pharmacy shelves this year. 3
The Auvi-Q™ has a similar needle length, gauge and injection force to that of Epi-pen™. Auvi-Q™ also injects 0.3mg of epinephrine and has similar peak and total epinephrine levels according to a randomized, crossover, bioavailability study. The advantage of the Auvi-Q™ lies in its design. 5,2
This new device is about the length and the width of a credit card and as thick as a smartphone. It can easily slip it into a pocket or be carried around in a purse. In order to use the autoinjector, the patient has to first pull off the outer case of the Auvi-Q™. When this case is removed, the device beeps and begins to dictate the instructions to the patient. Similar to the Epi-pen™, the Auvi-Q™ has a safety cap that needs to be pulled off in order to activate the needle. The difference lies in the color of the Auvi-Q’™’ safety cap (red) and its location (over the needle). The patient is then instructed to place the black end of the device over his or her outer thigh and press firmly for 5 seconds (as opposed to 10 seconds for the Epi-pen™). Auvi-Q™ counts down the 5 seconds and instructs the patient to seek emergency medical attention right away. 7
The Epi-pen™ and the Auvi-Q™ are both used for anaphylaxis and contain 0.3mg of epinephrine. The difference between them lies in the mechanism of drug delivery. The makers of Auvi-Q™ claim that their product is made from real-world experiences and feedback from the patients and their caregivers. Eric and Evan Edward believe that this gives them an advantage over the traditional Epi-pen™. Since this device was made available in the United States on January 28, 2013, it is too soon to tell how the Auvi-Q™ will fare in the market; but it is a product pharmacists should keep an eye on and appropriately counsel patients on. 8
- Anaphylaxis. National Institute of Health Web site. nlm.nuh.gov/medlineplus/ency/article/000844.htm. Updated May 30, 2012. Accessed March 1, 2013.
- Epi-pen: Frequently asked questions. Epi-pen Web site. www.epipen.com/about-epipen/faqs. Updated 2013. Accessed March 1, 2013.
- Thomas K. Brothers develop new device to halt allergy attacks. New York Times. February 1, 2013.
- Epi-pen: How to use Epi-pen. Epi-pen Web site. http://www.epipen.com/how-to-use-epipen. Updated 2013. Accessed March 1, 2013.
- Newly designed Epipen. Allergy UK Web site. www.allergyuk.org/news/latest-news/post/42-newly-designed-epipen. Updated September 12, 2012. Accessed March 1, 2013.
- In brief: Auvi-Q- A new epinephrine auto-injector. The Medical Letter Online Web site. www.secure.medicalletter.org/w1410a. Updated 2013. Accessed March 1, 2013.
- About Auvi-Q. Auvi-Q Website. www.auvi-q.com/auvi-q-demo. Updated 2013. Accessed March 1, 2013.
- Auvi-Q is now available in the US. Intelliject Web Site. www.intelliject.com/2013/01/29/auvi-q-tm-is-now-available-in-the-us. Updated January 2013. Accessed March 1, 2013.