1. Guildford and Waverley CCG Medicines Management - update on adrenaline autoinjectors 24 th July 2014

2. Prescribing Clinical Network Adrenaline 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

3. 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

4. MHRA Drug Safety Update – May 2014 Summary 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.

5. MHRA Adrenaline auto-injectors: a review of clinical and quality considerations – reported June 2014 MHRA 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.

6. 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 07795657974 www.epipen.co.uk www.epipen.co.uk To watch an animated video of how to use an Epi-pen go to www.epipen.co.uk www.epipen.co.uk

7. 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 www.jext.co.uk To watch a video on how to use Jext go to www.youtube.com/watch?v=CjgbwmQy2r8 www.youtube.com/watch?v=CjgbwmQy2r8

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

9. 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

10. Prescribing Advisory Database “PAD” Please visit the Prescribing Advisory Database "PAD" at its new website address http://pad.res360.net/ http://pad.res360.net/ Google – Prescribing Advisory database Download App from the website