Epipen® brand (150 microgram and 300microgram devices) is considered the first line Adrenaline Auto Injector (AAI) across BSW.

Jext® brand (150 microgram and 300microgram devices) may also be used across BSW if supply issues necessitate.

Emerade ® brand (150microgram, 300microgram and 500microgram devices) were previously included on the formulary but NOT currently available. See further information below.

Injection technique is device specific. To ensure patients receivethe AAI that they have been trained to use, prescribers should prescribe by brand. Resources to support initial training, or when switching device:

Epipen demo video;  Epipen prescriber checklist; Jext demo video;

• Jext prescriber checklist; 

Additional notes:

All healthcare professionals in primary, secondary or specialist healthcare services who prescribe, supply or administer AAIs, or who advise patients and carers should ensure that:

• When patients next request a prescription, they are reviewed to ensure their AAI  prescription is still appropriate.

• Prescribers issue no more than TWO AAIs per patient (exceptions suggested to this in a 2019 DHSC supply disruption alert are ▪ where schools require separate AAI(s) to be kept on the school premises (e.g. in a medical room) in which case prescribers may need to consider issuing more than two but no more than four AAIs per child; ▪ for the rare scenario where patients might need more than two AAIs prescribed (for example, prior severe reaction resistant to treatment with adrenaline), the prescriber may issue additional AAIs).
• Patients are aware to not expose any brand of AAI to temperatures above 25°C. Storage above 25°C may increase the likelihood of a fault occurring with AAIs.
• Patients use their device(s) as instructed until the expiry date/extended expiry date. N.B. a device expiring in ‘March 2020’ does not expire until 31 March 2020.
• Patients are aware of the signs of anaphylaxis and the actions they should immediately take.

June 2020 -AAIs Supply Issues. 

Emerade® 150, 300 and 500 microgram AAI devices will be

unavailable for the foreseeable future. Patient and/or carers

should return Emerade AAIs to their local pharmacy once they have

obtained a prescription for, and been supplied with, an alternative brand.

While Emerade® remains unavailable, alternative devices should be considered

• Emerade® is the only AAI available in 500microgram formulation but The MHRA note that there is evidence to suggest that a single EpiPen® (300 microgram) or Jext® (300 microgram) device will be a suitable replacement for a single Emerade® 500 microgram device. 

• - GWH
• Non-formulary - RUH
• Non-formulary - SFT

• 1 in 10, 000 ampoules and minijet.
• Slow IV inj reserved for severely ill patients where there is doubt about adequacy of the circulation and absorption from the IM site with ECG monitoring.
• Ensure that the correct strength of adrenaline injection is used. 

• Injection podwer for reconstitution, 500 unit vial

• Acute Treatment or Short-term prophylaxis prior to planned procedures for Hereditary Angioedema and Acquired Angioedema

• In accordance with NHS England commissioning policy
• May only be initiated by (or on advice of) Specialist Centres
• Drug costs for emergency use in other hospitals will be reimbursed through the Specialist Centre
• Prophylactic treatment of hereditary angioedema (HAE) types I and II
• In accordance with NHS England commissioning policy in patients who fail, are intolerant or have contra-indications to oral prophylactic therapies.
• May only be supplied by Specialist Centres
• Prior approval must be given via Blueteq system

• Injection 10mg/ml - 3ml pre-filled syringe

• Non Formulary RUH 
• Available from SFT

• Commissioned by NHS England for Hereditary Angioedema and Acquired Angioedema for acute treatment or short-term prophylaxis prior to planned procedures. See NHS England Policy: B09/P/b.
  
   May only be initiated by (or on advice of) Specialist Centres where:

• C1inh is unsuitable due to adverse effects or administration difficulties the specialist clinician determines that Icatibant is the most suitable or cost-effective preparation for the patient
  Drug costs for emergency use in other hospitals will be reimbursed through the Specialist Centre