An expired Epipen may be a fact of life in some households. Whether it is due to difficulty in refilling it because of cost or because household members forget, allergic patients may be in a situation where they have an expired Epipen and they are in an anaphylaxis situation. If you are reading this and this is you, use it now and call 911 immediately! Otherwise, here we will look into studies of expired Epipens and see how efficacious they will be.
Current anaphylaxis guidelines recommend prompt use of epinephrine as the first line treatment of anaphylaxis that occurs outside of a a hospital. Patients at risk are instructed to carry them at all times and be prepared to use them when anaphylaxis occurs.
Storage recommendations for Epipen’s are to keep them between 68-77 degrees F. Also to protect them from excessive cold or heat and to replace it if its discolored or if it contains a precipitate.
There have been some previous studies on expired Epipens. In Albany there was a study which showed expired Epipens contained only 13-31% of epinephrine. In a study in Canada, expired Epipens showed that they contained 51-102% of labeled epinephrine dosage.
A most recent study of expired Epipens collected 35 of them past the expiration date. The percentage of labeled epinephrine dose calculated was between 84-101% and it decreased with increasing number of months past the expiration date. All expired Epipens that were no more than 24 months past the expiration date contained more than 90% of the labeled epinephrine dose. The expired epipens that were more than 24 months past the expiration date were discolored and contained less then the recommended dosages.
The bottom line is that if you are in anaphylaxis with only an expired Epipen available, you should immediately use it, especially if its less than 24 months after the expiration date. But all expired epipens should be replaced as the date arrives. An expired Epipen is preferable to no epinephrine at all as it might still have beneficial effects.
For those patients who have been using Auvi-Q as an injectable epinephrine, those products were recalled and should be replaced immediately. https://allergylosangeles.com/allergy-blog/auvi-q-recall/
Update May 9th, 2017
A recent study published in the Annals of Internal Medicine now shows that Epipens still remain 84% potent even 4 years after the expiration date. The Epipens were still in the therapeutic range as long as there was no discoloration seen. Although the authors of the study still recommended getting the Epipens renewed after the expiration date, but if there was nothing else to be used, an expired Epipen is better than no Epipen at all. To read more about it, click on the link below. EpiPens still potent 4 years after expiration date, study says