Does EpiPen (epinephrine) cause side effects?
EpiPen (auto-injectable epinephrine) is a sympathomimetic catecholamine used for self-administration during life-threatening allergic reactions, including
- anaphylactic reactions caused by insect stings or bites,
- allergen immunotherapy,
- chemicals used for diagnostic testing substances such as radiocontrast media, and
- other allergens.
EpiPen also is used for treating anaphylaxis due to exercise or unknown causes. EpiPen is used for emergency use only and are should not replace proper medical care. Epinephrine, the medicine contained in EpiPen, is an excitatory chemical naturally made by our bodies.
Epinephrine stimulates alpha and beta-adrenergic receptors found throughout the body. When injected during an allergic reaction, epinephrine works in multiple ways to treat the many signs of anaphylaxis. It causes blood vessels to constrict or tighten which helps to increase blood pressure and decrease swelling.
Epinephrine also stimulates the heart muscle, causing the heart to beat faster and pump more blood to the vital organs. Epinephrine helps patients breathe better by relaxing the muscles in the lungs and allowing the airways to open up. Additionally, it also helps to prevent further release of inflammatory chemicals that were triggered by the initial allergic reaction.
Common side effects of EpiPen include
- shortness of breath,
- pale skin (pallor),
- tremor, and
Serious side effects of EpiPen include
- abnormal heartbeats,
- chest pain,
- high blood pressure,
- respiratory difficulties,
- increased heart rate, and
Drug interactions of EpiPen include cardiac glycosides, diuretics (water pills), or drugs for treating irregular heartbeats (anti-arrhythmics), because coadministration can cause the development of irregular heartbeats.
- The effects of EpiPen may be enhanced by medicines such as tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), levothyroxine, and certain antihistamines.
- The treatment benefits of EpiPen can be reduced by beta-adrenergic blocking medicines such as propranolol and alpha-adrenergic blocking medicines such as phentolamine.
- Some anti-migraine medications may also interfere with the benefits of EpiPen treatment.
Use of EpiPen has not been adequately evaluated in pregnant women. EpiPen should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
It is unknown if EpiPen is excreted in breast milk. Since many drugs are excreted in breast milk and have the potential of causing harm to the nursing infant, caution should be used when EpiPen is administered to a breastfeeding mother.
What are the important side effects of EpiPen (epinephrine)?
Common side effects of EpiPen include:
- Shortness of breath
- Pale skin (pallor)
Possible serious side effects of EpiPen include:
- Abnormal heart beats
- Chest pain
- High blood pressure
- Respiratory difficulties
- Increased heart rate
EpiPen (epinephrine) side effects list for healthcare professionals
Due to the lack of randomized, controlled clinical trials of epinephrine for the treatment of anaphylaxis, the true incidence of adverse reactions associated with the systemic use of epinephrine is difficult to determine. Adverse reactions reported in observational trials, case reports, and studies are listed below.
Common adverse reactions to systemically administered epinephrine include
- nausea and vomiting;
- headache; and/or respiratory difficulties.
These symptoms occur in some persons receiving therapeutic doses of epinephrine, but are more likely to occur in patients with hypertension or hyperthyroidism.
- Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or those receiving certain drugs.
- Rapid rises in blood pressure have produced cerebral hemorrhage, particularly in elderly patients with cardiovascular disease.
- Angina may occur in patients with coronary artery disease.
- Rare cases of stress cardiomyopathy have been reported in patients treated with epinephrine.
- Accidental injection into the digits, hands or feet may result in loss of blood flow to the affected area.
- Adverse events experienced as a result of accidental injections may include increased heart rate, local reactions including injection site pallor, coldness and hypoesthesia or injury at the injection site resulting in bruising, bleeding, discoloration, erythema or skeletal injury.
- Lacerations, bent needles, and embedded needles have been reported when EpiPen has been injected into the thigh of young children who are uncooperative and kick or move during the injection.
- Injection into the buttock has resulted in cases of gas gangrene.
- Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), have been reported following epinephrine injection, including EpiPen, in the thigh.
What drugs interact with EpiPen (epinephrine)?
- Patients who receive epinephrine while concomitantly taking cardiac glycosides, diuretics, or anti-arrhythmics should be observed carefully for the development of cardiac arrhythmias.
- The effects of epinephrine may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine sodium, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine.
- The cardiostimulating and bronchodilating effects of epinephrine are antagonized by beta- adrenergic blocking drugs, such as propranolol.
- The vasoconstricting and hypertensive effects of epinephrine are antagonized by alphaadrenergic blocking drugs, such as phentolamine.
- Ergot alkaloids may also reverse the pressor effects of epinephrine.
EpiPen (auto-injectable epinephrine) is a sympathomimetic catecholamine used for self-administration during life-threatening allergic reactions, including anaphylactic reactions caused by insect stings or bites, allergen immunotherapy, foods, drugs, chemicals used for diagnostic testing substances such as radiocontrast media, and other allergens. Common side effects of EpiPen include anxiety, dizziness, shortness of breath, flushing, headache, nausea, nervousness, pale skin (pallor), restlessness, sweating, tremor, and vomiting. EpiPen should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is unknown if EpiPen is excreted in breast milk.
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Related Disease Conditions
How Long Does an Allergic Reaction Last?
Allergic reactions may last for varying lengths of time. They may take a few hours to a few days to disappear. If the exposure to the allergen continues, such as during a spring pollen season, allergic reactions may last for longer periods such as a few weeks to months.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
What Are the 4 Types of Allergic Reactions?
Allergists recognize four types of allergic reactions: Type I or anaphylactic reactions, type II or cytotoxic reactions, type III or immunocomplex reactions and type IV or cell-mediated reactions.
Fragrances and preservatives in cosmetics may cause allergic reactions in some people. Symptoms include redness, itching, and swelling after the product comes in contact with the person's skin. Treatment typically involves the use of over-the-counter cortisone creams.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs of a food allergy reaction include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Eye allergy (or allergic eye disease) are typically associated with hay fever and atopic dermatitis. Medications and cosmetics may cause eye allergies. Allergic eye conditions include allergic conjunctivitis, conjunctivitis with atopic dermatitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Dry eye, tear-duct obstruction, and conjunctivitis due to infection are frequently confused with eye allergies. Eye allergies may be treated with topical antihistamines, decongestants, topical mast-cell stabilizers, topical anti-inflammatory drugs, systemic medications, and allergy shots.
Cold, Flu, Allergy Treatments
Before treating a cold, the flu, or allergies with over-the-counter (OTC) medications, it's important to know what's causing the symptoms, which symptoms one wishes to relieve, and the active ingredients in the OTC product. Taking products that only contain the medications needed for relieving your symptoms prevents ingestion of unnecessary medications and reduces the chances of side effects.
Allergy Treatment Begins at Home
Avoiding allergy triggers at home is one of the best ways to prevent allergy symptoms. Controlling temperature, humidity, and ventilation are a few ways to allergy-proof the home. Cleaning, vacuuming, and using HEPA air filters also helps control allergies.
Peanut allergies causes signs and symptoms that include hives, itching, redness, and a rash. Severe reactions may cause decreased blood pressure, lightheadedness, difficulty breathing, nausea, and behavioral changes. Someone with a peanut allergy should have an EpiPen with them at all times.
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Drug Allergy (Medication Allergy)
Drug or medication allergies are caused when the immune system mistakenly creates an immune response to a medication. Symptoms of a drug allergic reaction include hives, rash, itchy skin or eyes, dizziness, nausea, diarrhea, fainting, and anxiety. The most common drugs that people are allergic to include penicillins and penicillin type drugs, sulfa drugs, insulin, and iodine. Treatment may involve antihistamines or corticosteroids. An EpiPen may be used for life-threatening anaphylactic symptoms.
Latex allergy is a condition where the body reacts to latex, a natural product derived from the rubber tree. The reaction can either be delayed and cause a skin rash or immediate, which can lead to anaphylaxis. Avoiding latex is the most effective way to prevent an allergic reaction.
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Medications & Supplements
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.