How to Give an Epinephrine Injection

Treating anaphylactic reactions means knowing how to give an epinephrine shot.

How & When to Use an EpiPen

If your child has a severe allergic or anaphylactic reaction, it is important to understand how to use an epinephrine, or epi, shot, usually from an injectable device such as an EpiPen(R), in a shot pack. An epi shot is easy to administer and will help save your child's life. 

You should also devise an anaphylaxis action plan with your allergist, says Dr. Hemant Sharma, M.D., director of the Food Allergy Program at Children’s National Health System in Washington, D.C.  Go to foodallergy.org/faap to print out instructions that you can share with others.

    How to Administer the Epinephrine

    Your child needs to hold still during the injection. If she cannot, have another adult hold your child. If you are alone with your child, lay him down and then lay down across his chest to keep him still. Use one hand to hold a leg and the other hand to give the injection.

      1. With the injector's tip facing down, grab it with one hand and make a fist. Do not touch the tip.
      2. With the other hand, remove the cover from the shot.
      3. Hold the injector close to your child's leg and jab the shot forcefully into the thigh. The shot should be given only in the upper leg muscle of the child. The shot can and should be given through clothing.
      4. Hold the injector in your child's thigh for several seconds. You should see a red flag in the injector window, which indicates that the epinephrine has been given.
      5. Remove the injector and put it in the storage tube that came in the pack. Keep it with you to give to the doctor later.
      6. Call 911. A shot is not a cure or a complete treatment for an allergic reaction; it simply gives you more time to get your child to the hospital.

        After you have given the shot, there will be liquid remaining in the injector. This remaining liquid does not mean that you should re-inject your child. It is normal for liquid to remain. Be sure that your shot pack is always with your child. Teachers and caregivers should always carry the pack and be confident giving this shot.

        You can also ask your pharmacist for a shot trainer to help you and your child practice how an injection will be given. Practicing and discussing the shot with your child before an emergency can help your child be a willing participant.

        The epinephrine shot can be effective only if the medicine is still potent. Epi shots do not need to be refrigerated, but they do need to be kept at room temperature and away from direct sunlight. There are three instances when the shot pack should be replaced: If the liquid in the injector is no longer clear, if particles are floating in it, or if the expiration date on the shot pack has passed, throw out the pack immediately and get your prescription refilled.

        Less Expensive EpiPen Options

        EpiPens expire after about a year, and the soaring price (more than $600 for a two-pack) has made it tough for some families, especially those on a high-deductible health insurance plan, to pay for refills. Fortunately, Bobby Q. Lanier, M.D., executive medical director of the American College of Allergy, Asthma and Immunology, recommends several new safe and less expensive options. 

        1. Generic EpiPen. A new version from Mylan is identical to its brand-name product, according to Dr. Lanier. (Cash price: $300 per two-pack)
        2. Epinephrine injection, USP auto-injector. This generic version of Adrenaclick is now available. Just be sure you’re trained by a doctor or a pharmacist on how to use it—the autoinjector must be held against the middle of the outer thigh for a full ten seconds instead of three seconds for the EpiPen. (Cash price: from $110 per two-pack at CVS)
        3. AUVI-Q. After being recalled in 2015 due to a small number of devices potentially having inaccurate dosage delivery, this compact “talking injector” (it delivers audible step-by-step instructions) should be out again in February. (Cash price: At press time the product’s developer, Kaléo, announced that it would be $360 and financial support would be available for families without insurance coverage who have a household income of less than $100,000.) 

        When To Use the Pen

        1. For one severe symptom: Including breathing problems, tightness in the throat, feeling faint or having a weak pulse, swelling of the tongue or lips, hives over the whole body, or severe diarrhea or vomiting.
        2. For moderate symptoms affecting two parts of the body: Including hives, itchy mouth, nausea, and sneezing or drippy nose. If a child is having an anaphylactic reaction and you don’t have an EpiPen, call 911. Lay him flat, with legs elevated to keep blood flowing to vital organs, advises Hemant Sharma, M.D., director of the Food Allergy Program at Children’s National Health System in Washington, D.C. Prop up the child’s head if he’s having trouble breathing; if he’s vomiting, turn him on his side until help arrives.

        When To Hold Off

        1. For only one mild to moderate symptom. Instead, give him a kids’ antihistamine, call your doctor, and then watch for any changes.

        All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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