The above question is common from patients with a history of an allergic reaction seen for a repeat emergency department visit. The manufacturers of EpiPen caution not to use the pen beyond the expiration date, and if the drug solution becomes discolored (oxidation). But EpiPens are expensive! Is there harm in using the pen beyond the expiration date? What should we tell our patients?1
The answer to the title’s question is perhaps more pertinent now than ever. Since this post in 2014, the price of EpiPen has unethically increased by more than 400%. This unnecessary price increase may interfere with our patients’ ability to obtain and refill EpiPen prescriptions on time. Emergency care providers may find themselves answering the title question more frequently than before.
An additional bench study was recently published addressing the potency of epinephrine in expired EpiPens.2 The authors collected 31 expired EpiPens and 9 EpiPen Junior autoinjectors. The expiration dates ranged between 1 and 50 months past the manufacturer expiration date. The concentration of active epinephrine ranged between 84 – 100%, with decreasing concentration over time.
- Outdated Epipens start losing epinephrine once expired.
- A significant amount of epinephrine may still be present up to 90 months after the expiration date.
- We should always recommend in-date pens to be used and provide a new prescription or a refill if needed; however, as advocated by the publication article’s authors, if an expired, non-discolored EpiPen is the only out-of-hospital intervention available for an anaphylactic reaction, it should be used as the risk of harm is minimal with significant benefit.