ACP has encouraged individuals to discuss alternatives during the EpiPen® shortage. Pharmacists are reminded that any individual who seeks your advice and care should be cared for without judgement and in a manner that addresses their personal health needs at that time, regardless of whether they are a regular client of your pharmacy or not. Individuals who are assessed as being susceptible to rapid on-set anaphylaxis should be prioritized for access to EpiPens® when possible.
If pharmacies are unable to supply EpiPens®, alternatives such as using two doses of EpiPen Junior®for adults, or possibly using EpiPens® that have passed their expiry date may be considered. The feasibility of either alternative is situation dependent; the first instance depends on availability, and the second depends on the period beyond which expiry occurred. In a state of emergency, an outdated EpiPen® may be better than nothing.
Providing access to other forms of epinephrine
Pharmacists faced with a situation in which EpiPen® cannot be supplied and no other reasonable alternatives are available may use their professional judgement to consider providing other forms of epinephrine as an interchangeable product.
In cases where an EpiPen® cannot be obtained as a result of the shortage, providing ampoules or vials of epinephrine and syringes together with training on preparing the syringe and administration is an alternative pharmacists may consider.
As with all medications, the pharmacist is responsible for ensuring a drug is appropriate for the patient and training them on proper use. This includes directions for use and administration. To complement appropriate training, you may consider providing patient education handouts produced by the British Columbia Pharmacy Association.
DO NOT PRE-LOAD SYRINGES WITH EPINEPHRINE
It is not recommended that pharmacy professionals pre-load syringes with epinephrine. Despite some pharmacies having availability of sterile compounding environments, there is insufficient data to support a lengthy BUD without end-product sterility testing.
For more information on assigning beyond-use dates, consult the Model Standards for Pharmacy Compounding of Non-Hazardous Sterile Preparations.
Prescriptions Required for Epinephrine Ampoules and Vials
While an EpiPen® is a Schedule 2 product and does not require a prescription under the Scheduled Drugs Regulation, ampoules and vials of epinephrine do require a prescription.
- If EpiPen® is unavailable, a pharmacist with APA may write a prescription for epinephrine ampoules or vials. If this is the preferred alternative and a pharmacist does not have APA, the individual may be referred to a pharmacist with APA or their family physician to get a prescription.
- If a patient has an existing prescription or brings in a new prescription for EpiPen®, pharmacists can adapt the prescription and provide the patient with ampoules or vials of epinephrine if an EpiPen® is unavailable.