同: Adrenalin, EpiPen
関: Epinephrine

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/22 14:03:27」(JST)

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An old version of a 0.3 mg EpiPen auto-injector

An epinephrine autoinjector, or EpiPen, is a medical device for injecting a measured dose or doses of epinephrine (adrenaline), by means of autoinjector technology; it is most often used for the treatment of anaphylaxis. The EpiPen is derived from the Mark I NAAK ComboPen, which was developed for the U.S. military for treating exposure to nerve agents in the course of chemical warfare.^[1] Trademark names for the autoinjector device include Emerade, Twinject, Adrenaclick, Anapen, Jext, Allerject, and Auvi-Q.

Medical uses

After activation, the patient holds the device in place for between 5 and 10 seconds as the epinephrine is delivered. This gives the drug enough time to be absorbed by the body's muscles and diffused into the bloodstream.

Auto-injectors are sometimes used unnecessarily. Injection into a vein (intravenous injection) can be fatal. It can cause ventricular tachycardia, in which the heart beats uncontrollably and is not able to pump blood adequately. It can also restrict blood flow to the area of the injection site, and damage the extremities.^[2] After administering the device, patients are advised to seek immediate medical attention.

An emergency technique (not manufacturer-approved) to obtain additional epinephrine from a used autoinjector has been published in the medical literature.^[3]

Units that have exceeded their expiration date can still be used in an emergency if an unexpired unit is unavailable.^[4]

Effectiveness

None of these devices prevent future episodes of anaphylaxis. Patients who experience severe or life-threatening reactions may be treated further via allergen immunotherapy for long-term protection. A series of allergy injections composed of increasing concentrations of naturally occurring substances (such as venom) provide excellent and usually lifelong protections against adverse effects of future insect stings. The initial injections have a very low concentration, usually 1 ppb or less.^[5]

Design

The devices contain a spring-loaded needle that exits the tip of the device (in some cases through a sterile membrane) and penetrates the recipient's skin, to deliver the medication via intramuscular injection.^[6]^[7]^[8]

Epinephrine autoinjectors contain a pre-determined dose of epinephrine, usually between 300 μg^[9]^[10] and 500 μg^[9]^[11] of active ingredient at a concentration of 1:1000. They typically contain more medication than the amount needed for a single dose, but any extra amount is not intended for use and is inaccessible without destroying the device. Manufacturers have also made pediatric dosed versions available at 150 μg of active ingredient.^[9]^[12] There was a version that contained two individual doses (in case a repeated application is required) previously sold under the trade name Twinject.^[13] The company that produced Twinject autoinjectors, Shionogi, announced that it was discontinuing Twinject effective March 30, 2012.^[14]

In 2010, European regulators approved a new epinephrine auto-injector made by ALK and sold under the brand name Jext. ^[15]^[16] The product was launched in the European Union in September 2011.^[17]

On August 13, 2012, the U.S. Food and Drug Administration (FDA) approved a new version of epinephrine auto-injector made by Intelliject and Sanofi called the Auvi-Q.^[18] It is rectangular in shape, 3.5 inches by 2 inches by 0.5 inch. It has a soundchip in it to give audio cues to a patient or caregiver to aid in the proper use of the device.^[19]

In January 2013, the UK MHRA approved Emerade (from Namtall AB), the first auto-injector fitted with 25mm needles to the 300μg and 500μg models.

In most countries, epinephrine is a prescription drug, and therefore obtaining the device requires a prescription from a doctor. However, in some jurisdictions, epinephrine autoinjectors are an over-the-counter drug and may be purchased from a pharmacy counter.^{[where? — see talk page]}

References

^ Smetana, Kevin (September 24, 2009). "EpiPen inventor helped millions and died in obscurity". St. Petersburg Times. Retrieved 2010-07-07.
^ http://www.bmj.com/cgi/content/full/326/7389/589
^ Hawkins, S (December 2013). "Retrieval of Additional Epinephrine from Auto-Injectors". Wilderness & Environmental Medicine 24: 434–444. doi:10.1016/j.wem.2013.03.025.
^ Simons, FE; Gu, X; Simons, KJ (May 2000). "Outdated EpiPen and EpiPen Jr autoinjectors: past their prime?". The Journal of allergy and clinical immunology 105 (5): 1025–30. doi:10.1067/mai.2000.106042. PMID 10808186.
^ Resiman, R (August 1994). "Insect Stings". New England Journal of Medicine 26: 523–7. doi:10.1056/NEJM199408253310808. PMID 8041420.
^ http://www.epinephrineautoinject.com/what_is_epinephrine_injection_USP_auto_injector.php
^ https://www.epipen.com/en/about-epipen/how-to-use-epipen
^ https://www.auvi-q.com/about-auvi-q
^ ^a ^b ^c "Epipen and Epipen Jr; Dosing | Epinephrine Dose | Anaphylaxis". EpiPen. Retrieved 2010-07-07.
^ "Anapen 300 product information sheet". Lincoln Medical Ltd.
^ "Anapen 500 product information sheet". Lincoln Medical Ltd.
^ "Anapen 150 product information sheet". Lincoln Medical Ltd.
^ Verus Pharmaceuticals Announces U.S. Launch of Twinject for Anaphylaxis
^ http://download.springer.com/static/pdf/951/art%253A10.1007%252Fs11882-012-0284-1.pdf?auth66=1416610912_1f1285141ebce0234a8a5a3ec3f6be96&ext=.pdf
^ "ALK media release (07 October 2010)". Retrieved 2014-04-08.
^ "ALK media release (13 October 2010)". Retrieved 2014-04-08.
^ "ALK media release (06 September 2011)". Retrieved 2014-04-08.
^ "Sanofi Announces FDA Approval for Auvi-Q" (PDF). Retrieved 18 August 2012.
^ "Auvi-Q Fact Sheet" (PDF). Retrieved 18 August 2012.

The Anaphylaxis Campaign. Accessed on March 19, 2007.
BMJ Clinical Review of Epinephrine Administration. Accessed on March 19, 2007.

External links

Training video for EpiPen and Anapen from the Anaphylaxis Campaign (UK)

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. アナフィラキシー自己治療のためのエピネフリン処方 prescribing epinephrine for anaphylaxis self treatment
2. アナフィラキシー：迅速な認識および治療 anaphylaxis rapid recognition and treatment
3. 患者情報：エピネフリン自己注射器の使用（詳細） use of an epinephrine autoinjector beyond the basics

English Journal

Acute allergy and anaphylaxis in the emergency department-a review of 1 year's patient presentations.

Noble R, Friedlaender G, Cuthbertson B, Gray A.SourceUniversity of Edinburgh, Edinburgh, United Kingdom.
Emergency medicine journal : EMJ.Emerg Med J.2013 Oct;30(10):874. doi: 10.1136/emermed-2013-203113.19.
OBJECTIVES & BACKGROUND: There is limited epidemiological data for allergy Emergency Department (ED) presentations. Following recent launch of NICE guidelines and World Allergy Organisation (WAO) severity descriptions we investigated the epidemiology, management and outcomes of allergy patients
PMID 24014713

[Necrosis in fingers and toes following local anaesthesia with adrenaline - an urban legend?].

Finsen V.AbstractBACKGROUND It is often maintained that a local anaesthetic (usually lidocaine) with adrenaline must not be used in fingers and toes because it may cause necrosis due to vascular spasm in end arteries. This review article is an attempt to find evidence to support this warning.METHOD Relevant literature was found by means of searches in PubMed limited downwards to 1946 and in EMBASE from 1980 to 2012, and in reference lists.RESULTS Five review articles on finger necrosis following local anaesthesia concluded that lidocaine with adrenaline does not entail a risk of ischaemic injury. One article found 48 reported cases of finger necrosis in the period 1880 to 2000. Most were from the first half of the 1900s, and none involved lidocaine. Gangrene of part of the finger tip has subsequently been described in one patient with Raynaud's syndrome. No cases of necrosis have been described in a large number of reported accidents in which EpiPen injections contained the same quantity of adrenaline as is found in 60 ml lidocaine with adrenaline. Over a quarter of a million reports have been made of operations on feet, hands, fingers and toes anaesthetised with lidocaine with adrenaline without resulting necrosis.INTERPRETATION There are no grounds for the warning against using lidocaine with adrenaline in fingers and toes. This anaesthetic offers considerable practical advantages. Care should be taken with infected fingers or fingers with poor circulation.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række.Tidsskr Nor Laegeforen.2013 Sep 17;133(17):1827-30. doi: 10.4045/tidsskr.13.0373.
BACKGROUND It is often maintained that a local anaesthetic (usually lidocaine) with adrenaline must not be used in fingers and toes because it may cause necrosis due to vascular spasm in end arteries. This review article is an attempt to find evidence to support this warning.METHOD Relevant literatu
PMID 24042296

Bioavailability of Auvi-Q and EpiPen: Focus on Pharmacokinetics.

Edwards ES.Source1Intelliject, Inc, Richmond, VA, USA.
Clinical pediatrics.Clin Pediatr (Phila).2013 Sep;52(9):890. doi: 10.1177/0009922813488654. Epub 2013 May 13.
PMID 23671267

Japanese Journal

専門医のためのアレルギー学講座 ⅩⅩⅢ.集団生活でのアレルギー管理(1)食物アレルギー

アレルギー = Japanese journal of allergology 65(7), 893-900,907, 2016-08
NAID 40020934978

臨床研究・症例報告食物アレルギーによるアナフィラキシーへの対応の理解度ならびにエピペンについての実態調査

小児科臨床 69(8), 1426-1432, 2016-08
NAID 40020883007

〈Originals〉Strategies for preventing and managing allergic reactions to food in Japanese educational facilities such as kindergartens and schools

ACTA MEDICA KINDAI UNIVERSITY = The Kindai University Medical Association 41(1), 25-29, 2016-06
NAID 120005821346

Related Pictures

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★リンクテーブル★

リンク元

「アドレナリン」

　　[★]

英: adrenarine
同: (国試)エピネフリン epinephrine、エピレナミン epirenamine、スプラレニン suprarenin
化: 酒石酸水素エピネフリン
商: Adrenalin, EpiPen、ボスミン、エピペン
関: カテコールアミン、ノルアドレナリン、アドレナリン受容体

SPC. 61,68,86,142
GOO. 244

副腎髄質のクロム親和性細胞で合成・分泌される
MAOやCOMTによって代謝される

作用機序

薬理作用

血管作用

小動脈、前毛細血管括約筋？収縮
アドレナリン反転 epinephreine reversal

アドレナリン投与下にα受容体阻害薬を投与すると末梢血管抵抗が低下し血圧が低下する現象。α受容体を介した末梢血管収縮が抑制され、β2受容体を介した末梢血管平滑筋が弛緩することによる。

動態

適応

効能又は効果

(エピネフリン注０．１％シリンジ「テルモ」添付文書)

下記疾患に基づく気管支痙攣の緩解

気管支喘息，百日咳
各種疾患もしくは状態に伴う急性低血圧またはショック時の補助治療
心停止の補助治療

用量

心肺蘇生

ACLS：静注1mg　　←　　プレフィルのシリンジは大抵1mg/1mlで調製されている。
PALS：静注・骨髄 0.01mg/kg　気管内投与 0.1mg/kg

アナフィラキシーショック：皮下注～筋注で0.3mg

注意

本剤は心筋酸素需要を増加させるため、心原性ショックや出血性・外傷性ショック時の使用は避けること(エピネフリン注０．１％シリンジ「テルモ」添付文書)

禁忌

副作用

[1] Smetana, Kevin (September 24, 2009). "EpiPen inventor helped millions and died in obscurity". St. Petersburg Times. Retrieved 2010-07-07.

[2] ttp://www.bmj.com/cgi/content/full/326/7389/589

[3] Hawkins, S (December 2013). "Retrieval of Additional Epinephrine from Auto-Injectors". Wilderness & Environmental Medicine 24: 434–444. doi:10.1016/j.wem.2013.03.025.

[4] Simons, FE; Gu, X; Simons, KJ (May 2000). "Outdated EpiPen and EpiPen Jr autoinjectors: past their prime?". The Journal of allergy and clinical immunology 105 (5): 1025–30. doi:10.1067/mai.2000.106042. PMID 10808186.

[5] Resiman, R (August 1994). "Insect Stings". New England Journal of Medicine 26: 523–7. doi:10.1056/NEJM199408253310808. PMID 8041420.

[6] ttp://www.epinephrineautoinject.com/what_is_epinephrine_injection_USP_auto_injector.php

[7] ttps://www.epipen.com/en/about-epipen/how-to-use-epipen

[8] ttps://www.auvi-q.com/about-auvi-q

[epipen-9] "Epipen and Epipen Jr; Dosing | Epinephrine Dose | Anaphylaxis". EpiPen. Retrieved 2010-07-07.

[10] "Anapen 300 product information sheet". Lincoln Medical Ltd.

[11] "Anapen 500 product information sheet". Lincoln Medical Ltd.

[12] "Anapen 150 product information sheet". Lincoln Medical Ltd.

[13] Verus Pharmaceuticals Announces U.S. Launch of Twinject for Anaphylaxis

[14] ttp://download.springer.com/static/pdf/951/art%253A10.1007%252Fs11882-012-0284-1.pdf?auth66=1416610912_1f1285141ebce0234a8a5a3ec3f6be96&ext=.pdf

[ALK_media_release_.2807_October_2010.29-15] "ALK media release (07 October 2010)". Retrieved 2014-04-08.

[ALK_media_release_.2813_October_2010.29-16] "ALK media release (13 October 2010)". Retrieved 2014-04-08.

[ALK_media_release_.2806_September_2011.29-17] "ALK media release (06 September 2011)". Retrieved 2014-04-08.

[18] "Sanofi Announces FDA Approval for Auvi-Q" (PDF). Retrieved 18 August 2012.

[19] "Auvi-Q Fact Sheet" (PDF). Retrieved 18 August 2012.

匿名

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案内

案内

EpiPen