What are the generic alternatives to Epipen?

How do EpiPens work?

An EpiPen auto-injector with a safety cover.
Source: Tokyogirl79 (Wikimedia Commons)

EpiPen has caused a sensation in the past few months. Last summer, pharmaceutical company Mylan received widespread criticism when it was revealed that its adrenaline auto-injector had increased by 500 percent. According to Congress investigations, Mylan agreed to introduce a cheaper generic version of the drug, as well as funding programs designed to help patients afford the cost.

But the damage has already been done: Since the beginning of 2017, doctors have been prescribing alternatives to EpiPen at a rate six times higher than in 2016. Without insurance, a generic version is called Adrenaclick costs only $ 10 for a two-pack at CVS.

How do EpiPens and other brands of adrenaline autoinjectors even work?

A young boy with anaphylaxis.
Source: James Heilman, MD (Wikimedia Commons)

Millions of people consider adrenaline auto-injectors to be because of their riskAnaphylaxis. Anaphylaxis is a serious allergic reaction - most commonly to certain foods, animal stings or bites, and medications - that can occur within minutes of exposure to the allergen. Symptoms include shortness of breath, swelling of the throat or tongue, vomiting, drowsiness, and a drop in blood pressure.

Why such a violent reaction? In response to the allergen, inflammatory mediators such as histamine cause smooth muscle (such as the lungs) to contract, blood vessels to dilate and leakage, and changes in heart rate. A person can die of anaphylaxis if their heart stops beating or if they can no longer breathe due to swelling of the airways.

EpiPens work by quickly injecting a dose of epipinephrine (also called)adrenaline), Whichreverses the effects of anaphylaxis.

Source: Roland Mattern (Wikimedia Commons)

Adrenaline, which plays an important role in our fight or flight response, relaxes the smooth muscles of the airways and lungs, and quickly increases blood pressure by narrowing blood vessels. (It's the same hormone that makes us feel like we can run a marathon if we instead have to sweat through a public speech in front of a large, scary audience.) The pen is injected directly into the thigh muscle as the intramuscular route is faster is than subcutaneous administration (like how insulin is delivered).