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 Post subject: EpiPen Jr. vs. EpiPen
PostPosted: Thu Jun 30, 2005 11:52 am 
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Joined: Fri Apr 15, 2005 10:29 pm
Posts: 76
Location: Markham, Ontario
My daughter's father recently tried to fill a prescription for EpiPen Jr. for our 3 year old. She's 30 lbs. (13.6 kg) and the pharmacist took it upon herself to override the doctor's Rx and gave my daughter's father a regular EpiPen. I am furious! Just last month my daughter's allergist gave us 5 refills on the EpiPen Jr. and we saw her paediatrician yesterday, who weighed her and said she should be using the Jr. for at least another year. EpiPen Jr. is for 15 kg and under. She has a good 3 lbs to go before she reaches that limit and there's no way she's going to gain that in a year even.

When I told her father that the pharmacist was wrong, he sided with the pharmacist over her allergist and paediatrician.

What could the possible side effects be of an overdose should he ever need to inject our daughter? Any words of wisdom so I don't freak out every time she's over at his house?


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 Post subject:
PostPosted: Thu Jun 30, 2005 7:29 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
Aww, doesn't it drive you crazy when the health professionals don't agree?
Here's the EpiPen website.
www.epipen.com
Hopefully they can answer your questions. :)


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 Post subject:
PostPosted: Fri Sep 09, 2005 2:16 pm 
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Joined: Sat Apr 16, 2005 12:09 am
Posts: 1054
Quote:
EpiPen® Dosing

Epinephrine dosing is based on body weight. Your doctor will prescribe what is right for you. The EpiPen® auto-injector (0.3 mg) is for individuals weighing 66 lbs. or more. The EpiPen® Jr auto-injector (0.15 mg) is for individuals weighing between 33 and 66 lbs. Both strengths deliver a single dose.


The above quote is from the epipen website www.epipen.com/epipen_dosing.aspx. After pulling out my son's Epipen Jr. to confirm this info., I found printed on the labelling that it is for patients weighing 15 kg (33 lbs) and less only. Being that my 2 1/2 year old son is 40 lbs - I'm slightly panicked about not having the appropriate dose for him. Has anyone else noticed the discrepancy between the website info. and their injector's labelling? Am I missing something here?


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 Post subject:
PostPosted: Fri Sep 09, 2005 8:22 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
When I was reading your quote, I knew that wasn't what my son's epi-pen said.

The last time my son got a prescription for his epi-pen he was right on the border. He probably should have gotten the adult strength. The doctor and I discussed it, and we decided for him we would stick with the jr. This decision was based on several factors - one being that my son was very small for his age. He didn't often have growth spurts, and when he did, there wasn't a lot of growth involved.

He goes back to the doctor this week, and he will get the adult strength.

Some kids that are *on the boarder* the doctor might decide to go with the adult strength. But the pharmacist shouldn't be changing that without calling the doctor.


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 Post subject:
PostPosted: Sat Sep 10, 2005 11:38 pm 
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Joined: Fri Apr 15, 2005 10:29 pm
Posts: 76
Location: Markham, Ontario
ethansmom wrote:
Quote:
EpiPen® Dosing

Epinephrine dosing is based on body weight. Your doctor will prescribe what is right for you. The EpiPen® auto-injector (0.3 mg) is for individuals weighing 66 lbs. or more. The EpiPen® Jr auto-injector (0.15 mg) is for individuals weighing between 33 and 66 lbs. Both strengths deliver a single dose.


The above quote is from the epipen website www.epipen.com/epipen_dosing.aspx. After pulling out my son's Epipen Jr. to confirm this info., I found printed on the labelling that it is for patients weighing 15 kg (33 lbs) and less only. Being that my 2 1/2 year old son is 40 lbs - I'm slightly panicked about not having the appropriate dose for him. Has anyone else noticed the discrepancy between the website info. and their injector's labelling? Am I missing something here?


The dosing is different in the US than in Canada. The Canadian site is http://www.allerex.ca and it's distributed by Allerex rather than Dey. I'm not sure why there is such a huge difference in US and Canadian dosage, but I'm sticking with Jr. strength for a while. Like AnnaMarie, my daughter is also on the small side and I don't anticipate her crossing that 15 kg mark until she's well over 4 years old. Allerex's website doesn't offer any insight whatsoever about the dosing discrepancy, other than this general blurb:

Quote:
DOSAGE AND ADMINISTRATION: Usual epinephrine adult dose for allergic emergencies is 0.3 mg. For pediatric use, the appropriate dosage may be 0.15 mg or 0.30 mg depending upon the body weight of the patient. However, the prescribing physician has the option of prescribing more or less than these amounts, based on careful assessment of each individual patient and recognizing the life-threatening nature of the reactions for which this drug is being prescribed. With severe persistent anaphylaxis, repeat injections with an additional EpiPen® may be necessary.


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 Post subject:
PostPosted: Sun Sep 11, 2005 11:22 am 
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Joined: Sat Apr 16, 2005 12:09 am
Posts: 1054
I'll be calling my son's allergist in the morning to verify dosage for him. It might very well be that due to his age, regardless of the few pounds he's over, he'll recommend staying with the Epipen jr. Thanks for the input.


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 Post subject:
PostPosted: Wed Sep 14, 2005 12:50 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
I had my son in to the doctor yesterday, and we discussed this.

The maker of the epi-pen has a weight recommendation on their web-site and on their product.

But, when my doctor looked up the information in his compendium, it says "x" mg per "y" kg of weight of patient. By that, my son should receive 1 3/4 epi-pen jr. Since it's auto-injected, and pre-measured that is not possible. (In hospital or ambulance they don't use auto-injector and so his dosage would be measured out to the equivalent of 1 3/4 of a jr. epi-pen.)

So, the doctor and parent have to decide whether to go with the jr. or the full strength adult. This year, we decided to go with the adult. As the doctor put it - he'll be carrying it around for about a year, and he's not going to shrink over that time. :lol:

********

Another thing we discussed is the fact that the adult epi-pen is the same dosage whether you weigh 50 lbs. or 225 lbs.


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 Post subject:
PostPosted: Wed Sep 14, 2005 2:48 pm 
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Joined: Fri Apr 15, 2005 10:29 pm
Posts: 76
Location: Markham, Ontario
I Googled "Epinephrine dosage" and came up with this:

Quote:
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/95vol21/dr2122ea.html

Promptly administer 0.01 mL/kg (maximum 0.5 mL) of aqueous epinephrine 1:1,000 by subcutaneous or intramuscular injection in the opposite limb to that in which the immunization was given.


Going by that, I feel confident that my daughter should still be using the Jr. (0.136 mg based on her weight).


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 Post subject:
PostPosted: Fri Sep 16, 2005 12:09 pm 
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Joined: Sat May 07, 2005 8:35 pm
Posts: 64
My daughter is 37 lbs, and we just renewed our scrips for the epipen and got the adult ones. The cases are SO much better than for the kids, though maybe since last year they were all switched over? The cases now are very hard plastic, with a yellow twist top as opposed to the flimsy breakable children's pen with the metal black top. One thing that irked me though is the new pens come in a box, and the box has the expiry date on it, but I can't find the expiry date anywhere on the pen case itself. I don't have plans of carrying that bulky box with me everywhere I go, so its necessary to mark on the calendar when the pens expire.


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 Post subject:
PostPosted: Fri Sep 16, 2005 10:51 pm 
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Joined: Tue Mar 22, 2005 1:25 pm
Posts: 323
The expiry date is on the actual pen... at least on mine.


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 Post subject:
PostPosted: Mon Sep 19, 2005 1:36 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
The expiry date is also written on my pen (new container).

Those containers are new for both the adult and jr strength epi-pens. Colour coded too. One is yellow, the other is green.


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 Post subject:
PostPosted: Tue Sep 20, 2005 2:24 pm 
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Joined: Sat May 07, 2005 8:35 pm
Posts: 64
Okay, guess I just have to open my eyes lol. :lol:


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 Post subject:
PostPosted: Wed Oct 05, 2005 10:27 pm 
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Joined: Sat Apr 16, 2005 12:09 am
Posts: 1054
Was at the allergist today and spoke to him re dosing of epinephrine for my son -- he said that regardless of what it states on the Epipen Jr. itself - common practice (as per Sick Kids Hospital) is that a child is to receive the Epipen Jr. (0.15 mg) until they are at least 25 kg (50 lbs). I found this same recommendation on the Anaphylaxis Canada website:
Quote:
When does my child switch from Epipen Jr.® to a regular Epipen®?
Dosage should be worked out with your physician, but the current general recommendation is that children begin to use the adult Epipen® when their weight approaches 25 kg (55 lbs.) -- see http://www.anaphylaxis.org/content/what ... rine.asp#9 for more EPINEPHRINE FAQ'S.

This is definitely a grey area and I think the key here is "dosage should be worked out with your physician" based on your child's needs / situation.


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