The Anaphylaxis Campaign has recently experienced an increase in the number of people contacting our national helpline about the availability of adrenaline auto-injectors (AAIs) in the UK. We recognise that many people are experiencing issues when requesting repeat prescriptions for AAIs and that this can be both frustrating and worrying. We would like to thank you, our supporters, for raising to our attention issues you are experiencing in your local areas, as hearing about your experiences equips us to have informed conversations with the pharmaceutical companies that distribute AAIs in the UK.
We have contacted Bausch + Lomb UK who distribute Emerade®, Mylan UK who distribute EpiPen® and ALK-Abelló who distribute Jext® for an update on the availability of their AAI devices in the UK. As formal statements can sometimes take time to be approved, we summarise below the context of our understanding from the conversations we have had with each supplier. We also have advice about some frequently asked questions to our helpline about what to do if you are worried about your prescription.
If you are prescribed AAIs, to be well equipped during this time, we advise you to
- Check the expiry date on your medication regularly
- If needed, get a repeat prescription from your GP well in advance
- Do not dispose of any ‘expired’ AAI devices before you have a new AAI prescription
- Print out a copy of this statement to bring with you to your pharmacy and ask your pharmacist to contact their suppliers directly if they are experiencing supply issues
- If necessary, revisit your GP to ask if they can prescribe an alternative medication
- If you are prescribed an alternative AAI device, ensure that you know how to use it and train others that may need to use it in an emergency
Do continue to always carry your AAIs with you and follow your usual risk management techniques to avoid your allergen and reduce the likelihood that you will experience a severe allergic reaction and need to use your adrenaline.
Availability of adrenaline auto-injectors in the UK
Availability of Emerade®
Bausch + Lomb provided us with the following information on 20th July 2018:
Bausch + Lomb is committed to helping ensure that patients have access to the medicines they need and will do all that we can to meet the current increased demand.
Emerade® is available in three doses; 150, 300 and 500 micrograms (adrenaline tartrate). Emerade 500 micrograms solution for injection (adrenaline tartrate) can be considered for adults in the UK for over 60kg bodyweight depending on clinical judgement.
Our understanding is that in some areas of the UK availability of Emerade® is restricted, however a significant replenishment of stock delivery is expected next week commencing 23rd July 2018.
You can reach Bausch + Lomb UK customer services via +44 (0)208 781 2920.
Availability of EpiPen®
EpiPen® is prescribed in two doses. EpiPen® 0.3mg, also known as ‘Senior’, is generally prescribed for adults and children above 25kg in body weight. EpiPen Jr® 0.15mg or ‘Junior’ is generally prescribed for children between 7.5kg and 25kg body weight.
Our understanding is that due to manufacturing delays from Mylan UK’s contract manufacturer, Meridian Medical Technologies, a Pfizer company, there are intermittent supply constraints with EpiPen® 0.3mg in the UK and Pfizer cannot commit to a specific time for when the supply constraint will be fully resolved. They continue to maintain a stock management process for the distribution of EpiPen® 0.3mg Adrenaline Auto-Injectors. Pharmacies are allocated product on a prescription-only basis and can place orders for up to a maximum of two EpiPen® 0.3mg per prescription. In mid-June Mylan UK secured a limited volume of EpiPen® 0.3mg Adrenaline Auto-Injectors with an expiry date of October 2018 which is still available for pharmacies to order. The product meets all required quality standards and remains valid through the last day of the month (31st October 2018). There are currently sufficient supplies of EpiPen Jr® 0.15mg across the UK.
You can reach Mylan UK customer services via +44 (0)1707 853 100.
Availability of Jext®
Jext® is prescribed in two doses. Adults and children over 30kg are generally prescribed 300mcg. Children between 15kg and 30kg are generally prescribed 150mcg.
ALK-Abelló provided us with the following statement on 19th July 2018:
ALK is the manufacturer of Jext® and over the last few months our product supply team has come under increasing pressure due to the inability of our competitor to secure consistent supply of product across the whole of the EU. As a result, we have increased production at our European manufacturing site to try and reduce the risk to patient safety.
In the UK we currently have stock of both our 150mcg and 300mcg pens but this situation remains fluid and is affected significantly by availability of other devices. With this in mind I would anticipate that sometime in July ALK will be out of stock of Jext 300mcg.
Our next deliveries will arrive in the UK next week followed by an increased level of stock for the rest of the year.
ALK would urge patients to be mindful of the expiry date of their pens; check the clarity of the adrenaline through the window in the side of the pen and order new pens in a timely and appropriate manner through their local pharmacy. In this way we can all help ensure patient safety while we manage these global supply issues.
You can reach ALK-Abelló customer services via 0118 903 7940.
Frequently Asked Questions
What is anaphylaxis?
Anaphylaxis (pronounced ana-fill-ax-is) is a severe and life-threatening allergic reaction that can be fatal. Severe symptoms such as a swollen tongue, difficulty breathing or becoming unconscious usually develop suddenly, often within minutes after being exposed to an allergy trigger such as a particular food, insect stings or certain drugs. There’s no cure for anaphylaxis, so people at risk have two options: manage their condition and carry adrenaline, a potentially lifesaving emergency medication. You can find out more about anaphylaxis in our anaphylaxis factsheet: www.anaphylaxis.org.uk/our-factsheets.
What is an Adrenaline Auto-Injector?
Adrenaline is the first line treatment for severe allergic reactions (anaphylaxis) and is available on prescription in a pre-loaded injection device known as an Adrenaline Auto-Injector or AAI for self-use in an emergency. The AAIs prescribed in the UK at present are Emerade®, EpiPen® and Jext®. You can find out more about adrenaline in our adrenaline factsheet: www.anaphylaxis.org.uk/our-factsheets.
How do I check the expiry date on my AAIs?
As some of the additional stock available in the UK at present has an expiry date of October 2018, we are advising patients to check the expiry date on their Adrenaline Auto-Injectors when they receive them and not to dispose of any ‘expired’ AAI devices before they have obtained a new device.
Your AAI devices will have instructions for use printed on the outside and generally will have a shelf life of up to 18 months. The expiry date will be printed on the casing. Each of the three companies who distribute AAIs run an expiry alert service. If you register your device and expiry date with them, they will send you a reminder when it is due to expire.
Whichever devices you have been prescribed, it is important that you keep your AAIs in their original containers to prevent light exposure, do not store them above 25°C and do not freeze them. If the liquid in your AAI appears cloudy or discoloured, it should be replaced with a new device. If the liquid in the device is not cloudy or discoloured, the AAI device can still be used in an emergency.
What should I do if I have concerns about my prescription during a supply issue?
If you are worried about your prescription, we advise you to visit your GP and discuss this directly with them. If necessary, your GP can prescribe an alternative medication.
What should my pharmacist do if they are experiencing issues?
Your pharmacist should contact the supplier of your AAI through their distribution partner e.g. Alliance Healthcare, or their customer service department directly for updates regarding any issues they experience.
I have been prescribed a new brand of AAI, what should I do?
We believe your GP or pharmacist should make sure you know how to use your new brand of AAI. You should also train anyone who might be required to administer it in an emergency, such as family members and friends. You can order a trainer pen to practice with and find further help on the website relevant to the medication you carry.
- An Emerade® trainer can be ordered from the Emerade® website: www.emerade-bausch.co.uk.
- An EpiPen® trainer can be ordered from the EpiPen® website: www.epipen.co.uk.
- A Jext® trainer can be ordered on the Jext website: www.jext.co.uk.
Can I get help with my prescription costs?
If you require support with prescription costs, prescription prepayment certificates (PPC) are available or you may be able to get help through the NHS Low Income Scheme (LIS). Find out more on the NHS Business Services Authority website here: https://www.nhsbsa.nhs.uk/nhs-help-health-costs.
I have a different question, can you help?
You can contact our helpline and information team at email@example.com or call 01252 542 029 for support between Monday-Friday, 9am-5pm.