All Emerade brand adrenaline auto-injectors (AAIs) have now been recalled from patients due to concerns that some devices required higher than normal force to activate. Initially in November 2019, the Emerade AAIs were recalled to pharmacy level only. However, results from manufacturer testing of devices recalled from patients in Europe indicated that approximately 13% needed higher than normal force to activate, implying a higher risk of activation failure than had been previously understood. In March, April and May 2020, three further alerts were issued for 150mcg, 300mcg and 500mcg AAIs respectively recalling the devices from patients.
Primary Care practitioners in the UK were notified of the recalls via the CAS alert system and following the patient level recalls were asked to identify and review patients holding Emerade AAIs.
When reviewing patients holding Emerade AAIs practitioners first need to look at whether the patient still needs AAIs. It is possible that some patients may have outgrown their allergy or may have been wrongly prescribed adrenaline in the first place (for example if they have a drug allergy, it is not necessary to carry adrenaline). If the patient does still need to carry AAIs, one of the other two brands that are available can be prescribed. These brands are Jext and EpiPen.
Practitioners also need to review the weight of the patient in order to prescribe the most appropriate dose. Jext and EpiPen are both available in a 150mcg/0.15mg dose and a 300mcg/0.3mg dose.
Some practitioners may have concerns about what to prescribe for patients who have previously been prescribed the Emerade 500mcg AAI. Prior to the recall, the Emerade 500mcg was often prescribed to patients over 60kg on the basis of a larger dose and longer needle length. However, recently published data has looked at the blood level of adrenaline when delivered by a 300mcg AAI that has a shorter needle length, but a higher propulsive force than an Emerade 500mcg, such as that of Jext and EpiPen. This research showed that even in larger individuals who may have much greater skin-to-muscle depth in the thigh, that this dose was sufficient and did in fact show a trend to superior adrenaline bioavailability in the time critical first 30 minutes.
This shows us, and allergy specialists have agreed, that there are absolutely no concerns with switching a patient who was previously on an Emerade 500mcg to a Jext or Epipen 300mcg/0.3mg device.
When prescribing a new brand of AAI, it is very important to make sure that the patient knows how to use it as there are differences in how each brand of AAI is operated. At the current time, when primary care may not be conducting face to face appointments the patient should be directed to the manufacturers’ websites where there are instructional videos showing them how to use their pen. Patients can also order trainer pens for free from the websites to practice using their device safely.
Further details about each Emerade alert here
For more information on who should be prescribed adrenaline and dosages, please go here
For links to AAI manufacturer websites, please go here
Ewan, P., Brathwaite, N., Leech, S., Luyt, D., Powell, R., Till, S., Nasser, S. and Clark, A., 2016. BSACI guideline: prescribing an adrenaline auto-injector. Clinical & Experimental Allergy, 46(10), pp.1258-1280.
Medicines.org.uk. 2020. Emerade, 500 Micrograms, Solution For Injection In Pre-Filled Pen – Summary Of Product Characteristics (Smpc) – (Emc). [online] Available at: <https://www.medicines.org.uk/emc/product/5279/smpc> [Accessed 17 June 2020].