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EpiPen vs Auvi-Q: A Comprehensive Analysis of Epinephrine Auto-Injectors

Written by Andrew Le, MD

UpdatedFebruary 22, 2024

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. It has been estimated to be fatal in 0.7% to 2% of cases. Given the potential danger, immediate treatment with epinephrine is recommended as the first line of defense.

When it comes to epinephrine auto-injectors, two leading options are the EpiPen and Auvi-Q. But how do they compare for treating anaphylaxis episodes?

In this article, we’ll compare the two injectors side-by-side, examining their design, ease of use, effectiveness, dosage, side effects, patient preferences, and cost. With information on both injectors, you’ll be better equipped to understand the options for anaphylaxis treatment.

🔑 Key Takeaways

  • The EpiPen and Auvi-Q are designed as compact auto-injectors for portability and ease of use in anaphylaxis emergencies. The EpiPen uses color-coding and straightforward instructions, while the Auvi-Q adds voice guidance.
  • Both devices are made to quickly and effectively deliver epinephrine during severe allergic reactions. They have similar administration steps of removing safety guards, placing them against the thigh, and pressing firmly to inject.
  • The EpiPen and Auvi-Q should only be used during anaphylactic episodesinvolvingdifficulty breathing, swelling, wheezing, and rapid heartbeat. They are not substitutes for emergency medical care.
  • Dosages differ based on patient weight. The EpiPen has 0.3 mg and 0.15 mg doses. The Auvi-Q has 0.3 mg, 0.15 mg, and 0.1 mg doses. Proper intramuscular injection technique is critical.
  • Side effects are similar and include fast heart rate, paleness, sweating, dizziness, nausea, and breathing issues. Seek medical care if injection site reactions occur.
  • Studies show Auvi-Q users have higher confidence and preference compared to EpiPen. Auvi-Q was favored for instructions, size, shape, and usability.
  • Both brands are costly without insurance. EpiPen has an authorized generic alternative. Auvi-Q offers copay and discount programs to increase affordability.

1. Design and Shape

When it comes to the design and form factor of epinephrine auto-injectors, several key factors influence usability and accessibility in emergency situations. While the EpiPen and Auvi-Q share compact sizes for portability, they differ in elements like visual cues, voice guidance, and safety features.

EpiPen

The EpiPen is designed as a compact auto-injector, emphasizing ease of use and portability. The device is housed in a clear carrier, allowing quick visibility of its contents. When flipped open, the yellow cap reveals the tube containing the auto-injector. The color-coded design (blue safety release and orange tip) aids users step-by-step, simplifying the administration procedure.

The shape is convenient for carrying in a pocket or bag, enhancing accessibility during emergencies. The straightforward design ensures that users can swiftly and efficiently administer epinephrine. The visual and verbal step-by-step instructions contribute to the user-friendly design, making it accessible for individuals in high-stress situations.

Auvi-Q

The Auvi-Q distinguishes itself with an innovative design that includes voice instructions. This adds an extra layer of guidance, especially beneficial in emergencies. The compact size of the Auvi-Q, akin to the EpiPen, makes it easily portable. The outer case ensures protection and quick retrieval.

Upon removal from the outer case, the Auvi-Q immediately provides voice instructions, adding an auditory element to the step-by-step process. The red safety guard, once removed, reveals the injection end, ensuring a visual cue for users. The black base, where the injection occurs, is designed to be placed against the middle of the outer thigh, streamlining the administration process.

The retractable needle feature in Auvi-Q enhances safety after injection, eliminating the risk of needle exposure post-administration. The overall design emphasizes simplicity, guided by voice instructions and color-coded elements, promoting ease of use.

2. Speed and Effectiveness

When facing life-threatening anaphylactic reactions, the speed and effectiveness of epinephrine auto-injectors can make all the difference. Here we examine how the EpiPen and Auvi-Q are engineered to rapidly deliver epinephrine during emergencies.

EpiPen

The EpiPen is designed for swift and efficient epinephrine delivery during an anaphylactic reaction. Its auto-injector mechanism allows for quick administration, which is crucial in emergencies where time is of the essence.

The three-step process, from preparation to injection, is structured for ease of use, ensuring that even individuals without medical training can swiftly and effectively deliver the medication.

The rapid deployment of epinephrine into the muscle aims to promptly halt severe allergic reaction symptoms. This speed of action is vital in stabilizing the individual until emergency medical help arrives.

Auvi-Q

Similar to the EpiPen, the Auvi-Q is designed to provide a rapid and effective response to anaphylactic reactions. Its compact and pre-assembled form allows for quick accessibility, and the auto-injector is equipped with a voice instruction system for added clarity in high-stress situations.

The process involves pulling off the safety guard, placing the device against the thigh, and pressing firmly to administer the medication. The automatic needle retraction feature increases efficiency, minimizing the risk of accidental injuries post-injection.

Auvi-Q's emphasis on simplicity and speed aims to ensure that individuals can promptly and effectively address severe allergic reactions, contributing to the overall effectiveness of the treatment.

👍 Recommendation

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3. When and How to Use

Knowing when and how to properly deploy epinephrine injectors during an emergency is critical. Here we outline the recommended uses and administration steps for both EpiPen and Auvi-Q.

EpiPen

The EpiPen is essential when severe allergic reactions manifest. The common symptoms of Anaphylaxis include:

Only those prescribed the EpiPen should use it, and it does not substitute for appropriate medical evaluation and treatment. Antihistamines are not a substitute for anaphylaxis treatment, as they lack the speed and effectiveness to address the symptoms.

When encountering the symptoms mentioned, the EpiPen becomes crucial. To use it on yourself, follow these steps:

  • Prepare: Remove the EpiPen from its carrier, open the yellow cap, and slide the device out. Hold it with the orange tip pointing down. Remove the blue safety release.
  • Administer: Place the orange tip on your thigh, aiming for the middle. Swing the pen back, push firmly against the thigh until it clicks, and hold for 3 seconds. Remove from the thigh, and massage the injection site.
  • Get Emergency Help: Even after using the EpiPen, call 911 or emergency services. If symptoms persist, a second dose may be needed.

For children, the process is similar but with some differences:

  • Prepare: Use the EpiPen Jr. Remove it from the carrier, open the green cap, and slide it out. Hold with the orange tip down, remove the blue safety release.
  • Administer: Hold the child's leg firmly, place the orange tip on the thigh, swing back, push against the thigh until it clicks, and hold for 3 seconds. Remove and massage the site.
  • Emergency Help: Call 911 or take the child to the emergency room.

Auvi-Q

Auvi-Q is deployed when encountering severe allergic reactions, similar to EpiPen. Anaphylaxis symptoms necessitate its use—swift action is crucial. Here's how to use it:

  • Give the Injection: Remove Auvi-Q from the outer case. Pull off the red safety guard firmly. Place the black end on the middle of the outer thigh and press firmly, holding for 2 seconds. Auvi-Q clicks, hisses, and confirms usage through voice instructions.
  • After Use: Call 911 immediately, seek medical attention, and take the used auto-injector to the hospital. Check the expiration date and replace before it expires.

After use, seek medical attention promptly, as the effects of epinephrine may diminish in 10-20 minutes. Remember, Auvi-Q is not a substitute for emergency medical care, and 911 should be called after use.

4. Dosage

When it comes to epinephrine auto-injectors, administering the proper dosage based on body weight is imperative. We take a look at the dosage options for EpiPen and Auvi-Q.

EpiPen

The EpiPen comes in two dosage strengths:

  1. EpiPen 0.3 mg: This is intended for patients weighing greater than or equal to 30 kg, which is approximately 66 pounds or more.
  2. EpiPen Jr 0.15 mg: This dosage is designed for patients weighing between 15 kg to 30 kg, approximately 33 pounds to 66 pounds.

It's crucial to inject the EpiPen or EpiPen Jr intramuscularly or subcutaneously into the thigh, avoiding injection into other areas like the buttocks, digits, hands, or feet.

Each EpiPen or EpiPen Jr contains a single dose of epinephrine for single use. Alternative forms of injectable epinephrine should be considered if doses lower than 0.15 mg are needed. In cases of severe persistent anaphylaxis, additional injections may be necessary, but more than two sequential doses should only be administered under direct medical supervision.

The EpiPen solution in the clear window of the Auto-Injector should be visually inspected for particulate matter and discoloration. After use, the remaining epinephrine solution (approximately 1.7 mL) in the Auto-Injector should be discarded.

Auvi-Q

Auvi-Q also offers three dosage strengths based on patient body weight:

  1. AUVI-Q 0.3 mg: This is recommended for patients weighing over or equal to 30 kg, or approximately 66 pounds or more.
  2. AUVI-Q 0.15 mg: Intended for patients weighing between 15 kg to 30 kg, approximately 33 pounds to 66 pounds.
  3. AUVI-Q 0.1 mg: This lower dosage is designed for patients weighing 7.5 kg to 15 kg, or 16.5 to 33 pounds.

Similar to EpiPen, AUVI-Q should be injected intramuscularly or subcutaneously into the thigh. The prescriber should carefully assess each patient to determine the most appropriate dose of epinephrine.

It's emphasized that since the doses of epinephrine delivered from AUVI-Q are fixed, other forms of injectable epinephrine should be considered if doses lower than 0.1 mg are necessary.

In cases of severe persistent anaphylaxis, repeat injections with an additional AUVI-Q may be necessary, but more than two sequential doses should only be administered under direct medical supervision.

5. Side Effects

While epinephrine auto-injectors can be lifesaving, it's important to be aware of potential side effects. Below, some of thecommon side effects associated with EpiPen and Auvi-Q are outlined.

EpiPen

Common side effects include:

  • Breathing problems
  • Fast or irregular heartbeats
  • Pale skin
  • Sweating
  • Nausea
  • Vomiting
  • Dizziness
  • Weakness or tremors
  • Headache
  • Restless or anxious feeling

It's crucial to note that side effects may be more pronounced in older adults. Additionally, if you observe any signs of infection around the injection site, such as pain, swelling, warmth, or redness, it's essential to contact your healthcare provider promptly.

Auvi-Q

Common side effects associated with Auvi-Q include:

  • Breathing difficulties
  • Fast or irregular heartbeats
  • Pale skin
  • Sweating
  • Nausea
  • Vomiting
  • Dizziness
  • Weakness or tremors
  • Headache
  • Restless or anxious feeling

Older adults may be more susceptible to these side effects. If you notice any signs of infection around the injection site, such as pain, swelling, warmth, or redness, you must inform your healthcare provider promptly.

📒 Doctor’s Note

Always consult a healthcare professional for personalized advice and guidance on the correct usage and dosage of epinephrine auto-injectors.

6. Users’ Preference


In a study comparing Auvi-Q and EpiPen users, significant trends emerged. Auvi-Q users were almost twice as likely to carry their device consistently in the last seven days.

Adults prescribed Auvi-Q expressed over double the confidence in using the device compared to their EpiPen counterparts.

Notably, there were no substantial differences in confidence levels among parent/guardian respondents. Auvi-Q users were three times more likely to find device instructions "very clear" than EpiPen users. Overall, Auvi-Q demonstrated higher carrying compliance, user confidence and perceived clarity of instructions.

In a multicenter simulated-use study assessing preferences for Auvi-Q or EpiPen, a consistent preference for Auvi-Q emerged across various age groups (adults, caregivers, and children).

This preference extended to key aspects, including method of instruction, preference to carry, device size, and device shape. Importantly, this preference held for both experienced and inexperienced users. The study showed that Auvi-Q's design and usability are universally preferred.

A usability study on Auvi-Q and EpiPen Jr highlighted significant differences in user preference and successful administration. Auvi-Q users demonstrated a significantly higher completion rate of all injection tasks per device instructions (85.4% vs. 19.8%).

Additionally, Auvi-Q users outperformed in completing key injection tasks (94.8% vs. 72.9%). Importantly, no digital/hand injection errors were observed with Auvi-Q, unlike EpiPen Jr where 14.6% of users could have experienced injection errors.

Participants overwhelmingly preferred Auvi-Q (91.7% vs. 6.3%). This study underscores Auvi-Q's superior usability and user preference, highlighting the critical role of device design in emergency scenarios.

Overall, these studies consistently favor Auvi-Q over EpiPen. Auvi-Q users exhibited higher carrying compliance, greater confidence in usage, and a universal preference across diverse user groups.

7. Cost and Accessibility

The costs and accessibility of epinephrine auto-injectors are key considerations. Let’s examine the pricing and affordability programs offered by EpiPen and Auvi-Q.

EpiPen

The EpiPen comes at a considerable cost without insurance. A standard package, containing two auto-injectors, is priced between $650 to $700. However, there are more affordable options in generic versions, with the authorized generic being priced at around $200 for a two-pack. Teva Pharmaceuticals also offers a generic alternative.

For those with insurance coverage, it's crucial to check with the provider to explore potential coverage for generic epinephrine auto-injectors, which can significantly lower costs.

Auvi-Q

Auvi-Q, also comes with a comparable cost. A two-pack of Auvi-Q injectable kits is priced at approximately $664.38. The manufacturer offers support programs to enhance affordability. The Support Copay Program enables commercially insured patients to pay as little as $35 per carton.

For uninsured individuals, the Home Delivery Program provides a reduced price of $289 per carton. Additionally, alternative pharmacies may offer discounts, with GoodRx reducing the cost at Walmart to $289.00, reflecting a 71% savings.

📔 Note

The choice between EpiPen and Auvi-Q depends on individual circumstances. Both brands provide copay programs for those with insurance coverage, potentially resulting in low out-of-pocket expenses.

The generic EpiPen is a more affordable option for those without insurance or individuals prioritizing cost savings.

Auvi-Q, with its Home Delivery Program and GoodRx discounts, offers competitive pricing and flexibility, catering to a diverse range of preferences and needs. Individuals need to weigh these factors carefully when deciding based on their unique situation.

Wrap Up

The EpiPen and Auvi-Q are both effective epinephrine auto-injectors for treating anaphylaxis emergencies. While they share similarities in their compact design and quick action, studies show Auvi-Q users have higher confidence and preference.

Key factors like voice guidance, dosage flexibility, and affordability programs give Auvi-Q advantages. However, the EpiPen offers a more affordable generic option. Ultimately, the choice depends on individual priorities regarding cost, features, and accessibility. Both injectors can be lifesaving when used properly for severe allergic reactions.

FAQs on EpiPen and Auvi-Q

Why is EpiPen so expensive?

The high cost of EpiPen was primarily due to Mylan's monopoly, allowing them to increase prices. Following public outcry, Mylan introduced a generic version priced at $300. Additionally, there are now four other epinephrine manufacturers on the market: Kal'o, Impax Lab, Sandoz, and Teva Pharmaceuticals.

What happens if you accidentally inject epinephrine?

Accidental injection symptoms are typically not severe and may include temporary numbness or tingling, pain and swelling at the injection site, and an elevated heart rate and/or palpitations.

Can I buy an EpiPen over the counter?

In the US, you cannot buy EpiPen without a prescription from your doctor. Some schools may stock the product for emergency use, but its administration would still be under the direction of a healthcare provider.