Epi-pen or Epi-pen jr. for your child?

Posted on: Wed, 06/11/2003 - 3:50am
Tamie's picture
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Joined: 09/23/2002 - 09:00

My dd will be 7 in the fall and weighs about 64 pounds, her allergist just changed her epi-pen jr. to the regular one after I had asked about the weight on it? Is this correct? It just makes me a little nervous since this is the same dose as my dh. Thanks
Tamie

Posted on: Wed, 06/11/2003 - 4:12am
anonymous's picture
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Joined: 05/28/2009 - 16:42

My DD was switched to adult dose from the epi-jr at 2 1/2 years old - go figure!
Her weight (35lbs at the time)justified it in the mind of her ped. allergist. He is of the philosophy that it is better to receive a slightly larger dose (which will not over dose you) than too small a dose requiring repeated injections for her serious reactions.
I wasn't comfortable, so during our next appointment (a few months later, I pointed out the exact weight stuff on the boxes of the epi & epi-jr to him, and I asked him if I was carrying the wrong dose for her weight, as I felt she had been switched much too soon to the adult dose. He stated he wanted her definitely on the adult dose and confirmed that some ped. allergists switch doses right at the recommended weight requirements on the carton, and some use the "40lbs" rule - he increases to adult dose at 35lbs, and now that she's 40lbs now at 3 1/2 years old, I'm more comfortable carrying the adult doses (still have two at all times)for her reactions.
Hope this gives you alittle piece of mind that it isn't a bad thing to have an adult dose prescribed for a child. Warm regards, [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Wed, 06/11/2003 - 6:17am
tgab's picture
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Joined: 06/24/2000 - 09:00

Our allergist also switched dd to the adult dose a while back. I think she was 4, and probably around 40 pounds. He would rather her have a little too much than not enough.

Posted on: Fri, 06/13/2003 - 1:09am
Tamie's picture
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Joined: 09/23/2002 - 09:00

Thank you, I feel better now! I also talked to the pharmacist and she said it was fine also. I trust our pharmacist more than any of our doctors!
tamie

Posted on: Fri, 06/13/2003 - 7:13am
Lidia's picture
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Joined: 04/25/1999 - 09:00

As I recall the epi insert suggests 30 KG not Pounds as the limit for the epi jr. That is approximately equivalent to 65 pounds. I would check that with your allergist/Pediatrician before administering. My son weighs close to 60 pounds and he still has a epi jr. I have specifically asked this question. I fear that a doctor would stand by his decision just not to show he made a mistake when not realizing the weight recommendation was in kg.

Posted on: Sun, 06/15/2003 - 8:27pm
nancy023's picture
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Joined: 12/12/2002 - 09:00

At a conference I attended a few years ago this was discussed. Dr. Wood said to change to epi at 40 lbs. to err on the side of stopping the reaction. The Dey representative said to stick to the written recommendations in the package. I think it's a matter of opinion and a little controversy.

Posted on: Sun, 06/15/2003 - 9:13pm
MeCash's picture
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Joined: 04/18/2001 - 09:00

My son was 5 and about 60lbs when he was dx'd PA. He was prescribed a regular EpiPen. He is now 7 and 95lbs. (He's also really tall). My 2 year old daughter is only about 28lbs, so on EpiPen Jr.
~Melanie

Posted on: Sun, 06/15/2003 - 11:15pm
Sandra Y's picture
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Joined: 08/22/2000 - 09:00

My son just switched to the adult Epi at his last dr. visit. He is 7 yrs and weighs 42 lbs.

Posted on: Mon, 06/16/2003 - 6:26am
California Mom's picture
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Joined: 07/14/2000 - 09:00

Now I'm really ticked off. I just asked our advice nurse (at the allergist's office) and she said the switch happens at 88 pounds! MY dd is about 60 pounds now and I was thinking it might be time to switch to the regular. 88 pounds just didn't sound right, but I hadn't bothered to check the reccomendation on the package. Miriam

Posted on: Mon, 06/16/2003 - 12:41pm
Renee111064's picture
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Joined: 07/05/2001 - 09:00

Our Allergist stated 65 to 70 lbs to go to the adult dosage of epi.
best wishes,
Renee [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

Posted on: Mon, 06/16/2003 - 8:36pm
anonymous's picture
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Joined: 05/28/2009 - 16:42

Our allergist made the switch at 45 pounds. He said it's better to have too much, than too little.

Posted on: Mon, 06/16/2003 - 10:52pm
StaceyK's picture
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Joined: 05/06/2003 - 09:00

.
[This message has been edited by StaceyK (edited October 21, 2004).]

Posted on: Tue, 06/17/2003 - 1:24pm
Yonit's picture
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Joined: 06/24/2002 - 09:00

Our allergist also suggested that we switch to the adult epi this summer, when our jrs. expire. My son is 5 years old and weighs only 40 pounds. We Haven't filled the new scrip yet, and I'm a bit concerned about the adult dose. The allergist feels he could need that dose, based on his skin test and rast scores, and his contact sensitivity (he's never ingested peanut). Has anybody here ever actually used an adult epi dose on a child under 65 pounds?

Posted on: Tue, 06/17/2003 - 4:07pm
cynde's picture
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Joined: 12/10/2002 - 09:00

Yonit, I have unfortunately had to use the adult epi on our DS three times over the last year and a half, he is 8 1/2 years old now, and just under 60 pounds. So the first time I used it, he was just under 7 years old and not even 50 pounds. He has had no adverse reaction to the dosage. I would rather he had to much epinepherine than not enough. For his second reaction, I thought I was going to have to inject him a second time, and actually got the epi ready. He is so skinny, I have to grab a chunk of his thigh muscle to get enough to inject into.
Anyone with concerns should probably discuss them with a trusted pharmacist. They are the experts when it comes to drugs.

Posted on: Tue, 06/17/2003 - 9:48pm
Kim M's picture
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Joined: 06/09/2001 - 09:00

This question has come up a couple times here, and unfortunately doctors don't seem to agree, which makes it difficult for us. It's true that the adult Epipen says that its dosage is for someone in the 60 pound range. But the Epi Jr. range doesn't go up to 60 lbs; I think it works out to around 30 (I did the calculations a couple years ago, but don't have the Epi Jr insert to confirm the numbers now.) So the problem is that there is a gap. I think a lot of doctors play it safe and switch around 40 lbs, because the danger of being underdosed is greater than giving too much. We were switched when my daughter was around 40 lbs; never have had to use the pen, though.
Miriam, I would definitely get your daughter switched to an adult Epi. Don't know where the nurse got 88 lbs. It sounds like she (or someone) did the pound/kilogram conversion wrong.

Posted on: Tue, 06/17/2003 - 10:35pm
BS312's picture
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Joined: 09/05/2001 - 09:00

Dr. Hugh Sampson addresses this question in "Anaphylaxis and Emergency Treatment" in the supplement "Pediatric Food Allergy" in the journal Pediatrics for June, 2003. he states, "Most allergists will prescribe the EpiPen Jr for children who weigh from 10 kg to 20 kg (22 lb-44 lb) and the EpiPen for children greater than or equal to 28 kg (62 lb)....In children who weigh 21 kg to 28 kg, the use of the EpiPen or the EpiPen Jr will depend on the physician's judgment as to the risk of the patient's experiencing a severe anaphylactic reaction. Simons et al found that 5 of 5 children who weighed an average of 25.4 kg (56 lb) developed pallor, tremor, anxiety, and palpitations or other cardiovascular effects after using the 0.3 mg EpiPen, and several developed headache and nausea. In general, if a patient in this weight range has experienced a severe anaphylactic reaction previously and/or is at high risk for such a reaction,ie, history of asthma or allergic to peanut, tree nut, or seafood, then the 0.3 mg EpiPen is probably the appropriate choice. However, if the patient has never experienced a severe allergic reaction and is not in the higher risk group, then the physician may continue the 0.15 mg EpiPen Jr until the patient is greater than or equal to 28 kg (62 lb)."
I would suggest that anyone with concerns about their child's dose should have their pediatrician or allergist read this entire article, and then make a recommendation. We will ask Dr. Wood to switch DD to the EpiPen when she hits 40 lbs, as she had a near-fatal reaction to peanut butter.

Posted on: Wed, 06/18/2003 - 12:56am
Kim M's picture
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Joined: 06/09/2001 - 09:00

BS312, thanks. That is the best explanation of the issue that I have read.

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