Anaphylaxis: If The Only Auto-Injector Available Has Expired

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Have you ever wondered whether an expired epinephrine auto-injector is safe to use, in an emergency, if a newer one is unavailable?

Even when stored according to manufacturer recommendations ephinephrine gradually breaks down. Auto-injectors maintain their ideal potency for approximately one year after manufacture.

Question and Answer

Since auto-injectors are rarely used, and time flies, people sometimes forget to purchase an up-to-date auto-injector, or may have difficulty meeting the expense of a new one. It is not unusual, then, for people to have expired epinephrine in their possession.

Yet, what if the day comes when an auto-injector is needed to save a person's life, and the one available has expired?

Fifteen years ago, researchers at the University of Manitoba decided to find an answer to that question. They concluded that if “the only auto injector available is an outdated one, it could be used as long as no discoloration or precipitates are apparent because the potential benefit of using it is greater than...no epinephrine treatment at all.”

Specifically Speaking

The study showed that expired auto-injectors contained less epinephrine than up-to-date ones, but even units that were several years old contained a significant amount of epinephrine that could be administered for anaphylaxis if no other epinephrine source were available.

Specifically, auto-injectors that were five to seven years past their expiration date contained more than 70 percent of the original epinephrine dose. Would that be enough of the medication to save a child or adult experiencing anaphylaxis? That is impossible to say.

Still, it may help to know that in emergencies, according to one research study, the benefit of using expired, less-potent epinephrine was found to outweigh the risk of giving it—as long as the epinephrine has no discoloration or precipitates.

Precipitate Wisdom

The significance of “discoloration or precipitates” is not explained by the researchers, though it likely indicates a potentially dangerous degradation of the epinephrine. Unfortunately, it is questionable whether a person facing an emergency situation would notice subtle discoloration, tiny particles, or deposits in the epinephrine.

For this reason, and maybe others, not all doctors or allergists will agree with the researchers’ conclusions, and may advise against ever using expired epinephrine—but what if expired epinephrine is the only available option? Using it remains a judgment call that people hope they never have to make.

Wisdom and peace of mind, it seems, lies in finding a way to remind ourselves when it’s time to renew our auto-injector prescription.

Source: NCBI/PubMed ; Dr. Daniel More/About Allergies Photo credit: Greg Friese

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