Epinephrine Concentrations in EpiPens After the Expiration Date
Authors: David Stepensky, Pavel Gorenbein
Journal: Annals of Internal Medicine (2018)

Letters2 January 2018Epinephrine Concentrations in EpiPens After the Expiration DateDavid Stepensky, PhD and Pavel Gorenbein, MScDavid Stepensky, PhDBen-Gurion University of the Negev, Beer-Sheva, Israel (D.S.)Search for more papers by this author and Pavel Gorenbein, MScIsraeli Defense Forces, Rishon LeZion, Israel (P.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0494 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Cantrell and colleagues (1) conclude that expired EpiPen autoinjectors retain substantial amounts of epinephrine (>80%) and would still provide beneficial pharmacologic responses 50 months after their expiration date. The data in this report (and in its references 2 and 3) unfortunately may not correctly reflect the key quality parameters of expired EpiPens.First, the reported epinephrine content reflects the sum of its pharmacologically active and inactive forms (the l- and d-epinephrine isomers, respectively) at unknown ratios. The l-epinephrine isomer that is used to manufacture EpiPens undergoes racemization to d-epinephrine, which may make up approximately 5% of the ...References1. Cantrell FL, Cantrell P, Wen A, Gerona R. Epinephrine concentrations in EpiPens after the expiration date. Ann Intern Med. 2017;166:918-9. [PMID: 28492859]. doi:10.7326/L16-0612 LinkGoogle Scholar2. Simons FE, Gu X, Simons KJ. Outdated EpiPen and EpiPen Jr autoinjectors: past their prime? J Allergy Clin Immunol. 2000;105:1025-30. [PMID: 10808186] CrossrefMedlineGoogle Scholar3. Rachid O, Simons FE, Wein MB, Rawas-Qalaji M, Simons KJ. Epinephrine doses contained in outdated epinephrine auto-injectors collected in a Florida allergy practice [Letter]. Ann Allergy Asthma Immunol. 2015;114:354-6. [PMID: 25707326] doi:10.1016/j.anai.2015.01.015 CrossrefMedlineGoogle Scholar4. Stepensky D, Chorny M, Dabour Z, Schumacher I. Long-term stability study of L-adrenaline injections: kinetics of sulfonation and racemization pathways of drug degradation. J Pharm Sci. 2004;93:969-80. [PMID: 14999733] CrossrefMedlineGoogle Scholar5. U.S. Pharmacopeia. Particulate matter in injections. 2017. Accessed at www.pharmacopeia.cn/v29240/usp29nf24s0_c788.html on 24 November 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: Ben-Gurion University of the Negev, Beer-Sheva, Israel (D.S.)Israeli Defense Forces, Rishon LeZion, Israel (P.G.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0494. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEpinephrine Concentrations in EpiPens After the Expiration Date F. Lee Cantrell , Patricia Cantrell , Anita Wen , and Roy Gerona Epinephrine Concentrations in EpiPens After the Expiration Date Carolyn L. Taylor and Thomas M. Ellington Epinephrine Concentrations in EpiPens After the Expiration Date F. Lee Cantrell Metrics 2 January 2018Volume 168, Issue 1Page: 81-82KeywordsDrug safetyDrugsEpinephrineEpipensParticulatesResearch designSafetySodiumTemperatureToxicity ePublished: 2 January 2018 Issue Published: 2 January 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...