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Epinephrine Autoinjectors: Differences in Administration
The three brands of auto-injectors are currently available in the United States: EpiPen (Dey Pharma),
Twinject (Shionogi Pharma), and Adrenaclick (Shionogi Pharma). In addition, a generic epinephrine
autoinjector (without a specific name) is being distributed by Greenstone (a generic division of Pfizer).
According to Greenstone's website, the injector is identical to Adrenaclick. Shionogi has authorized
Greenstone to distribute the same device as an unbranded or "generic" item. The following highlights the
differences between the products.

All products use the same drug (epinephrine) to treat anaphylaxis caused by allergic reactions to
foods, insect stings, or other allergens.

All offer two dosages: 0.15 mg and 0.30 mg. and are available as single (1 dose) and dual packs
(2 doses)

Twinject contains two doses in a single pen-shaped injector. However, only the first dose is
administered automatically through the pen. For the second dose, remove a syringe from the
container, stick the needle into thigh, and press the plunger to administer the pre-measured dose

EpiPen and Twinject dual packs are packaged with autoinjector training devices

Physicians and pharmacists can request training devices for Adrenaclick (which can also be used
for the Greenstone generic product) by calling 1-888-894-6528

Greenstone generic product is less expensive (~$15 less than EpiPen or Adrenaclick) and may be
a cost effective alternative especially for members enrolled in a high deductible plan or plan with
other coverage limitations.

EpiPen has instructions that are different than Adrenaclick, Twinject, and the "generic" automatic
epinephrine injector. Currently, no generic autoinjectors employ the same administration
technique as EpiPen.
Cost and Administration Differences
Autoinjectors AWP*
Administration Instructions+
Twinject
$96.36
Press the injector against the outer thigh
EpiPen
$74.58
Swing and firmly push injector against outer thigh
Adrenaclick
$73.15
Press the injector against the outer thigh
Greenstone
$67.05
Press the injector against the outer thigh
*Average wholesale price for 0.3mg dual pack
+see accompanying illustrations for more explanation
With multiple auto-injectors now on the market, it is important to recognize the differences between these
products, most notably the instructions for administration, and convey them to your patients. You may
have trained your patient for the administration of one type of injector, and the pharmacy may provide
another type on which the patient has not been trained. It should, however, be noted that equivalency
ratings have not yet been established for these products therefore, currently all products are covered tier 2.
During the stress of an anaphylactic reaction, this may be confusing to a patient and could result in the
delay or perhaps an error in the administration of the drug. Patient education can help ensure proper
administration and treatment.
You can view each type of injector and the instructions for its administration at each of the respective
websites:
Twinject: http://www.twinject.com/
Adrenaclick: http://www.adrenaclick.com/about-adrenaclick/adrenaclick-training.aspx
Greenstone “generic”: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16934
EpiPen: http://www.epipen.com/page/how-to-use-epipen-auto-injector-index
EPINIPHERINE AUTOINJECTORS
INSTRUCTIONS FOR ADMINISTRATION
Adrenaclick / Twinject / Greenstone “generic”
EpiPen