References

1. EpiPen^® prescribing information. Morgantown, WV: Mylan Specialty LP; 2016.

2. Consumer Reports. How to get cheaper EpiPen alternative. https://www.consumerreports.org/drugs/how-to-get-cheaper-epipen-alternative/. Accessed October 20, 2016.

3. O’Shea, Timothy. “6 Surprising Pharmacy Laws.” Pharmacy Times, 1 July 2015. https://www.pharmacytimes.com/contributor/timothy-o-shea/2015/07/6-suprising-pharmacy-laws. Accessed March 23, 2018.

4. Lieberman P, Nicklas R, Randolph C, et al. Anaphylaxis a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115:341-384.

5. Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy Clin Immunol. 2006;117(2):391-397.

6. Epinephrine injection, USP auto-injector. Patient information leaflet. Bridgewater, NJ: Amneal Pharmaceuticals; 2021.

7. Wood RA, Camargo CA, Lieberman P et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. http://www.aafa.org/media/Anaphylaxis-in-America-JACI-Article-2014.pdf. Accessed October 20, 2016.

8. Simons FER. Anaphylaxis. J Allergy Clin Immunol. 2010;125(suppl 2):S161-S181.

9. Golden DB, Moffitt JE, Nicklas RA, et al. Stinging insect hypersensitivity: A practice parameter update. J Allergy Clin Immunol. 2011;127(4):852-854.

10. American Latex Allergy Association. Common latex Products. http://latexallergyresources.org/common-latex-products. Accessed October 4, 2016.

11. Burks AW, Jones SM, Boyce JA, et al. NIAID-Sponsored 2010 guidelines for managing food allergy: Applications in the pediatric population. Pediatrics. 2011;128:955–965.

12. Epinephrine injection, USP auto-injector. Prescribing Information. Bridgewater, NJ: Amneal Pharmaceuticals; 2021.

13. Centers for Disease Control and Prevention. Voluntary guidelines for managing food allergies in schools and early care and education programs. Washington, DC. Department of Health and Human Services; 2013. https://www.cdc.gov/healthyschools/foodallergies/pdf/13_243135_A_Food_Allergy_Web_508.pdf. Accessed July 6, 2017.

14. Sicherer SH, Simons FER. Quandaries in prescribing an emergency action plan and self-injectable epinephrine for first-aid management of anaphylaxis in the community. J Allergy Clin Immunol. 2005;115(3):575-583.

IMPORTANT SAFETY INFORMATION

Epinephrine injection, USP auto-injector is intended for immediate administration as emergency supportive
therapy and is not intended as a substitute for immediate medical care. In conjunction with the administration of
epinephrine, the patient should seek immediate medical or hospital care. More than two sequential doses of
epinephrine should only be administered under direct medical supervision.

Epinephrine injection, USP auto-injector should ONLY be injected into the anterolateral aspect of the thigh. Do not
inject intravenously. Do not inject into buttock. Do not inject into fingers, hands or feet. Instruct caregivers to
hold the child’s leg firmly in place and limit movement prior to and during injection to minimize the risk of injection
related injury.

Epinephrine should be administered with caution to patients who have heart disease, including patients with
cardiac arrhythmias, coronary artery or organic heart disease, or hypertension. In such patients, or in patients who
are on drugs that may sensitize the heart to arrhythmias, epinephrine may precipitate or aggravate angina pectoris
as well as produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported
in patients with underlying cardiac disease or those receiving certain drugs. Patients who receive epinephrine
while concomitantly taking cardiac glycosides, diuretics or anti-arrhythmics should be observed carefully for the
development of cardiac arrhythmias. Epinephrine should be administered with caution to patients with
hyperthyroidism, diabetes, elderly individuals, and pregnant women. Patients with Parkinson’s disease may notice
a temporary worsening of symptoms.

Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by
Clostridia, have been reported at the injection site following epinephrine injection for anaphylaxis. Advise patients
to seek medical care if they develop signs or symptoms of infection.