How To Use An EpiPen: Instructions, Emergency Tips, And More

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What is an EpiPen?

An EpiPen is a device used to quickly deliver the medication epinephrine to someone who’s experiencing anaphylaxis. Anaphylaxis is a severe and potentially life threatening consequence of an allergic reaction.

With anaphylaxis, your body becomes triggered by something you’re allergic to, such as a type of food or bee venom, and your immune system overreacts to it by causing life threatening symptoms. The reaction may start off mild but can rapidly become a medical emergency as it affects your blood pressure and breathing.

The EpiPen is an auto-injector, a device that delivers a set dose of medication deep in the muscle. Auto-injectors are also used with other medications. The needle is located inside the device, and you can conveniently carry the auto-injector in your pocket or bag.

Once you inject epinephrine into the muscle, it can stop the severe acute allergic reaction symptoms. However, people experiencing anaphylaxis should still use 911 or local emergency services after using an EpiPen.

Read on to learn how to use an auto-injector if you or someone else is experiencing anaphylaxis.

Symptoms of anaphylaxis

The symptoms of anaphylaxis can come on quickly and worsen quickly as well. Anaphylaxis is an emergency. If you or someone else is experiencing symptoms of anaphylaxis, don’t hesitate to use an epinephrine auto-injector. Then use 911 or local emergency services.

Symptoms to look out for can include:

difficulty breathing
swelling of the throat, face, or lips
wheezing or hoarseness
feeling dizzy or light-headed
having a rapid heart rate
having pale or clammy skin
low blood pressure
having a feeling of doom
fainting or collapsing

Other symptoms may include:

hives and itching
abdominal pain
nausea or vomiting
diarrhea

How to use an EpiPen on yourself

According to the manufacturer, the three steps to using an EpiPen are:

Prepare
Administer
Get emergency medical help

Prepare

Remove the EpiPen from its clear carrier. Flip open the yellow cap of the tube and slide the device out.
Hold the device in your fist with the orange tip pointing down. You can remember this by using the saying “Blue to the sky, orange to the thigh.”
Remove the blue safety release. Using your opposite hand, pull straight up, avoiding bending or twisting the device.

Administer

Place the orange tip on your thigh. Next, aim for the middle of the outer thigh, holding it at a right angle to the thigh.
Swing the pen back about 6 inches and firmly push it against your thigh. The orange tip contains the needle, and it should click when the injection has started.
Hold firmly in place for 3 seconds. Hold the needle still in the muscle while counting slowly for 3 seconds.
Remove the EpiPen from your thigh. Once removed, the orange tip should cover the needle, but don’t reuse the device if it doesn’t.
Massage the injection site. Rub the area around the injection site for 10 seconds.

Removing safety release from EpiPen — Step 1: Take off EpiPen safety releases. Firmly grip the EpiPen with one hand. Photography by Monica Pardo

How to use an Epipen — Step 2: Keep leg still and push EpiPen down into leg until a click is heard. Hold for 3 seconds. Gif by Monica Pardo.

Get emergency medical help

Call 911 or local emergency services, or have someone quickly take you to the nearest emergency room. Because symptoms may reoccur, it’s not recommended that you drive yourself unless absolutely necessary.

If you use an epinephrine auto-injector that’s not an EpiPen, please review that manufacturer’s administration instructions and go to a doctor with any questions or concerns.

Sometimes the person may need a second dose (requiring an additional auto-injector) should they not respond effectively to the first dose.

If you need to administer epinephrine to another adult by using an auto-injector, follow the steps above and administer the injection into the upper thigh. It may help to administer the injection while the person is lying down or sitting.

How to administer an EpiPen injection to a child

The steps are similar but different with children. The three steps still apply, but there are significant differences you should know before administering epinephrine to a child.

Prepare

Remove the EpiPen Jr device from its clear carrier. Flip open the green cap of the tube and slide the device out.
Hold the device in your fist with the orange tip pointing down. A great way to remember this is by using the saying “Blue to the sky, orange to the thigh.”
Remove the blue safety release. Using your opposite hand, pull straight up, avoiding bending or twisting the device.

Administer

Hold the child’s leg firmly in place while administering the injection. This step will help ensure they receive the entire dose and will prevent injuries.
Place the orange tip on the thigh. Next, aim for the middle of the outer thigh, holding it at a right angle to the thigh.
Swing the pen back about 6 inches and firmly push it against their thigh. The orange tip contains the needle, and it should click when the injection has started.
Hold firmly in place for 3 seconds. Hold the needle still in the muscle while counting slowly for 3 seconds.
Remove the EpiPen Jr device from their thigh. Once removed, the orange tip should cover the needle, but don’t reuse the device if it doesn’t.
Massage the injection site. Rub the area around the injection site for 10 seconds.

Get emergency medical help

Call 911 or local emergency services, or quickly take them to the nearest emergency room.

Don’t use an adult EpiPen to treat children. The EpiPen Jr device has a lower dosage of epinephrine, and if children receive too much epinephrine, it may hurt them. If your child has an allergic reaction and doesn’t have an EpiPen Jr, you’ll want to use 911 or local emergency services as soon as possible.

Many doctors’ offices and healthcare facilities have a training device for practice. It may be best for them to show you how to administer an EpiPen in person.

When to use an EpiPen

You should use an EpiPen when you suspect that you or others are experiencing a severe allergic reaction. When the symptoms of anaphylaxis begin, that’s when the device is needed.

However, only those who’ve been prescribed the device by their doctor should use it.

Also, epinephrine shouldn’t be given in place of medical treatment. You’ll still need to ask for medical help immediately.

Antihistamine vs. EpiPen

Antihistamine medications, such as diphenhydramine (Benadryl) or loratadine (Claritin), can be used to manage allergy symptoms.

These medications can relieve mild allergy symptoms, such as sneezing, itchy or watery eyes, and hives.

Antihistamines can’t treat anaphylaxis on their own. Not only do they not act as quickly as epinephrine, but they also can’t effectively treat anaphylaxis by opening the airway or helping to raise your blood pressure.

Doctors may recommend taking antihistamine medications for a few days after returning from the hospital to help prevent symptoms from returning. Other therapies used can include:

steroids
inhaled bronchodilators, which widen the airways
medications to increase your blood pressure
oxygen therapy

What to do in an emergency

What should you do in the event that someone is experiencing anaphylaxis? Follow the steps below in an emergency situation.

Call 911 immediately.
Ask the person if they’re carrying an epinephrine auto-injector on them. If so, ask them if they need your help administering the injection.
Administer the epinephrine injection.
Loosen any tight-fitting clothing.
Help the person lie on their back. If they’re feeling nauseous or have vomited, gently turn them on their side. Also, turn them on their side if they’re unconscious, pregnant, or having trouble breathing.
Remove any allergy triggers if possible.
Cover the person with a blanket if available.
Avoid giving them any food or drink.
If a second epinephrine auto-injector is available, give another injection if symptoms haven’t improved in about 5 to 15 minutes. However, more than two injections shouldn’t be given without the supervision of a medical professional.
If there are no signs of breathing, administer CPR.
Stay with the person and continue to reassure them until help arrives.

Other safety tips

To help prevent an anaphylactic reaction, or to be prepared if you experience one, follow the safety tips below:

Identify and avoid your allergy triggers. Examples of common allergy triggers include:
- medications
- venom from insect bites or stings
- foods, such as peanuts and shellfish
- contrast agents used in medical imaging
- latex
Always carry your epinephrine auto-injector with you. Try to carry a double pack in case you have a reaction and one dose doesn’t alleviate your symptoms or your symptoms come back before help arrives.
Monitor the expiration date. The drug’s life depends on the manufacturer and the Food and Drug Administration (FDA) confirmation. They may extend use dates if needed. You can find the expiration date on the device itself or on the FDA website.
Check your auto-injector regularly. Note the expiration date and the color of the liquid in the injector, which should be clear. Replace your auto-injector if the fluid is discolored.
Always store your epinephrine auto-injector at room temperature. Extremes in temperature may make the medication less effective.
Know the symptoms of an anaphylactic reaction. Knowing this information can allow you to administer your epinephrine injection promptly.
Learn how to use an epinephrine auto-injector. Be sure your family, friends, and caregivers know as well. Many manufacturers include a practice injector (trainer) to practice administering an injection.
Let others know about your allergy. This can help them learn what to do if you have a severe allergic reaction. Consider wearing medical identification jewelry or carrying a medical identification card to let people know about your allergy in case of an emergency.
Always use 911 or local emergency services if you experience anaphylaxis. Don’t wait for your symptoms to improve. Ask for medical care as soon as you experience any symptoms of a severe allergic reaction.
Make sure you properly dispose of your EpiPen. The device contains a needle and must be disposed of in a special container for sharp objects. These containers should be available through a local pharmacy, medical supply company, or healthcare professional. If not available, the FDA recommends disposing of your EpiPen in an empty laundry detergent container that’s sealed with a lid.

Frequently asked questions

Can you use an expired EpiPen?

When you don’t store your EpiPen properly or replace it when it expires, it can compromise the effectiveness of the medication. For example, a 2017 study showed a significant drug breakdown after the expiration date and cited cases in which patients died from anaphylaxis after receiving a dose from expired EpiPens.

To ensure you receive proper treatment when you need it most, it’s best to replace your pens before they expire.

How do you get an EpiPen?

A doctor can write you a prescription to get an EpiPen from a pharmacy.

Before prescribing the drug, they may test you for allergies and monitor your symptoms. If you experienced an anaphylactic event in the past, make sure to let the doctor know what happened.

How much does an EpiPen cost?

The cost of an EpiPen depends on how you’re paying for it.

If you’re using health insurance, note that different plans offer varying amounts of coverage and that different deductibles and copays may apply. You’ll want to call the customer service number on the back of your insurance card to find out your costs.

If you use Medicare, you’ll want to learn more about what coverage includes.

If you’re paying out of pocket without insurance, you’ll want to check online for pharmacy coupons to help with the costs. Prices for one EpiPen syringe can range from $127.50 to $603.57.

However, costs can vary based on the distributor and based on whether you use a mail-order or in-person pharmacy. You can learn more about the costs of EpiPens here.

The bottom line

Anaphylaxis is a severe allergic reaction and an emergency medical situation. Using an EpiPen can stop the symptoms of anaphylaxis and help stabilize you until help arrives.

If you have a severe allergy, you should carry an auto-injector or two at all times in case of a reaction. The injection typically takes effect quickly. The injection is given in the upper part of the thigh.

Both you and those close to you should learn to identify the symptoms of anaphylaxis and know how to administer an EpiPen injection properly.

Recognizing anaphylaxis and promptly giving an epinephrine injection can save lives.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Dodd A, et al. (2021). Evidence update for the treatment of anaphylaxis.https://www.sciencedirect.com/science/article/pii/S0300957221001507
Dougherty JM, et al. (2021). Allergy.https://www.ncbi.nlm.nih.gov/books/NBK545237/
Epinephrine injection. (2022).https://medlineplus.gov/druginfo/meds/a603002.html
How to use an EpiPen (epinephrine injector, USP) auto-injector. (n.d.).https://www.epipen.com/-/media/files/epipen/howtouseepipenautoinjector.pdf
McLendon K, et al. (2021). Anaphylaxis.https://www.ncbi.nlm.nih.gov/books/NBK482124/
Overview: Anaphylaxis. (2019).https://www.nhs.uk/conditions/anaphylaxis/
Posner LS, et al. (2017). Update on the usage and safety of epinephrine auto-injectors 2017.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367766/
Reber LL, et al. (2017). The pathophysiology of anaphylaxis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657389/
Safely using sharps (needles and syringes) at home, at work and on travel. (2021).https://www.fda.gov/medical-devices/consumer-products/safely-using-sharps-needles-and-syringes-home-work-and-travel
Vijayaraghavan R. (2020). Autoinjector device for rapid administration of drugs and antidotes in emergency situations and in mass casualty management.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243406/

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Medically reviewed by Jennie Olopaade, PharmD, RPH — Written by Jill Seladi-Schulman, Ph.D. — Updated on April 20, 2022

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What is an EpiPen?

Symptoms of anaphylaxis

How to use an EpiPen on yourself

Prepare

Administer

Get emergency medical help

How to administer an EpiPen injection to a child

Prepare

Administer

Get emergency medical help

When to use an EpiPen

Antihistamine vs. EpiPen

What to do in an emergency

Other safety tips

Frequently asked questions

Can you use an expired EpiPen?

How do you get an EpiPen?

How much does an EpiPen cost?

The bottom line

How we reviewed this article:

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