EpiPen Alternatives You Should Know About

If you have a serious allergy, having an EpiPen® on hand can mean the difference between life and death. But they expire within just 12 to 18 months — and between cost and availability issues, it can be tough to get your hands on a new one.

Are there safe, effective and less-expensive alternatives to an EpiPen for treating anaphylaxis? The answer is yes, according to pediatric allergist Bridget Wilson, MD.

Dr. Wilson shares the options currently on the market and how to decide which one is best for you.

What EpiPen alternatives are available?

If the cost of an EpiPen is too steep for you, if there’s a shortage in your area or if you struggle to use the device, Dr. Wilson recommends asking your allergist about alternative epinephrine products.

There’s one option they’ll likely advise against: Buying an old-school epinephrine vial and syringe is the most affordable option — but it’s not recommended for safety reasons. There are a lot of opportunities for human error with a DIY approach, like getting the dosage wrong or struggling to switch needles.

“When you’re in the middle of an anaphylactic reaction, you may not be able to self-administer the epinephrine quickly,” Dr. Wilson explains. “And you can’t assume that people around you know how to dose and inject your medication.”

So, that’s one option off the table. But it’s not the only game in town. Your provider will probably mention these, too:

Nasal spray

Neffy®, the first-ever epinephrine nasal spray, is a new entry into the market, having only received U.S. Food and Drug Administration (FDA) approval in August of 2024. Instead of injecting medicine into your skin and muscle, Neffy users spray a single pump of liquid epinephrine into one of their nostrils.

There are lots of reasons to consider using Neffy as an alternative to an EpiPen or other injectable epinephrine product, Dr. Wilson observes. Neffy:

• Doesn’t involve needles: Neffy is a less painful way to administer epinephrine. This is a breakthrough for people with a fear of needles (trypanophobia), who are sometimes unable to self-inject epinephrine, even in a life-threatening emergency.
• Has a longer shelf life: Depending on dosage, Neffy expires in 24 to 30 months. That’s about double the shelf life of an EpiPen and other injectable epinephrine options. Research also suggests that Neffy is more stable than auto-injectors and prefilled syringes when exposed to extreme heat.
• Has different side effects: All epinephrine products have side effects — it’s one of several reasons you have to be monitored after using them. But if you’re prone to skin-related complications like injection site pain, bruising or infection, switching from an injection to a nasal spray may be helpful.

Of course, Neffy has its drawbacks, too. There’s a possibility you could have problems administering it, as the way you use it is slightly different from some other types of nasal sprays. And you may have side effects like runny nose, throat irritation and mouth numbness instead.

Also, Neffy is a relatively new medication. Dr. Wilson notes that more research is needed to understand how effective it is in treating people with allergic reactions.

“Since we are still learning about Neffy, it’s important to talk with your allergist about your care plan,” she advises. “Your allergist may recommend keeping injectable epinephrine as a back-up option in addition to Neffy.”

Also, be sure to tell your provider if you’ve ever broken your nose, had nasal surgery or have structural issues like polyps, as these could interfere with medication absorption.

Other brands of auto-injectors

While they’re definitely the most popular brand, EpiPens aren’t the only epinephrine auto-injectors on the market.

“Alternative devices that also contain epinephrine will keep you and your kids safe,” Dr. Wilson says. Other brands to consider include:

• AUVI-Q®: This brand offers adult, child and infant doses. And for some people, it can be more affordable than the EpiPen, Dr. Wilson notes. It also comes with a trainer. The unique thing about the AUVI-Q is that it gives voice-guided instructions to talk you through using the device in the moment. It’s also smaller and more compact than other epinephrine autoinjectors.
• Adrenaclick®: This auto-injector may cost slightly less than the EpiPen. There are also more affordable, generic versions of Adrenaclick available through some retailers.

Again, each auto-injector dispenses medication a little differently. That’s why it’s important to have — and use — a trainer (more on that in a bit).

Pre-filled syringes

If you want the convenience of a syringe but worry about fiddling with a vial in an emergency, you might want to consider Symjepi®, which is a pre-filled syringe.

To use Symjepi, you remove the cap and manually inject the epinephrine into the skin and muscle of your outer thigh by depressing a plunger.

Symjepi is a bit more labor-intensive than an auto-injector and not as widely available as brand-name EpiPens and other epinephrine auto-injectors. Unlike epinephrine auto-injectors, the needle on Symjepi is exposed. But it’s typically more affordable.

Authorized generics

If cost is your main concern, Dr. Wilson recommends asking your provider about authorized generics of the EpiPen or Adrenaclick. An authorized generic is the exact same medication sold by the same manufacturer. The only differences? The product’s name and price point.

What to consider when choosing an alternative

Having a wide variety of epinephrine products on the market means that anaphylaxis care doesn’t have to be one-size-fits-all. So, it’s important to work with your allergist to determine the approach that’s going to be safest and most effective for you.

Dr. Wilson says those conversations should touch on the following topics:

• Cost: Epinephrine products can be pricey, so take advantage of every savings opportunity you can. Whether you’re paying with insurance or out-of-pocket, always ask your provider about savings cards, coupons, rebates, patient assistance programs and more.
• Insurance, Medicare and Medicaid coverage: “Find out which epinephrine products your healthcare plan covers and how much coverage they offer,” Dr. Wilson recommends. “And remember: Out-of-pocket expenses may be high if you haven’t met your deductible.”
• Dosage: How much epinephrine you need in a single dose depends on your weight. And no matter what device you use to administer your epinephrine, Dr. Wilson adds that you always need to have a second dose on hand, in case the first isn’t effective enough.
• Ease of use: If needles aren’t your friend, going the nasal spray route may be your preferred option, and worth discussing with your allergist. On the other hand, people with hand strength or dexterity issues may have an easier time using an auto-injector.
• Training: “The difficulty with the generic devices is that they often don’t come with a demonstrator,” Dr. Wilson clarifies. If the product you use doesn’t have a trainer, she urges you to review the training videos on the manufacturer’s website and have your allergist show you how to use the device properly.
• Storage: Research suggests that Neffy is more stable than auto-injectors and prefilled syringes when exposed to extreme heat. Depending on where you live and your lifestyle, that may make it a better option.
• Side effects: Epinephrine is a lifesaving emergency medicine that’s generally safe to use. But it packs a wallop — and the administration process can cause side effects. Whatever product you use, always get emergency medical care after using epinephrine, even if you’re feeling better.
• Interactions: Talk to your provider about everything you take, including prescription and over-the-counter medications, vitamins, supplements and more. If there’s a drug interaction, Dr. Wilson says it could have an impact on your dosing or other aspects of your allergy action plan.

Final thoughts

There are more ways to administer epinephrine in an emergency than ever before. And still more products are expected to hit the market in the next few years. Whatever option you go with, give yourself plenty of time to get comfortable using it.

“You never know when a reaction will occur — and minutes can make a big difference,” Dr. Wilson emphasizes. “Being trained and comfortable administering epinephrine can save valuable time, so be sure to discuss all of your options and practice using them with your allergist. And always check the expiration date on your medications to make sure they are up to date.”