When Your Pharmacy Can't Fill Your Epipen Prescription

If you've been prescribed Epipen and your pharmacy can't fill it — whether because of a shortage, a stock issue, or cost — you might be wondering: are there other options?

The short answer is yes. Epipen is the most recognized name in epinephrine auto-injectors, but it's far from the only product available. Several alternatives deliver the same life-saving medication in similar or even improved devices.

In this article, we'll explain what Epipen is and how it works, then walk through the real alternatives you can discuss with your doctor or pharmacist.

What Is Epipen and How Does It Work?

Epipen is a brand-name auto-injector that delivers a pre-measured dose of epinephrine (also known as adrenaline) into the outer thigh muscle. It's prescribed for the emergency treatment of anaphylaxis — a severe, whole-body allergic reaction that can be fatal without immediate treatment.

Epinephrine works by stimulating both alpha and beta adrenergic receptors in the body. Here's what that means in plain language:

• Opens the airways: Epinephrine relaxes the muscles around the bronchial tubes, making it easier to breathe when your throat and lungs are swelling shut.
• Raises blood pressure: It tightens blood vessels, reversing the dangerous drop in blood pressure that occurs during anaphylaxis.
• Reduces swelling: It decreases the swelling in your skin, lips, and mucous membranes.
• Slows the allergic cascade: It suppresses the release of additional histamine and other chemicals from mast cells, helping stop the reaction from getting worse.

These effects happen within minutes, which is why epinephrine is the first-line treatment for anaphylaxis — and why having an auto-injector on hand can literally save your life. For a deeper dive, see our article on how Epipen works.

Epipen Alternatives: Your Options

All of the alternatives below contain the same active ingredient — epinephrine. They differ in their delivery device, size, pricing, and availability. The medication itself works identically.

1. Auvi-Q (Epinephrine Auto-Injector)

Auvi-Q is a compact, credit-card-sized epinephrine auto-injector made by Kaléo. It's one of the most popular alternatives to Epipen for several reasons:

• Talking instructions: Auvi-Q has a built-in speaker that provides step-by-step voice instructions during an emergency. This can be invaluable when you're panicking or when a bystander is administering the injection.
• Three dose options: Available in 0.1 mg (for infants 16.5 to 33 lbs), 0.15 mg (for children 33 to 66 lbs), and 0.3 mg (for patients over 66 lbs). The 0.1 mg dose is unique — Epipen doesn't offer it.
• Compact size: Significantly smaller and thinner than Epipen, making it easier to carry in a pocket or purse.
• Affordability program: Kaléo offers a $0 out-of-pocket copay program for patients with commercial insurance. For uninsured patients, they also offer direct pricing options.

Auvi-Q uses a slightly different injection technique than Epipen — make sure you review the instructions and practice with the trainer device.

2. Generic Epinephrine Auto-Injectors

Viatris (the company behind Epipen) also manufactures an authorized generic version of Epipen. It's the exact same device with the exact same medication — just sold at a lower price under a generic label.

• Same device: Identical design and operation to brand-name Epipen.
• Lower cost: The generic typically costs $150 to $400 for a 2-pack without insurance, compared to $300 to $700+ for brand-name Epipen.
• Same strengths: Available in both 0.15 mg and 0.3 mg.

If you're comfortable using Epipen but want to save money — or if brand-name Epipen is out of stock — the authorized generic is often the easiest switch.

3. Adrenaclick / Generic Adrenaclick

Adrenaclick is another epinephrine auto-injector available in 0.15 mg and 0.3 mg doses. It has a slightly different activation mechanism than Epipen:

• You must remove two end caps (instead of one blue safety cap) before injecting.
• The injection technique is the same — press firmly against the outer thigh and hold.

Generic versions of Adrenaclick are available and tend to be among the most affordable epinephrine auto-injector options. However, a pharmacist cannot automatically substitute Adrenaclick for an Epipen prescription — your doctor may need to write a new prescription specifically for Adrenaclick or for "epinephrine auto-injector" generically.

4. Symjepi (Epinephrine Injection)

Symjepi is different from the other options because it's not an auto-injector — it's a pre-filled, single-dose syringe. Available in 0.15 mg and 0.3 mg strengths, Symjepi is:

• Smaller and thinner: About the size of a marker, it's very easy to carry.
• Manual injection: You remove the cap and push the plunger yourself, similar to using a regular syringe. This requires a bit more comfort with needles.
• Potentially more affordable: Symjepi may offer cost advantages over auto-injectors.

Symjepi is a good option for adults who are comfortable with self-injection, but the manual technique may not be ideal for young children or people who are anxious about needles.

How to Switch to an Alternative

Switching from Epipen to an alternative is straightforward, but there are a few things to keep in mind:

1. Talk to your doctor. Your prescriber can write a new prescription for a specific alternative or write it generically as "epinephrine auto-injector" to give your pharmacist flexibility.
2. Learn the new device. Each auto-injector has a slightly different design and technique. Practice with the trainer device that comes in the box before you need to use it for real.
3. Check your insurance coverage. Your plan may prefer one product over another. Call your insurance company or check their formulary to see which epinephrine auto-injector has the lowest copay for you.
4. Update your emergency action plan. If you or your child has an allergy action plan on file at school, work, or camp, make sure it's updated to reflect the new device.

You can also use Medfinder to check which epinephrine products are currently in stock at pharmacies near you.

Final Thoughts

Not being able to get Epipen is frustrating, but it doesn't mean you have to go without protection against anaphylaxis. Auvi-Q, generic epinephrine auto-injectors, Adrenaclick, and Symjepi all contain the same life-saving medication and are legitimate alternatives.

Talk to your doctor about which option makes the most sense for you based on availability, cost, and ease of use. And if you're looking for the best price, check out our guide on how to save money on Epipen and its alternatives.

The most important thing is that you always have an epinephrine auto-injector within reach. The brand name on it matters far less than having it available when seconds count.