Can't Get Neffy? Here Are Your Other Options

Neffy has been a game-changer for people with severe allergies. A needle-free epinephrine nasal spray that's easy to carry and simple to use in an emergency — what's not to love?

But what happens when you can't find it at your pharmacy, your insurance won't cover it, or the cost is too high? The most important thing is this: never go without epinephrine if you're at risk for anaphylaxis. There are other options that work well, and your doctor can help you find the right one.

What Is Neffy and How Does It Work?

Neffy is the brand name for Epinephrine nasal spray, manufactured by ARS Pharmaceuticals. It was FDA-approved in August 2024 as the first needle-free epinephrine product for treating severe allergic reactions (anaphylaxis).

Neffy delivers epinephrine through the nasal passages. Epinephrine works by activating alpha- and beta-adrenergic receptors throughout the body. This causes blood vessels to constrict (raising blood pressure), airways to open (reversing bronchospasm), and heart rate to increase — all of which counteract the dangerous effects of anaphylaxis.

The 2 mg nasal spray is for adults and children weighing 66 pounds or more, and the 1 mg spray is for children aged 4+ weighing 33 to 65 pounds. You spray it into one nostril, and if needed, administer a second dose in the same nostril after 5 minutes.

For a deeper look at how the drug works, see our post on Neffy's mechanism of action.

Alternative #1: EpiPen (Epinephrine Auto-Injector)

EpiPen is the most well-known epinephrine product and has been the standard of care for decades. It delivers a 0.3 mg dose of epinephrine via intramuscular injection into the outer thigh.

• How it works: Press the device firmly against the outer thigh. The needle deploys automatically and delivers the dose.
• Doses available: EpiPen (0.3 mg for patients 66 lbs+) and EpiPen Jr (0.15 mg for patients 33-66 lbs)
• Cost: Brand-name EpiPen costs $300 to $700+ for a 2-pack without insurance. Generic versions from Teva and Viatris are available for roughly $150 to $350.
• Pros: Widely available at virtually every pharmacy. Well-understood by patients, caregivers, and first responders. Generic options bring the cost down.
• Cons: Requires a needle injection, which can be intimidating. Must be injected into the thigh. Some patients hesitate to use it in emergencies because of needle fear.

Alternative #2: Auvi-Q (Epinephrine Auto-Injector)

Auvi-Q is a compact, wallet-sized epinephrine auto-injector made by Kaléo. Its standout feature is built-in voice guidance that talks you through each step of the injection.

• How it works: The device provides audio instructions, then you press it against the outer thigh to deliver the injection automatically.
• Doses available: 0.1 mg (for infants/toddlers 16.5-33 lbs), 0.15 mg (33-66 lbs), and 0.3 mg (66 lbs+)
• Cost: About $300 for a 2-pack with coupons. Kaléo offers a $35 copay program for commercially insured patients.
• Pros: Voice-guided instructions reduce user error. Very compact — fits in a pocket. Multiple dose options for all ages including infants.
• Cons: Still requires needle injection. Brand-name only (no generic). May require prior authorization from insurance.

Alternative #3: Generic Epinephrine Auto-Injectors (Adrenaclick and Others)

Several manufacturers produce generic epinephrine auto-injectors that work similarly to EpiPen but at a lower cost.

• Available options: Teva's authorized generic EpiPen, generic Adrenaclick, and other authorized generics
• Doses: 0.15 mg and 0.3 mg
• Cost: $150 to $350 for a 2-pack, depending on the pharmacy and any coupons used
• Pros: Lower cost than brand-name options. Widely available.
• Cons: Requires needle injection. Operating mechanism may differ slightly from EpiPen — make sure you know how to use the specific device prescribed to you.

Alternative #4: Symjepi (Epinephrine Pre-Filled Syringe)

Symjepi is a pre-filled, single-dose syringe of epinephrine that you inject manually into the outer thigh.

• Doses: 0.15 mg and 0.3 mg
• Cost: Generally comparable to generic auto-injectors
• Pros: Compact design. No auto-injection mechanism to malfunction.
• Cons: Requires manual injection — you push the plunger yourself. May be harder to use under stress for some patients.

How to Choose the Right Alternative

Here are some factors to consider when talking to your doctor about alternatives:

• Needle comfort: If needle fear is why you wanted Neffy in the first place, keep trying to find it. In the meantime, Auvi-Q's voice guidance may help ease anxiety about injection.
• Cost: Generic epinephrine auto-injectors are typically the most affordable option. Check prices at Medfinder to compare.
• Age and weight: Auvi-Q is the only option with a 0.1 mg dose for very small children. Neffy's 1 mg spray covers children 33 lbs and up.
• Availability: EpiPen and its generics are stocked at virtually every pharmacy in the country. If availability is your main concern, these are the safest bet.

Don't Give Up on Finding Neffy

If you prefer Neffy but just can't find it right now, keep looking. Use Medfinder to check pharmacy inventory in real time. Ask your pharmacy to special-order it. And check our guide on how to find Neffy in stock near you for more strategies.

The bottom line: the best epinephrine device is the one you have with you and can use. Whether that's Neffy, an EpiPen, Auvi-Q, or a generic auto-injector, carry it everywhere and know how to use it.

Final Thoughts

Neffy is a fantastic option, but it's not the only way to carry life-saving epinephrine. If you can't fill your Neffy prescription right now, talk to your doctor about one of these alternatives. All of them deliver the same active ingredient — epinephrine — and all of them can save your life during a severe allergic reaction.

For more information on Neffy specifically, see our posts on what Neffy is, Neffy side effects, and how to save money on Neffy.