What Is Neffy?

Neffy is the first and only needle-free epinephrine nasal spray approved for the emergency treatment of Type I allergic reactions, including anaphylaxis, in adults and children aged 4 years and older weighing 33 lbs (15 kg) or greater. Made by ARS Pharmaceuticals, Neffy delivers epinephrine through a simple nasal spray, eliminating the need for an intramuscular injection. This makes it an important option for patients who have needle phobia or caregivers who may hesitate to administer an injection during an emergency.

Neffy was approved by the FDA in August 2024 and became commercially available in late 2024. It is prescribed for patients at risk of anaphylaxis from food allergies, insect stings, medications, latex, exercise, or unknown triggers.

How does Neffy work?

Neffy delivers epinephrine (adrenaline) directly through the nasal mucosa into the bloodstream. Epinephrine is a sympathomimetic catecholamine that acts on both alpha- and beta-adrenergic receptors throughout the body:

• Beta-2 receptors: Relaxes bronchial smooth muscle, opening the airways to restore breathing
• Beta-1 receptors: Increases heart rate and cardiac output to combat dangerously low blood pressure
• Alpha-1 receptors: Constricts blood vessels, reversing the vasodilation and swelling that occur during anaphylaxis

One spray is administered into one nostril at the first sign of a severe allergic reaction. If symptoms persist after 5 minutes, a second dose can be given using a new device in the same nostril. Patients should always carry two devices and seek emergency medical care after any use.

What doses are available for Neffy?

• Neffy 1 mg/0.1 mL nasal spray — For children weighing 15 to less than 30 kg (33 to less than 66 lbs). Available since May 2025.
• Neffy 2 mg/0.1 mL nasal spray — For adults and children weighing 30 kg (66 lbs) or more.

How hard is it to find Neffy in stock?

Neffy receives a findability score of 55 out of 100, reflecting intermittent availability challenges. As a relatively new product (FDA-approved August 2024), pharmacy stocking is still expanding. While Neffy is not in a formal shortage, many local pharmacies may not carry it yet due to limited initial distribution. Patients may need to check multiple pharmacies or use Medfinder to locate it in stock near them. Availability is expected to improve throughout 2026 as more pharmacies add it to their inventory.

Who Can Prescribe Neffy?

Neffy can be prescribed by a range of healthcare providers, including:

• Allergists/Immunologists — Most commonly prescribe Neffy as part of an anaphylaxis action plan
• Pediatricians — For children with known food or environmental allergies
• Family Medicine physicians — For patients of all ages at risk of severe allergic reactions
• Internal Medicine physicians — For adult patients requiring an epinephrine rescue device
• Emergency Medicine physicians — May prescribe upon discharge after an anaphylactic event
• Primary Care Physicians — General prescribers for allergy management

Telehealth appointments are also available for obtaining a Neffy prescription in many cases.

Is Neffy a controlled substance?

No, Neffy is not a controlled substance. It is not scheduled by the DEA. Epinephrine is a naturally occurring hormone and does not carry the abuse or dependence risks associated with controlled medications. Neffy can be prescribed and dispensed without the additional restrictions that apply to scheduled drugs.

Common Side Effects of Neffy

Because Neffy is delivered as a nasal spray, its side effects include both typical epinephrine effects and nasal-specific reactions:

• Nasal discomfort
• Headache
• Throat irritation
• Chest and nasal congestion
• Feeling overly excited, nervous, or anxious
• Nosebleed
• Nose pain
• Sneezing and runny nose
• Dry nose or throat
• Tingling sensation (including in the nose)
• Fatigue and dizziness
• Nausea and vomiting

Serious side effects are rare but may include chest pain, fast or irregular heartbeat, severe hypertension, pulmonary edema, and ventricular arrhythmias. Seek immediate medical attention if these occur.

Alternative Medications to Neffy

If you cannot find Neffy or it is not covered by your insurance, the following epinephrine auto-injectors serve as alternatives for emergency anaphylaxis treatment:

• EpiPen (Epinephrine Auto-Injector) — The most widely known injectable option, available in 0.3 mg (adults/children over 66 lbs) and 0.15 mg (children 33–66 lbs). Generic versions from Teva and Viatris are available. Cash price is approximately $300–$700 for a 2-pack.
• Auvi-Q (Epinephrine Auto-Injector) — A compact auto-injector with voice-guided instructions, available in 0.1 mg, 0.15 mg, and 0.3 mg doses. Cash price approximately $300 for a 2-pack with coupons; a $35 copay program is available for commercially insured patients.
• Adrenaclick / Generic Epinephrine Auto-Injector — A lower-cost injectable alternative available in 0.15 mg and 0.3 mg doses.
• Symjepi (Epinephrine Injection) — A pre-filled syringe for manual injection in a compact form factor, available in 0.15 mg and 0.3 mg doses.

Drug Interactions with Neffy

Neffy (epinephrine) can interact with several medication classes. Always inform your healthcare provider about all medications you take:

• Beta-blockers — May reduce the effectiveness of epinephrine and cause severe hypertension
• MAO inhibitors — Can potentiate the cardiovascular effects of epinephrine
• Tricyclic antidepressants — May potentiate cardiovascular effects
• Cardiac glycosides/Digoxin — Increased risk of arrhythmias when combined
• Diuretics — May potentiate arrhythmias due to hypokalemia
• Ergot alkaloids — May enhance vasoconstriction
• Other nasal sprays — May alter nasal mucosa absorption of Neffy for up to 2 weeks
• COMT inhibitors (for Parkinson's disease) — May increase epinephrine effects

Important: Despite these interactions, epinephrine should never be withheld during a life-threatening allergic reaction. There are no absolute contraindications to its use in anaphylaxis.

Final Thoughts on Neffy

Neffy represents a significant advancement in anaphylaxis treatment as the first needle-free epinephrine option. For patients with needle phobia, young children, or caregivers worried about administering an injection during a crisis, Neffy offers a simpler alternative that can be life-saving. While its retail cash price of $685–$800 per 2-pack is significant, the manufacturer's savings program can reduce costs to as little as $0 for insured patients or $25 for uninsured patients.

As a newer medication, finding Neffy in stock at your local pharmacy may take some effort. Use Medfinder to quickly locate pharmacies that have Neffy available near you. If your pharmacy doesn't carry it yet, ask them to order it — stocking is expanding rapidly as demand grows.