Tuesday, November 19, 2019

Epinephrine--Is It a "Must-Have" or "Nice-To-Have" in Your Medical Kit?

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 

Epinephrine, a hormone produced in the adrenal glands, is also a medication.  When you go to the bathroom in the middle of the night in a very quiet house, and when your mother jumps out at you as you open the door to leave and scares the bejeebers out of you, you experience an adrenaline rush.  The fight or flight response.  It makes the heart beat faster, widens air passages to facilitate breathing, raises blood pressure, and dilates pupils.  (Epinephrine and adrenalin are the exact same thing; the former is derived from Greek and the latter from Latin.  Americans favor the term epinephrine, and the rest of the world uses adrenalin.)

Synthetic epinephrine acts in much the same way.  It is effective against all aspects of anaphylaxis, which is the first big reason you may want to have it in your medical kit.  And that is because anyone can have a reaction to anything at any time.  People who are allergic to nuts, bee stings, etc., already know that they should be carrying an epi-pen at all times and that all their family members should know how to use it as well.  In a true anaphylactic reaction, the patient's airway is being compromised or entirely shut down.  In addition, the patient's blood pressure drops, the tongue and/or back of the mouth may swell, further compromising the airway, the chest may become tight, and there may be hives and weakness or confusion.  These symptoms most often appear during the first hour after the sting or eating the food.  Epinephrine must be injected to act quickly enough to save that person's life.

Without epinephrine, you may be able to help the patient with Benadryl, oral steroids if you have them, and/or a histamine blocker like Zantac (ranitidine) or Pepcid (famotidine).  Of course, your patient's best bet is to get to a functioning hospital where he can get intramuscular injections of epinephrine, as well as steroids and antihistamines in a clinical setting.

Because it is a liquid, epinephrine doesn't have great shelf life, usually about a year.  Even the EpiPens have a pretty short shelf-life, and once they hit their date, you're supposed to throw them away.  Never mind that they are incredibly expensive in this country.  However, the dirty little secret is that they don't automatically go bad once they hit their use-by date.  Even EpiPens five years out of date may have enough epinephrine in them to save a life.  So if you have a source for EpiPens that are out of date, get them and hang on to them.  Yes, the efficacy decreases, about ten percent each year.  EpiPens five years out of date are about 60% effective, but a lot will depend on how it was stored.  A nice, moderate temperature is critical.  Do not let it freeze under any circumstances, and do not let it get hot.  Also, always protect it from light, and always know exactly where it is in the medical kit.

Now, one more item about EpiPens, and this is mainly for people who have them or their family members.  Those epinephrine pens actually have five full doses in them.  But you can only use one dose at a time.  Yes, it doesn't really make sense, and the manufacturers all know this, but they still continue to put the full five doses in, even though only one will be used.  The EpiPen can be dissembled and reloaded so that it can be used again.   Please note, this should only be done when you have no other options--no other epinephrine, no doctor, no hospital, no trained medical personnel whatsoever.  There are Youtubes and other instructions online; click here for one such video.  Note that this requires strong hands and you and anyone else in the room will need safety glasses.  It would also be best to do this in a small, enclosed area if possible.  That spring is gonna go flying. 

A second reason that it is nice to have epinephrine is that as a vasoconstrictor, epinephrine also helps to stop bleeding.  In this case, epinephrine is usually combined with lidocaine in a 1-2% solution.  It is not to be used on fingers, toes, noses, or ears because it may cut off circulation entirely.  It also should probably not be used in the feet of diabetics or others with compromised circulation.  It is great when used with lidocaine on superficial wounds with significant bleeding, especially scalp wounds.

Finally, a third reason to consider having epinephrine in your medical kit is for treating croup.  Croup is most often caused by a virus, and most often in fall and winter.  It's a little more common in boys than in girls and usually occurs between the ages of six months and five years, though it can occur in patients as old as fifteen years.  My daughter, Charlotte, was nearly eight years old when she had it in the summer.  Croup causes swelling of the inside of the trachea which results in the classic seal bark cough, stridor (high pitched breath sound due to turbulent airflow in the larynx), and hoarse voice.  The symptoms are often worse at night and usually last only one or two days.  It afflicts about 15% of children at some point in their lives, and 1-5% of these cases are severe enough to require hospitalization.  A single dose of steroids is usually administered in more serious cases.  Lacking steroids, epinephrine may also be used.

However, systemic epinephrine will not work in the case of croup.  The epinephrine needs to actually come into contact with the vocal cords.  So the epinephrine, if it is liquid, as most of it is, needs to be put in a nebulizer.  Dry epinephrine may be put into a pot of boiling water for the patient to inhale the steam.  In this case, 1/4 cc, or 1/4 gram, of epinephrine should be added to one cup of water.

Epinephrine is not a controlled substance.  It is not illegal to possess it.  But it is not so easy to find, either.  If you've got a good relationship with your doctor or veterinarian, you may be able to get a vial that way.  And one vial is all you should need to get you through TEOTWAWKI.

The other possibility for obtaining epinephrine is online at Dr Natural Healing.com.  It's labeled as being straight epinephrine, with 0.22 mg per capsule.  It also comes with the inhaler and instructions on how to use it.  It probably won't work for someone who is having an anaphylactic reaction, as that person won't be able to inhale it.  It is designed for asthma sufferers.  The doctor I showed it to and asked about it believes it would work as an injectable if combined with sterile saline.

So now, the $64,000 question.  Is epinephrine a "must-have" or "nice-to-have" for you?  I asked this very question of the doctor teaching the off-grid medicine classes I attended.  I shared our family medical history, with no one having any known allergies to anything except stupid pollen, and my husband's brother being truly allergic to bee stings.  He said if dollars were limited, he would forgo the EpiPen in our situation and use that money elsewhere.  He'd still recommend getting a vial of epinephrine, if at all possible.  Without having tried out the epinephrine capsules, he said he couldn't recommend it, but it might be a good thing to have just in case.

One final note:  The US FDA took Primatene Mist, a mainstay for treating mild asthma for many years, off the market in 2011 because it didn't like the propellant used in it.  It is finally available again, as of late last year.  However, Amazon doesn't have it.  (And even though I've been looking for it for the past two years, I only checked Amazon and so I didn't realize it was back on the market until just last week.) Walmart, Walgreens, and CVS do carry it.  It would be a really good idea to have this in your kit for treating mild asthma, anaphylaxis, severe wheezing and coughing, and croup.  At $30 each, it's not cheap, but it is OTC. 

Links to related posts:
Common and Off-Label Uses of Antihistamines
Antacids, H2-Blockers, and Proton Pump Inhibitors 

For further reading:
Armageddon Medicine
The Survival Medicine Handbook, pp 249-251.

© 2019, PrepSchoolDaily.blogspot.com    


  1. Thank you for this really useful information. I had no idea about the longevity or the extra doses in the Epi-Pen, nor did I know that Primatene was back on the market.

  2. I'm so glad your found this article of benefit. I think there is so much useful information out there, but we just need someone to bring it to our attention.