People with severe allergies, including to foods or insects, are often prescribed an adrenaline autoinjector to treat anaphylaxis. These devices contain a single premeasured dose of adrenaline in a pen-like device. They are designed to be easy to use in an emergency. EpiPen and Anapen are two brands of adrenaline autoinjector (and the only two available in Australia at the moment). Find out how the two devices compare and what real patients think of them when considering EpiPen versus Anapen.
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Choice of adrenaline autoinjectors in Australia
Until reasonably recently, people at risk of anaphylaxis in Australia only had one choice of adrenaline autoinjector. EpiPen was the only emergency medication available for a number of years. So it was exciting when a second autoinjector entered the market. (Anapen had previously been available for a short period in 2011to 2014). People with serious allergies in Australia can currently be prescribed either EpiPen or Anapen to treat anaphylactic reactions.
Before we have a look at how these two autoinjectors compare, it’s important to remember that you should discuss which one is best for you with your prescribing doctor or allergy specialist. They will take into account your individual needs in prescribing what is right for you.
However, there are some important differences between the two autoinjectors, including some practical considerations that can be important to the people who need to carry and use them.
EpiPen vs Anapen: similarities and differences
How do the two devices compare?
Use
Both EpiPen and Anapen contain a single dose of life saving adrenaline (epinephrine) medication to treat anaphylaxis. They are safe and effective and easy for someone to self-administer in an emergency.
However, EpiPen and Anapen are administered differently and have different instructions for use. This is very important to remember. We’ll describe the difference in more detail below.
The autoinjectors previously had different ASCIA Anaphylaxis Action Plans to match either EpiPen or Anapen. In 2023 ASCIA released new Anaphylaxis Action Plans which show how to use both devices. If you don’t have the new version yet, it’s important to make sure you have an action plan that matches your autoinjector. You can see the different types of action plan on the ASCIA website.
When to use the device is the same in both cases: at the first sign of a life threatening allergic reaction (anaphylaxis). An anaphylaxis action plan prepared by your allergist or doctor will outline the symptoms to watch out for. These include
- difficult/noisy breathing
- swelling of tongue
- swelling/tightness in throat
- difficulty talking and/or hoarse voice
- wheeze or persistent cough
- persistent dizziness or collapse
- pale and floppy (young children)
Cost
In Australia, you can get 2 EpiPens or 2 Anapens on a PBS (subsidised) prescription, so they cost the same amount. If you buy additional devices over the counter at a pharmacy at full price, the price is also similar.
Size
EpiPens and Anapens are roughly comparable in size. Anapens are thinner but also slightly longer which can be an important when deciding how to carry them (see below).
Dose size
EpiPen is available in 150 microgram (EpiPen Junior) and 300 microgram sizes. The manufacturer states that EpiPen Juinior is suitable for children up to 30kg and that a standard EpiPen should be used above that weight. However, the Australian Society of Clinical Immunology and most allergists recommend moving up from EpiPen Junion to the next when a child passes 20kg. Your allergist is the best person to determine this.
Anapen is available in the same 150 microgram and 300 microgram doses. However, Anapen is also available in a larger 500 microgram dose for people over 60kg.
Packaging
EpiPens come packaged in a hard clear case which helps protect the device when carried. Anapens do not have a hard case and need to be carried in the box or other protective container.
How to use an autoinjector to treat anaphylaxis
If someone is having a severe allergic reaction (anaphylaxis), look for their action plan which is stored with their EpiPen or Anapen and follow the instructions on it.
It’s important to keep the person calm and make them lie flat, or sit up slightly if they are having trouble breathing. Don’t allow the person to stand or walk, even after you have administered adrenaline. You will need to call an ambulance straight after using the device as the person will need to go to hospital for observation.
How to use an EpiPen
Make a fist around the middle of the EpiPen, so that your fingers and thumb aren’t near the ends. Hold the EpiPen with the blue end upwards (remember “blue to the sky, orange to the thigh”).
Carefully remove the blue safety cap from the top. Place the orange end of the EpiPen firmly against the mid outer thigh, halfway between the hip and the knee, at a 90 degree angle. Push the EpiPen down until it clicks and keep it in position for 3 seconds. After this, you can remove the EpiPen from the thigh and put it safely to one side as the orange end will extend to cover the needle. As soon as you have administered the EpiPen, call an ambulance (even if the person is feeling better).
You can administer an EpiPen through a single layer of clothing, but not through thick material like the seams or pockets.
Allergy & Anaphylaxis Australia has a really helpful video of how to use an EpiPen. Share this with family, friends and anyone who may look after your child with allergies. You can also get a trainer EpiPen to practice with safely.
How to use an Anapen
Anapen has a red button with a grey cap at one end and a black needle shield at the other. To use the Anapen, pull off the black needle shield first. This also removes the inner grey needle shield. Next pull of the grey safety cap from the red button end.
Hold the Anapen in your fist, with your thumb positioned close to the red button end. Anapen is administered in the same place as an EpiPen. Place the Anapen at the person’s outer mid thigh, half way between the hip and the knee. Keeping the leg still, hold the white end of the Anapen against the leg at a 90 degree angle. Hold the red button down firmly with your thumb until it clicks. Keep the Anapen in position for a full 3 seconds before removing from the thigh. You will need to be very careful of the exposed needle and put the Anapen aside safely.
As soon as you have administered the Anapen, you’ll need to call an ambulance.
Anapen can also be administered through a single layer of clothing, but avoiding thick seams or pockets.
For Anapens, remember “white end on leg, press thumb on red”. Learn how to properly administer an Anapen by watching the helpful video from Allergy & Anaphylaxis Australia. A&AA also sells Anapen trainer devices to practice with.
What do people with allergies think?
We spoke to people with allergies to ask their thoughts about EpiPen and Anapen and which they personally prefer. While some made a decision after discussion with their doctor about which would be most suitable, some people were not even aware that there were different adrenaline injectors available.
Why people prefer Epipen
The main reason people give for preferring EpiPen to Anapen are:
- familiarity;
- better packaging; and
- no exposed sharp needle after use.
More awareness of Epipen
Many people, especially those who have been dealing with allergies for a long time (before Anapen was available in Australia), prefer EpiPen. This is what they are familiar with and what they have always used. There is also a general perception that schools, members of the public and first responders are more aware of and familiar with EpiPen autoinjectors and how to use them. Many EpiPen users said they would be reluctant to change to Anapen because of this.
Anapen packaging concerns
Another issue for allergy sufferers was the packaging of the autoinjectors. EpiPens come in a clear case with a flip top lid, which helps protect the device while it is being carried. Anapen comes in a plastic tray inside the box, and does not have a case. The design of the Anapen means that pieces can become loose if not carried in the box. Some Anapen users leave the devices in the plastic case for added protection, but this makes them more bulky to carry and hard to fit in the most commonly available insulated medical bags. One suggestion is to put the Anapen inside a toothbrush case to protect it.
Another concern raised was that while EpiPens have clear instructions for use printed on the device, Anapen does not.
No exposed needle
After administering an EpiPen, the orange plastic shield on the lower part automatically extends to protect the exposed needle. This prevents accidental injury from needle sticks. There is no need to recap the device. Anapen on the other hand leaves the needle exposed after administration. Users need to be very careful not to touch the needle. Some people choose to replace the black needle shield manually, which can be risky. This difference was one of the most common reasons people chose EpiPen over Anapen.
Why people prefer Anapen
We found that people who prefer Anapen to EpiPen are more likely to be those who haven’t previously used EpiPens. These patients had been prescribed Anapen as their first autoinjector after an allergy diagnosis and were familiar with the device.
Another reason people prefer Anapen is because it is available in the larger 500 microgram dose, for people with a higher body weight (over 60kg). EpiPen is only available in 150 microgram (EpiPen Jr) and 300 microgram doses. Some people we spoke to were concerned that one EpiPen might not be adequate at higher weights and that Anapen’s larger dose might mean that it was less likely they would need to use a second autoinjector to treat an anaphylactic reaction. Often their doctor had recommended the switch to the larger dose Anapen based on weight.
Other reasons people preferred Anapen to EpiPen included that the Anapen was thinner, the simple red push button operation and a general dislike of the EpiPen manufacturer (Mylan).
Why you should be familiar with both brands
Regardless of whether you have EpiPens or Anapens, it’s really important that you know how to use both.
Sometimes there are supply issues with medications including EpiPens and Anapens, making it difficult to fill a prescription. This was a real problem in the past when only one brand of autoinjector was available. Now that there are 2 alternatives, you might need to substitute brands if your usual one is not available.
In an emergency you may need to administer whichever autoinjector is available to you. This might be for you, your child or if you are assisting another person. The autoinjector available at the time might be different to the brand you usually carry.
More about EpiPens and autoinjectors
If you have been prescribed EpiPen or Anapen for treating anaphylaxis, you’ll need to know how to look after your device. You can find lots of helpful tips for carrying, storing and learning about autoinjectors in our post Making Friends with Your EpiPen: How to Manage Your Allergy Medicine.
We also recommend that people with life threatening allergies take steps to alert others by:
- wearing a medical alert ID – there are so many different options available to suit everyone, including QR coded bands or sleeves for your smart watch band;
- recording your emergency medical information on your phone; and
- making use of a EpiPen or Anapen bag tag to let people know where your device is stored.
Another great tool for storing and sharing anaphylaxis action plans with others is the Allergy Pal App.
And don’t forget to subscribe for our updates with more helpful tips on living with allergies.
*Disclaimer: Allergy Spot does not provide medical advice. You should always consult a suitably qualified medical practitioner in respect of your own medical conditions, symptoms or concerns. See our Website Terms for more details.
