Adrenaline / Epinephrine

• Injection 1 in 1000 - 0.5ml, 1ml (£1.06 = 1ml amp)
• Jext auto-injector 150 microgram dose, 300 microgram dose (£53.80)
• Epipen auto-injector 300 microgram dose (£53.80)
• Epipen Junior auto-injector 150 microgram dose (£53.80)

Indications

• Emergency treatment of acute anaphylaxis

Notes

1. Prescribe by brand. Patient familiarity with one brand is important; instructions for use vary between preparations and patient training is required (see note 4).
2. National Patient Safety Alert (09 May 2023): All 300microgram and 500microgram Emerade auto-injectors are being recalled due to an issue being identified where some fail to deliver the product or activate prematurely. Patients should be prescribed an alternative brand, ensure they are given appropriate training on how to use the new device as the different brands work differently (see note 4).
3. MHRA Drug Safety Update (November 2021): Adrenaline auto-injectors: reminder for prescribers to support safe and effective use
   1. for each adrenaline auto-injector, follow advice in the Summary of Product Characteristics to prescribe appropriate doses for individual patients (see section on dosing considerations)
   2. remind patients to follow existing advice to carry 2 in-date adrenaline auto-injectors with them at all times and to replace them before they expire
   3. provide patients and their caregivers with training and advice specific to their prescribed adrenaline auto-injector; encourage them to order a trainer device from the manufacturer to ensure they are familiar with using their auto-injector (see note 5)
4. MHRA Drug Safety Update (June 2023): Adrenaline auto-injectors (AAIs): new guidance and resources for safe use
   1. A toolkit of resources is available to inform patients and caregivers what do if they suspect anaphylaxis and how to use adrenaline auto-injectors, including an infographic and video.
5. Links for educational materials (including how-to videos, guides, trainer pen ordering, expiry alert service, etc.):
   1. Jext: eMC risk materials (150micrograms / 300micrograms)
   2. EpiPen: eMC risk materials (150micrograms / 300micrograms)

Angioedema

The NHS Commissioning Board (NHS CB) will commission the use of injected treatments for acute severe attacks in hereditary angioedema (all ages) (see NHS CB Commissioning Policy for more details).

NHS England (NHSE) will commission plasma-derived C1-esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II (see NHSE Commissioning Policy for more details).

Berinert

(Human C1-esterase Inhibitor)

• Powder and solvent for solution for injection / infusion 500IU vial

Indications

• Hereditary angioedema

Notes

1. For use in North Devon District Hospital only
2. The administration of C1-esterase inhibitor, an endogenous complement blocker derived from human plasma (in fresh frozen plasma or in a partially purified form) can terminate acute attacks of hereditary angioedema but is not practical for long-term prophylaxis.

Berotralstat

• Capsules 150mg

Notes

1. NICE TA738: Berotralstat (Orladeyo) is recommended as an option for preventing recurrent attacks of hereditary angioedema in people 12 years and older (October 2021), only if:
   1. they have at least 2 attacks per month, and
   2. it is stopped if the number of attacks per month does not reduce by at least 50% after 3 months
   3. It is only recommended if the company provides berotralstat according to the commercial arrangement.

Cinryze

(Human C1-esterase inhibitor)

• Powder and solvent for solution for injection 500IU vial

Indications

• Hereditary angioedema

Ruconest

(Conestat alfa)

• Powder for solution for injection 2100U

Indications

• Acute angioedema attacks in adults and adolescents with hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency

Firazyr

(Icatibant)

• Solution for injection in pre-filled syringe 30mg/3ml

Indications

• Acute attacks of hereditary angioedema (HAE) in adults, adolescents and children aged 2 years and older, with C1-esterase-inhibitor deficiency

Lanadelumab

• Solution for injection 300mg

Notes

1. NICE TA606: Lanadelumab (Takhzyro) is recommended as an option for preventing recurrent attacks of hereditary angioedema in people aged 12 and older, only when the criteria of the NICE TA are met (October 2019).