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Letters |20 June 2017

Epinephrine Concentrations in EpiPens After the Expiration Date

F. Lee Cantrell, PharmD; Patricia Cantrell, MD; Anita Wen, BS; Roy Gerona, PhD

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This article was published at Annals.org on 9 May 2017.
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Background: Interest and outrage have been mounting over dramatic price increases for the emergency-use epinephrine autoinjection device EpiPen (Mylan). Since 2007, the price of this potentially lifesaving medication has risen more than 400%. This sharp increase has caused patients to ask health care practitioners whether they can use expired EpiPens because they cannot afford to replace them.
Objective: To determine whether EpiPens expired up to 50 months retain their stated potency.
Methods: Over 2 weeks, patients and practitioners at a community clinic were asked to provide unused, expired EpiPens. All pens were examined for color changes and expiration date. Two separate aliquots of each EpiPen's content were quantitatively analyzed for epinephrine concentrations by liquid chromatography (Agilent 1260 Infinity II LC, Agilent Technologies)–tandem mass spectrometry (Triple Quad 5500, AB SCIEX). Epinephrine was monitored using 2 transitions (mass–charge ratio, 184.1 to 107.0 and 184.1 to 166.0) and quantified by isotope dilution using epinephrine-d6 as an internal standard.
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Cantrell FL, Cantrell P, Wen A, Gerona R. Epinephrine Concentrations in EpiPens After the Expiration Date. Ann Intern Med. 2017;166:918–919. doi: 10.7326/L16-0612

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Published: Ann Intern Med. 2017;166(12):918-919.

DOI: 10.7326/L16-0612

Published at www.annals.org on 9 May 2017

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2017 American College of Physicians
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