New Drugs and Devices From 2011 – 2012 That Might Change Your Practice

Joe Lex, MD


Western J Emerg Med. 2013;14(6):619-628. 

In This Article


This is a crossbreed between a drug, which is very old, and a device which is very new. First of all, do you call the drug adrenaline (or adrenalin) or epinephrine (or epinephrin)? It was in 1893 that George Oliver, a Harrogate physician, and Edward Schäfer, professor of physiology at University College London, demonstrated that the adrenal (or suprarenal) glands contained a substance with dramatic pharmacological effects. American physician John Abel named the crude adrenal extracts he prepared in 1897, calling them epinephrin, thinking that epinephris was the best name for the suprarenal capsule.

But none of Abel's epinephrin extracts behaved physiologically like adrenaline does. Jokichi Takamine visited Abel in 1901; afterward, he prepared a pure extract of the active principle from the adrenal gland and patented it. When Parke, Davis & Co marketed his extract, they used the proprietary name Adrenalin. Thus, epinephrine became the generic name in America.

For patients with a history of anaphylaxis and severe allergy, auto-injectors containing a dose of epinephrine between 300 and 500 μg at a 1:1000 concentration (commercial names EpiPen, Twinject, Adrenaclick, Anapen, Jext, and Allerject) have been available for decades. They are somewhat cumbersome to carry because of their size and shape. In times of great stress, such as after having a potential allergic exposure, the patient often forgets the instructions given at the time of distribution.

Auvi-Q® is an epinephrine auto-injector that is amere 3.5 inches tall by 2 inches wide and as thick as a cell phone. This makes it easy to carry in the pants back pocket or shirt pocket. As an advantage, it "talks" to you when you remove the cover, walking you through the process of injection and counting down the number of seconds to leave the device in place. The cost is about the same as other commercially-available devices. Thus, I do not know that it offers any advantage over other auto-injectors, which generally retail for $255 for 2 devices. A common complaint about the older devices is that they expire so quickly without being used, and users may be tempted to squeeze another year or two out of them. A study done in 2000 shows that they actually do lose efficacy over time.