Auvi-Q injection for emergency treatment of anaphylaxis

Auvi-Q is an injectable epinephrine autoinjector used for the emergency treatment of life-threatening allergic reactions (anaphylaxis) in adults and children weighing 7.5 kg or more. It delivers fixed doses and is designed for immediate intramuscular or subcutaneous administration into the thigh.

Auvi-Q is indicated for the emergency treatment of type I allergic reactions, including anaphylaxis, in adult and pediatric patients weighing 7.5 kg or greater. It is intended for immediate self-administration or caregiver administration during an allergic emergency to rapidly reverse severe allergic symptoms.

Epinephrine

Epinephrine, the active ingredient in Auvi-Q, is a non-selective alpha and beta-adrenergic receptor agonist. It works by constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing swelling and hives caused by allergic reactions.

Recommended dosage by weight:

• 7.5 kg to less than 15 kg: 0.1 mg
• 15 kg to less than 30 kg: 0.15 mg
• 30 kg or greater: 0.3 mg

Administer Auvi-Q intramuscularly or subcutaneously into the anterolateral aspect of the thigh, through clothing if necessary. If symptoms do not improve or worsen, a second dose can be given 5 minutes after the first. More than two sequential doses require direct medical supervision. Patients should have immediate access to two Auvi-Q autoinjectors at all times.

Each device contains a single fixed dose and is for one-time use only. For patients needing doses lower than 0.1 mg, use other injectable epinephrine forms.

None reported for Auvi-Q.

Important warnings and precautions:

• Do not inject intravenously or into the buttocks, fingers, hands, or feet due to risks of serious adverse effects including ineffective treatment, tissue damage, or cerebral hemorrhage.
• Hold the leg firmly during injection in young children to prevent injury from movement.
• Rare cases of serious skin and soft tissue infections (including necrotizing fasciitis and gas gangrene) have occurred at injection sites; avoid buttock injections to reduce this risk.
• Use caution in patients with heart disease, cardiac arrhythmias, hypertension, or conditions such as hyperthyroidism, Parkinson's disease, diabetes, and renal impairment, as epinephrine can worsen these conditions.
• Despite containing sodium bisulfite, a sulfite known to cause allergic reactions in some, the presence of sulfite should not deter use in life-threatening allergic emergencies.

Common and serious side effects:

• Anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating
• Palpitations, pallor, nausea, vomiting, headache, respiratory difficulties
• Cardiac arrhythmias including tachycardia, ventricular ectopy, and potentially fatal ventricular fibrillation
• Serious injection site infections including necrotizing fasciitis and myonecrosis
• Hypertension, cerebral hemorrhage (especially with accidental intravenous injection)

Drug interactions to be aware of:

• Cardiac glycosides, diuretics, and anti-arrhythmics may increase risk of cardiac arrhythmias when used with epinephrine.
• Tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine, certain antihistamines, and catechol-O-methyl transferase inhibitors may potentiate epinephrine effects.
• Beta-adrenergic blockers (e.g., propranolol) can antagonize epinephrine’s cardiostimulating and bronchodilating effects.
• Alpha-adrenergic blockers (e.g., phentolamine) can antagonize vasoconstricting and hypertensive effects of epinephrine.
• Ergot alkaloids may reverse the pressor effects of epinephrine.

Pregnancy:

Long-term use of epinephrine in pregnant women has not been associated with major birth defects or adverse maternal/fetal outcomes. Animal studies have shown teratogenicity at doses many times higher than human therapeutic levels. Anaphylaxis itself poses serious risks to mother and fetus, so epinephrine treatment should not be delayed during pregnancy.

Lactation:

There is no data on epinephrine presence in human milk, but transfer is expected to be low due to poor oral bioavailability and short half-life. Breastfeeding should not be delayed during treatment of anaphylaxis.

Overdose or accidental intravenous administration of epinephrine can cause a dangerous, sharp rise in blood pressure leading to cerebral hemorrhage. Treatment involves supportive care and may include rapidly acting vasodilators to counteract vasoconstriction.

Store Auvi-Q as instructed by the manufacturer. Visually inspect the solution through the viewing window for particulate matter, cloudiness, or discoloration prior to use.