Are Expired EpiPens Still Effective?

Expired EpiPens may still remain effective, even many months after their stated expiration date, researchers reported in a small study.

In the past year, price increases in EpiPens have entered the national spotlight and sparked outrage. The prices of EpiPens have greatly increased (more than 400% since 2007), and some patients have struggled to afford replacing them. As a result, patients have begun questioning health care professionals about whether expired EpiPens can still be used.
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To allow health care professionals to better answer this question, researchers asked patients and practitioners at a community clinic to provide expired EpiPens that were not used. They analyzed 31 EpiPens (1 mg/mL epinephrine) and 9 EpiPen Jrs (0.5 mg/mL epinephrine) for color changes and expiration dates. The EpiPens had all expired in the past 1 to 50 months.

Using liquid chromatography-tandem mass spectrometry, the investigators quantitatively analyzed 2 separate aliquots of each EpiPen’s contents. They found that approximately 56% of the EpiPen Jrs and 65% of the EpiPens retained at least 90% of the labeled concentration of epinephrine. All the EpiPens that had expired up to 29 months before being evaluated still had 89% or more of the epinephrine listed on the package.

Notably, two EpiPens that had been expired for 50 months had 88% and 84% of the original amount of epinephrine.

"Although we observed declining concentrations of epinephrine over time, we expect that the dose available 50 months after expiration would still provide a beneficial pharmacologic response,” the study’s authors wrote.

“Thus, we conclude that the process for establishing expiration dates for EpiPens should be revised and that, in the setting of outpatient anaphylaxis without other therapeutic alternatives, patients and caregivers should consider the potential benefits of using an expired EpiPen," they stated.

—Lauren LeBano

Reference

Cantrell FL, Cantrell P, Wen A, Gerona R. Epinephrine concentrations in EpiPens after the expiration date [published online May 10, 2017]. Ann Intern Med.