You’ll hear buzz about Neffy, the first epinephrine NASAL SPRAY for treating severe allergic reactions including anaphylaxis.
We know that INJECTABLE epinephrine devices (EpiPen, etc) have been the go-to for decades. But many patients or caregivers fear needles, use these products incorrectly, etc...and shortages often crop up.
The thought is that a nasal form of epinephrine will reduce these barriers...so people don’t delay or avoid lifesaving treatment.
Evidence suggests epinephrine 2 mg nasal spray achieves similar blood levels and increases in BP and heart rate as injectable epinephrine.
But these data are in healthy patients NOT experiencing anaphylaxis...and real-world use of the nasal spray is limited.
Epinephrine 2 mg nasal spray is also only approved for patients who weigh 30 kg (66 lb) or more. But a 1 mg dose for children weighing 15 to 30 kg (33 to 66 lb) is being reviewed by FDA. Get patient weight with Rxs.
Expect your pharmacist to continue to recommend an epinephrine device based on patient preference, availability, and cost. The “best” product is the one that patients and caregivers are willing and able to use correctly.
Explain that a 2-pack costs about $710 for Neffy...$620 for the talking Auvi-Q...$300 for generic EpiPen...or $250 for Symjepi prefilled syringes. But most manufacturers have co-pay cards or assistance programs.
Be aware of other differences. For example, epinephrine 2 mg nasal spray has a shelf life of 30 months from date of manufacture...but most injection devices are labeled with an expiration of 15 to 20 months.
The nasal spray is also less sensitive to temperature excursions. It can withstand temps up to 122°F...or be thawed if inadvertently frozen.
When you dispense epinephrine nasal spray, pull in your pharmacist to train patients and caregivers on proper use. The single-use device is the same design as Narcan or Imitrex nasal spray...and contains 1 dose.
Patients or caregivers will need to hold the device with a thumb on the bottom of the plunger and a finger on each side of the nozzle...insert the nozzle fully into 1 nostril...and press the plunger to give a dose.
They should then call 911...since symptoms can recur after the initial reaction. A second dose of the nasal spray can be given in the SAME nostril 5 minutes after the first dose, if needed.
See our resource, Emergency Epinephrine Devices, for more on how products stack up and to order demos. And get our Managing Anaphylaxis FAQ for tips on recognizing symptoms, performing follow-up, etc.
- Ellis AK, Casale TB, Kaliner M, et al. Development of neffy, an Epinephrine Nasal Spray, for Severe Allergic Reactions. Pharmaceutics. 2024 Jun 14;16(6):811.
- Casale TB, Ellis AK, Nowak-Wegrzyn A, et al. Pharmacokinetics/pharmacodynamics of epinephrine after single and repeat administration of neffy, EpiPen, and manual intramuscular injection. J Allergy Clin Immunol. 2023 Dec;152(6):1587-1596.
- Ebisawa M, Lowenthal R, Tanimoto S, et al. neffy, epinephrine nasal spray, Demonstrates a Positive Efficacy and Safety Profile for the Treatment of Allergic Reactions in Pediatric Patients at-Risk of Anaphylaxis: Phase 3 Study Results. J Allergy Clin Immunol 2024 Feb;153(2):AB371.
- Medication pricing by Elsevier, accessed August 2024.