Imagine taking a bite of your favorite food and suddenly struggling to breathe. Your throat tightens, your heart races, and panic sets in. This could be anaphylaxis — a life-threatening allergic reaction. That’s why people with severe food allergies often carry an epinephrine auto-injector. This small device delivers a lifesaving dose of medication that can stop the reaction and keep you stable until emergency help arrives. Without fast treatment, anaphylaxis can block breathing and cause a sharp drop in blood pressure, leading to a medical emergency called anaphylactic shock.

The main treatment for anaphylaxis is epinephrine, which works by raising blood pressure and opening the airways to improve breathing. Epinephrine auto-injectors are single-use devices designed for quick and easy administration. Knowing how to use yours correctly is crucial, as it could make the difference between life and death in an emergency.

If you’re new to epinephrine auto-injectors, you might be curious about their cost, use, and storage. Below are eight questions you might have about epinephrine auto-injectors.

1. How Much Does an Epinephrine Auto-Injector Cost?

The most common brand of epinephrine auto-injector in the United States is the EpiPen (with the EpiPen Jr. available for children). In some areas of the United States, the full cost of an EpiPen set without insurance can be more than $600. EpiPens are sold in sets of two, as a second dose may be necessary to stabilize an allergic reaction.

In some areas of the United States, the full cost of an EpiPen without insurance can be more than $600.

If you have insurance, some plans will completely cover EpiPens. If not, manufacturer coupons may help lower the cost. If you don’t have insurance, the manufacturer offers a patient assistance program that provides epinephrine auto-injectors for free, but you must apply and be approved first.

There are other types of epinephrine auto-injectors on the market. Other brand-name epinephrine auto-injectors include Adrenaclick, Auvi-Q, and Symjepi, and authorized generic versions are also available. These brands may cost less or even be free for people with commercial insurance, which is health coverage from a job or a private company.

Whichever epinephrine auto-injector is affordable for you, make sure that you know how your injector works. Many auto-injectors come with practice devices, so make sure to use the one for your particular device. You can also ask your doctor for a tutorial on how to use your device.

2. Can You Use an Epinephrine Auto-Injector Through Clothes?

Epinephrine auto-injections are supposed to be administered into the muscle of the outer thigh. Because there’s often no time to remove clothing in an emergency, you may be curious if you can use an EpiPen through jeans or other pants. Fortunately, you can administer an epinephrine injection through clothes, even jeans. Avoid injecting through seams and pockets.

You can administer an epinephrine injection through clothes, even jeans. Avoid injecting through seams and pockets.

3. What Color Should the Liquid in an Epinephrine Auto-Injector Be?

The liquid in your epinephrine auto-injector should be clear. If the liquid has turned pink, brown, or cloudy, or if particles are floating in the liquid, it’s time for a new injector.

4. Can You Use an Expired Epinephrine Auto-Injector?

You may have wondered, “Does epinephrine expire?” The answer is yes. To ensure your safety, replace your epinephrine auto-injectors before they reach their expiration dates, which is usually about 18 months after manufacture.

However, if it’s an emergency and the choice is between an expired epinephrine auto-injector and no dosage at all, the expired auto-injector is almost always the best option — as long as the liquid inside is clear. If the liquid is discolored or cloudy or contains particles, do not use it. Epinephrine does decay quickly, but in some cases, it may still provide benefit. During a shortage of epinephrine auto-injectors in 2018, the U.S. Food and Drug Administration (FDA) approved a four-month expiration extension.

Replace your epinephrine auto-injectors before they reach their expiration dates. However, if it’s an emergency and the choice is between an expired epinephrine auto-injector and no dosage at all, the expired auto-injector is almost always always the best pick.

5. How Should You Store an Epinephrine Auto-Injector?

Ideally, you should keep your epinephrine auto-injector at room temperature — 68 to 77 degrees Fahrenheit (20 to 25 degrees Celsius). Avoid exposing it to extreme heat or cold, as temperature changes can reduce its effectiveness. A small study found that leaving epinephrine auto-injectors in a hot car for 12 hours reduced the concentration of epinephrine in the injection device.

However, healthcare professionals recommend having your epinephrine auto-injector on you at all times — and life isn’t climate-controlled. Investing in an insulated medication case can keep your injectors cool even in hot weather. Do not store epinephrine auto-injectors in the refrigerator or freezer, as this can also affect their effectiveness.

6. Can You Use an Epinephrine Auto-Injector if It Accidentally Went in the Washing Machine?

If you place your epinephrine auto-injector in a shirt or pants pocket, it can be easy to forget and send it through the wash. Unfortunately, epinephrine auto-injectors aren’t waterproof. Researchers tested epinephrine auto-injectors sent through a washing machine and found that excess liquid got into the injector, affecting the epinephrine concentration. In addition, some of the injectors didn’t work properly.

7. Can You Take an Epinephrine Auto-Injector on a Plane?

Epinephrine auto-injectors are completely safe to carry onto a plane. Keep them in your carry-on or hand luggage. It’s safe to send your epinephrine auto-injectors through the X-ray machine at the airport. The radiation is too low to affect the active ingredients. In addition, using the X-ray machine instead of requesting a hand inspection prevents security services from possibly mishandling and triggering the auto-injectors.

If you’re flying out of an American airport and your luggage is inspected, the Transportation Security Administration may need to see the prescription label. For safety’s sake, it’s best to keep your auto-injector in the box it came in, as that should have the prescription label and also reduces the risk of accidental injury.

Once you board the plane, make sure that your epinephrine auto-injector is on hand and not in the overhead bin. This way, you have what you need if you’re exposed to an allergen like peanuts on the plane.

8. How Do You Dispose of an Epinephrine Auto-Injector?

After you use your epinephrine auto-injector, throw it away safely. The FDA classifies these devices as “sharps” — medical items with needles or sharp edges that require special handling. You can take your used injector to a hospital or doctor’s office, where they can dispose of it properly.

Ask Your Doctor

Epinephrine auto-injectors can be lifesaving, but they come with important rules for storage, use, and disposal. If you have severe allergies, talk to your doctor about which auto-injector is best for you and how to use it correctly. They can also help you find financial assistance programs if cost is a concern. Being prepared and informed can make all the difference in an emergency.

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