FDA label 9fa83fd2-deeb-4996-8771-19f12e7ac629

5 WARNINGS AND PRECAUTIONS In conjunction with use, seek immediate medical or hospital care. ( ) • 5.1 Do not inject intravenously, into buttock, or into digits, hands, or feet. ( ) • 5.2 The presence of a sulfite in this product should not deter use. ( ) • 5.3 Administer with caution in patients with heart disease; may aggravate angina pectoris or produce ventricular arrhythmias. ( ) • 5.4 5.1 Emergency Treatment EpiPen and EpiPen Jr are intended for immediate administration as emergency supportive therapy and are not intended as a substitute for immediate medical care. More than two sequential doses of epinephrine should only be administered under direct medical supervision [ ]. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. see , and Indications and Usage (1) Dosage and Administration (2) Patient Counseling Information (17) 5.2 Incorrect Locations of Injection EpiPen and EpiPen Jr should be injected into the anterolateral aspect of the thigh [ ]. only see and Dosage and Administration (2) Patient Counseling Information (17) Large doses or accidental intravenous injection of epinephrine may result in cerebral hemorrhage due to sharp rise in blood pressure. Rapidly acting vasodilators can counteract the marked pressor effects of epinephrine if there is such inadvertent administration. • Do not inject intravenously. Injection into the buttock may not provide effective treatment of anaphylaxis. Advise the patient to go immediately to the nearest emergency room for further treatment of anaphylaxis. Additionally, injection into the buttock has been associated with gas gangrene. Cleansing with alcohol does not kill bacterial spores, and therefore, does not lower this risk. • Do not inject into buttock. Since epinephrine is a strong vasoconstrictor, accidental injection into the digits, hands or feet may result in loss of blood flow to the affected area. Advise the patient to go immediately to the nearest emergency room and to inform the healthcare provider in the emergency room of the location of the accidental injection. Treatment of such inadvertent administration should consist of vasodilation, in addition to further appropriate treatment of anaphylaxis [ ]. • Do not inject into digits, hands or feet. see Adverse Reactions (6) 5.3 Allergic Reactions Associated With Sulfite The presence of a sulfite in this product should not deter administration of the drug for treatment of serious allergic or other emergency situations even if the patient is sulfite-sensitive. Epinephrine is the preferred treatment for serious allergic reactions or other emergency situations even though this product contains sodium metabisulfite, a sulfite that may, in other products, cause allergic-type reactions including anaphylactic symptoms or life-threatening or less severe asthmatic episodes in certain susceptible persons. The alternatives to using epinephrine in a life-threatening situation may not be satisfactory. 5.4 Disease Interactions Some patients may be at greater risk for developing adverse reactions after epinephrine administration. Despite these concerns, it should be recognized that the presence of these conditions is not a contraindication to epinephrine administration in an acute, life-threatening situation. Therefore, patients with these conditions, and/or any other person who might be in a position to administer EpiPen or EpiPen Jr to a patient experiencing anaphylaxis should be carefully instructed in regard to the circumstances under which epinephrine should be used. Patients with Heart Disease • Epinephrine should be administered with caution to patients who have heart disease, including patients with cardiac arrhythmias, coronary artery or organic heart disease, or hypertension In such patients, or in patients who are on drugs that may sensitize the heart to arrhythmias epinephrine may precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias [ ]. . , see and Drug Interactions (7) Adverse Reactions (6) Other Patients and Diseases • Epinephrine should be administered with caution to patients with hyperthyroidism, diabetes, elderly individuals, and pregnant women. Patients with Parkinson’s disease may notice a temporary worsening of symptoms.

6 ADVERSE REACTIONS Due to the lack of randomized, controlled clinical trials of epinephrine for the treatment of anaphylaxis, the true incidence of adverse reactions associated with the systemic use of epinephrine is difficult to determine. Adverse reactions reported in observational trials, case reports, and studies are listed below. Common adverse reactions to systemically administered epinephrine include anxiety; apprehensiveness; restlessness; tremor; weakness; dizziness; sweating; palpitations; pallor; nausea and vomiting; headache; and/or respiratory difficulties. These symptoms occur in some persons receiving therapeutic doses of epinephrine, but are more likely to occur in patients with hypertension or hyperthyroidism [ ]. see Warnings and Precautions (5.4) Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or those receiving certain drugs [ ]. see and Warnings and Precautions (5.4) Drug Interactions (7) Rapid rises in blood pressure have produced cerebral hemorrhage, particularly in elderly patients with cardiovascular disease [ ]. see Warnings and Precautions (5.4) Angina may occur in patients with coronary artery disease [ ]. see Warnings and Precautions (5.4) Accidental injection into the digits, hands or feet may result in loss of blood flow to the affected area [ ]. see Warnings and Precautions (5.2) Adverse events experienced as a result of accidental injections may include increased heart rate, local reactions including injection site pallor, coldness and hypoesthesia or injury at the injection site resulting in bruising, bleeding, discoloration, erythema or skeletal injury. Injection into the buttock has resulted in cases of gas gangrene [ ] see Warnings and Precautions (5.4) . Adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties. ( ) 6 To report SUSPECTED ADVERSE REACTIONS, contact Mylan Specialty, L.P. at 1-877-446-3679 (1-877-4-INFO-RX) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.