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Medication Spotlight: Emerade

Drug shortages have always existed for the longest time, but it seems that they are occurring more frequently. In the past, patients who were at risk for anaphylactic allergic reactions had only one option - the Epipen. Back-ordered situations meant that there was no readily administered alternatives. Recently, Allerject had returned to the Canadian market, and now, patients will have less to worry about because they now have access to a third epinephrine product called Emerade.


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Dosing:


Emerade has three dose strengths, namely 0.15 mg, 0.3 mg and new to the market, 0.5 mg.

For children between 15 to 30 kg, the dose should be 0.15 mg. For children, adolescents and adults between 30 and 60 kg, the dose should be 0.3 mg. Finally, for adolescents and adults above 60 kg, the dose can be either 0.3 mg or 0.5 mg based on clinical expertise. Note: 0.5 mg is not approved for use in children, but ok in adolescents (what is age definition of adolescent?).


Since epinephrine is largely dosed based on weight up to 0.01 mg/kg, it makes sense that there is a 0.5 mg option to appropriately treat patients.


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How to Administer:

  1. Remove needle shield. It can be injected through clothing.

  2. Press the exposed opening intramuscularly into the anterolateral thigh area until you hear a click.

  3. Hold for 5 seconds. The shield protects the needle after use.

  4. Seek medical attention.

  5. A second dose may be administered in 5 to 15 minutes.

The manufacturer says that Emerade has less chance of accidental thumb injection compared to Epipen because the needle opening is obvious (compared to Epipen, where there are two ends - orange is the needle opening, blue is the top but patients sometimes mix them up).

Patients should always be reminded to seek medical attention after using Emerade since the effect is short-lived and the reaction may return.


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Final Reminders:

Common adverse effects include tachycardia, sweating, tremor, dizziness, anxiety and headache. The use of alpha and beta blockers may blunt the response to epinephrine (since it is a beta agonist).




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