Researchers Examine Prescribing Trends for Epinephrine

The significant cost increases of self-injectable epinephrine grabbed headlines recently, leading researchers to investigate prescription trends in a tertiary referral center in Los Angeles. Fonda Jiang, MD, VA Greater Los Angeles Allergy and Immunology, and colleagues, presented the study during the 2017 AAAAI Annual Meeting.

The researchers conducted a retrospective chart review of prescribed self-injectable epinephrine prescriptions at the West Los Angeles VA medical center and satellite clinics, with a focus on data pertaining to initial prescribing clinic, length of active prescription, and indication for prescriptions.

A total of 268 prescriptions for epinephrine were identified within a one-year period. After removing prescriptions filled multiple times by patients, Dr Jiang and colleagues narrowed the total to 172 unique prescriptions. The average length of prescription per patient was 1.45 years. The study showed that the majority of prescriptions originated from either an allergy or primary care clinic (40.7% and 37.2%, respectively). Venom hypersensitivity and food allergies topped the list as the two leading indications for self-injectable epinephrine (41.3% and 19.8%, respectively). Another 24 (14%) self-injectable epinephrine prescriptions were written for angioedema, of which eight (4.7%) prescriptions were for angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) induced angioedema.

While most of the self-injectable epinephrine prescriptions were prescribed for venom and food allergies from an allergy or primary clinic, the researchers noted that self-injectable epinephrine is not indicated for ACE inhibitor/ARB induced angioedema. “This serves as a reminder [that] self-injectable epinephrine should only be prescribed when indicated and appropriate particularly in light of its significant cost,” wrote the researchers. —Eileen Koutnik-Fotopoulos