Rising Prescription Rates of Self-injectable Epinephrine in a Tertiary Referral Center

RATIONALE:

There has been a significant increase in the rate of self-injectable epinephrine at West LA VA Medical Center over the last decade. Our study investigates the sources of and indications for these prescriptions.

METHODS:

This is a retrospective chart review of prescribed self-injectable epinephrine prescriptions at the West LA VA medical center and satellite clinics, comparing prescriptions from 2013-2014 to 2002-2003. Data was collected pertaining to initial prescribing clinic and indication for prescriptions.

RESULTS:

There was a 4-fold increase in unique self-injectable epinephrine prescriptions in a 10-year period (703 in 2013-2014, up from 172 in 2002-2003). The majority of 2013-2014 prescriptions originated from primary care clinics (43%); primary care clinics also represented the largest increase in prescriptions with a 372% increase in prescription rate (302 up from 64 in 2002-2003). Adverse reaction to food was the leading indication for prescriptions in 2013-2014, accounting for 35.6% of prescriptions (250 total), up from 19.8% in 2002-2013 (34 total). Of note, 7.1% of 2013-2014 prescriptions (50 total) had no associated record of the indication for prescription; all 50 of these prescriptions originated from primary care clinics.

CONCLUSIONS:

There has been a significant rise in the rate of self-injectable epinephrine in the last decade, with especially notable increases in prescriptions from primary care clinicians and prescriptions for adverse reactions to food. However, given the significant cost of self-injectable epinephrine devices and their potential adverse effects, it is important to thoroughly evaluate and document the necessity of these prescriptions.