Emerade
Adrenaline (Epinephrine) Auto-Injector for Emergency Treatment of Anaphylaxis
Quick Facts About Emerade
Key Takeaways About Emerade
- Life-saving emergency medication: Emerade delivers adrenaline (epinephrine) to reverse the cardiovascular collapse and airway constriction of anaphylaxis within minutes
- Always carry two pens: A single dose may not fully reverse a severe reaction — if symptoms persist or worsen after 5–15 minutes, use the second pen
- Inject into outer thigh only: Press firmly at a 90° angle against the outer thigh (through clothing if needed), hold for 5 seconds — never inject into the buttocks, hands, or feet
- Call emergency services after every use: Even if you feel better, anaphylaxis can recur (biphasic reaction) — always seek hospital observation
- Store correctly and check regularly: Keep below 25°C, do not freeze, and inspect the solution regularly — replace if expired, discoloured, or damaged
What Is Emerade and What Is It Used For?
Emerade is an adrenaline (epinephrine) auto-injector pen designed for the emergency treatment of life-threatening allergic reactions (anaphylaxis). It contains a pre-measured dose of adrenaline in solution for intramuscular injection, and is intended for immediate self-administration at the first signs of a severe allergic reaction.
Anaphylaxis is a rapid-onset, potentially fatal systemic allergic reaction that can affect multiple organ systems simultaneously. It occurs when the immune system overreacts to a substance (allergen) that is usually harmless to most people. The most common triggers include certain foods (such as peanuts, tree nuts, shellfish, eggs, and milk), medications (particularly antibiotics and non-steroidal anti-inflammatory drugs), insect stings or bites (from bees, wasps, and ants), latex, and exercise. In some cases, the trigger remains unknown, a condition known as idiopathic anaphylaxis.
Adrenaline is the first-line treatment for anaphylaxis, as recommended by the World Health Organization (WHO), the European Academy of Allergy and Clinical Immunology (EAACI), the World Allergy Organization (WAO), and the American Academy of Allergy, Asthma and Immunology (AAAAI). It works by stimulating both alpha and beta adrenergic receptors throughout the body, producing several critical effects that counteract the physiological cascade of anaphylaxis.
When injected intramuscularly, adrenaline causes vasoconstriction (narrowing of blood vessels), which reverses the dangerous drop in blood pressure that characterises anaphylactic shock. It also causes bronchodilation (widening of the airways), which relieves the severe breathing difficulties that can occur. Additionally, it stimulates the heart, increasing its rate and force of contraction, and reduces swelling (oedema) and hives (urticaria) by stabilising mast cells and reducing histamine release.
The Emerade device has been specifically designed for ease of use in emergency situations, even by people who have no medical training. Unlike some other auto-injectors, Emerade features a longer needle (16 mm for the 150 µg pen and 23 mm for the 300 µg and 500 µg pens) to help ensure intramuscular delivery, which is particularly important in patients with a thicker layer of subcutaneous fat. The pen is activated by pressing it firmly against the outer thigh — there is no need to remove a safety cap and then press a button as separate steps.
Adrenaline (also known as epinephrine) is included on the WHO Model List of Essential Medicines, reflecting its critical importance in global healthcare. Emerade is one of several adrenaline auto-injector brands available internationally, alongside EpiPen, Jext, and Anapen. All contain the same active ingredient and serve the same purpose, but differ in their injection mechanism and device design.
What Should You Know Before Using Emerade?
Emerade can always be used in a life-threatening allergic emergency, regardless of other medical conditions. However, certain conditions may increase the risk of side effects, so your doctor should be informed of your complete medical history. Your doctor will explain when and how to use Emerade.
Contraindications
There are no absolute contraindications to the use of adrenaline in a life-threatening anaphylactic emergency. The benefit of treating anaphylaxis always outweighs any potential risk. However, if you are allergic (hypersensitive) to sodium metabisulfite or any other excipient in Emerade, your doctor should instruct you about the specific circumstances under which Emerade should be used. Sodium metabisulfite, an antioxidant preservative in the formulation, can rarely cause severe hypersensitivity reactions and bronchospasm in susceptible individuals.
Warnings and Precautions
Talk to your doctor before using Emerade if you have any of the following conditions, as adrenaline may have more pronounced effects or require closer monitoring:
- Heart disease – adrenaline increases heart rate and cardiac workload, which could worsen certain cardiac conditions such as coronary artery disease, arrhythmias, or cardiomyopathy
- High blood pressure (hypertension) – adrenaline causes vasoconstriction, which can further elevate blood pressure
- Overactive thyroid (hyperthyroidism) – the cardiovascular effects of adrenaline may be enhanced in patients with thyroid disorders
- Diabetes – adrenaline can raise blood sugar levels; monitor blood glucose carefully after use
- Adrenal gland tumour (phaeochromocytoma) – may cause a dangerous hypertensive crisis
- Raised pressure in the eye (glaucoma) – adrenaline can further increase intraocular pressure
- Impaired kidney function – may affect adrenaline clearance from the body
- Prostate disease – adrenaline may worsen urinary retention
- Low potassium or high calcium levels in the blood – may increase the risk of cardiac arrhythmias
If you have asthma, you may be at increased risk of a severe allergic reaction. Ensure your asthma is well controlled and that you always carry your Emerade pens with you.
All patients who have experienced anaphylaxis should visit their doctor for allergy testing to identify the specific allergens involved. Knowing your triggers is essential for avoidance strategies. If you have food allergies, it is critical to check the ingredients in everything you eat and drink, including medications, as even trace amounts can cause severe reactions.
Accidental injection into the hands or feet can cause reduced blood flow to these areas due to vasoconstriction. Seek immediate medical attention if accidental injection into the hands, feet, or digits occurs. The Emerade pen should only be injected into the outer thigh. Do not inject into the buttocks, as there is a risk of accidentally injecting into a blood vessel.
Use in Children
Emerade should not be used in children weighing less than 15 kg. A dose below 150 micrograms cannot be administered with sufficient accuracy using this device, so its use is not recommended for very young children unless in a life-threatening situation and on medical advice. For children weighing 15–30 kg, the 150 µg pen is appropriate. For children weighing over 30 kg, the 300 µg pen should be used. The 500 µg pen is not recommended for children.
Pregnancy and Breastfeeding
There is limited clinical experience with the use of adrenaline during pregnancy. If you are pregnant, do not hesitate to use Emerade in a life-threatening allergic emergency, as your life and the life of your unborn child may be at risk. The potential benefits of treating anaphylaxis far outweigh any theoretical risks to the pregnancy.
If you are elderly or pregnant, the risk of side effects from adrenaline may be slightly increased. Your doctor will take this into account when prescribing Emerade and will advise you on appropriate use.
You can breastfeed after using Emerade. Adrenaline is rapidly metabolised in the body, and any amount that might pass into breast milk is expected to be negligible and would be broken down in the infant's digestive system.
Driving and Operating Machinery
An injection of adrenaline itself does not affect driving ability. However, a severe anaphylactic reaction can significantly impair your capacity to drive or operate machinery due to dizziness, confusion, and loss of consciousness. If you have experienced anaphylaxis, do not drive until you have been assessed and discharged by medical professionals.
How Does Emerade Interact with Other Drugs?
Several medications can either enhance or reduce the effects of adrenaline. Tell your doctor about all medicines you are currently taking, including prescription drugs, over-the-counter medicines, and herbal supplements. However, in a life-threatening emergency, Emerade should always be used regardless of other medications.
Drug interactions with adrenaline are clinically significant because they can alter its cardiovascular and metabolic effects. Some interactions may intensify the effects of adrenaline (increasing the risk of side effects such as dangerously high blood pressure or cardiac arrhythmias), while others may reduce its effectiveness in treating anaphylaxis.
Major Interactions
| Drug Class | Examples | Effect on Adrenaline | Clinical Significance |
|---|---|---|---|
| Tricyclic antidepressants | Amitriptyline, nortriptyline, imipramine | Enhanced effect | May cause severe hypertension and cardiac arrhythmias |
| MAO inhibitors | Phenelzine, tranylcypromine, moclobemide | Enhanced effect | Inhibit adrenaline breakdown; risk of hypertensive crisis |
| COMT inhibitors | Entacapone, tolcapone (Parkinson's drugs) | Enhanced effect | Inhibit adrenaline metabolism; prolonged and intensified effects |
| Beta-blockers | Propranolol, atenolol, metoprolol | Reduced effect | May reduce bronchodilation and cardiac stimulation; anaphylaxis may be more severe and harder to treat |
| Alpha-blockers | Doxazosin, tamsulosin, prazosin | Reduced effect | May reduce the vasoconstrictive effects of adrenaline |
| Cardiac glycosides | Digoxin, digitoxin | Increased arrhythmia risk | Both drugs can cause cardiac arrhythmias; combined use increases risk |
| Quinidine | Quinidine sulfate | Increased arrhythmia risk | May cause irregular heartbeat when combined with adrenaline |
Interaction with Diabetes Medications
Patients with diabetes should be aware that adrenaline can significantly raise blood sugar levels by stimulating glycogenolysis (the breakdown of glycogen into glucose) and inhibiting insulin secretion. After using Emerade, you should monitor your blood glucose levels carefully and adjust your diabetes medication as needed under medical guidance. This effect is temporary but can be clinically significant, particularly in patients with type 1 diabetes.
What Is the Correct Dosage of Emerade?
The dose of Emerade is determined by your doctor based on your body weight. Emerade is available in three strengths: 150 micrograms for children 15–30 kg, 300 micrograms for adults under 60 kg and children over 30 kg, and 500 micrograms for adults over 60 kg. Always use Emerade exactly as prescribed.
Your doctor will prescribe the appropriate Emerade strength based on your individual circumstances, primarily your body weight. It is critical that you understand how to use your Emerade pen before you ever need it in an emergency. Practice with a trainer pen (which contains no needle or medication) so that the technique becomes second nature.
Adults
Adults weighing less than 60 kg
The usual dose is 300 micrograms (Emerade 300), delivering 0.3 ml of 1 mg/ml adrenaline solution.
Adults weighing more than 60 kg
The usual dose is 300 to 500 micrograms (Emerade 300 or Emerade 500). Your doctor will determine which strength is most appropriate based on your weight, risk factors, and clinical history.
Children and Adolescents
Children weighing 15–30 kg
The usual dose is 150 micrograms (Emerade 150), delivering 0.15 ml of adrenaline solution. The 150 µg pen has a shorter exposed needle length of 16 mm.
Children weighing more than 30 kg
The usual dose is 300 micrograms (Emerade 300), following the same dosing recommendations as for adults.
Adolescents weighing more than 30 kg
Follow the adult dosing recommendations. Emerade 500 is not recommended for use in children or young adolescents.
| Patient Group | Body Weight | Dose | Needle Length |
|---|---|---|---|
| Children | 15–30 kg | 150 µg | 16 mm |
| Children / Adolescents | > 30 kg | 300 µg | 23 mm |
| Adults | < 60 kg | 300 µg | 23 mm |
| Adults | > 60 kg | 300–500 µg | 23 mm |
How to Use Emerade
The following instructions must be followed carefully to ensure correct injection. It is recommended that your family members, caregivers, or teachers also receive instruction in the correct use of Emerade.
- Remove the cap from the Emerade pen. Do not remove the cap until you are ready to use the device.
- Place Emerade against the outer thigh at a 90-degree angle. Press firmly so that the needle guard is pushed in. You will hear a click when the pen has been activated and the needle has penetrated the thigh. The injection can be given through clothing.
- Hold Emerade with steady pressure against the thigh for 5 seconds. Gently massage the injection site afterwards.
- Call emergency services immediately. State “anaphylaxis” even if you begin to feel better. You will need to go to hospital for observation and further treatment as needed, because the reaction can recur later (biphasic anaphylaxis). Take your used pen with you to the hospital.
If the Emerade pen does not activate on the first attempt, immediately apply increased force when pressing the pen against the injection site. If the injection still fails, use your second pen immediately. This is one of the key reasons why you should always carry two Emerade pens.
When to Use a Second Dose
Sometimes a single dose of adrenaline is not sufficient to fully reverse a severe allergic reaction. If your symptoms have not improved or have worsened within 5–15 minutes after the first injection, you or the person with you should administer a second injection using the second Emerade pen. For this reason, your doctor will typically prescribe two pens, and you should always carry both with you.
While waiting for emergency services, you should lie down with your feet raised unless this makes you short of breath, in which case you should sit up. Unconscious patients should be placed in the recovery position. Do not stand up or walk around, as this can worsen cardiovascular collapse.
Overdose
If you have injected too much adrenaline, accidentally injected into a blood vessel, injected into a hand or foot, or if a child has accidentally received a dose, contact emergency services immediately. Adrenaline overdose can cause a sudden and dangerous rise in blood pressure, irregular heartbeat (cardiac arrhythmias), and fluid accumulation in the lungs (pulmonary oedema) that may cause severe breathing difficulties. Hospital treatment may include blood pressure monitoring and administration of alpha-blocking agents or vasodilators.
Checking if Your Pen Has Been Activated
After using Emerade, you can verify successful activation by checking two indicators. First, the needle guard will be visibly extended (longer than its normal position). Second, by lifting the label on the pen to reveal the viewing window, you should see a coloured piston rod instead of clear solution:
- Emerade 150 µg: yellow piston rod
- Emerade 300 µg: green piston rod
- Emerade 500 µg: blue piston rod
If the viewing window still shows clear liquid (adrenaline solution) and the needle guard has not extended, the pen has not delivered its dose. Use your second pen immediately.
What Are the Side Effects of Emerade?
Like all medicines, Emerade can cause side effects, although not everyone experiences them. Most side effects are related to the pharmacological actions of adrenaline and are typically short-lived. The benefits of treating anaphylaxis always outweigh the potential side effects of adrenaline.
The side effects listed below are based on clinical experience with adrenaline (epinephrine) treatment across all formulations. Because Emerade is used in emergency situations where the patient is already experiencing anaphylaxis, it can be difficult to distinguish side effects of the medication from symptoms of the allergic reaction itself. The exact frequency of each side effect cannot be calculated from available data.
Cardiovascular Effects
Commonly reported
- Rapid heartbeat (tachycardia) or palpitations
- Irregular heartbeat (cardiac arrhythmias)
- Chest pain or tightness
- High blood pressure (hypertension)
- Vasoconstriction (narrowing of blood vessels)
Neurological & Psychological Effects
Reported with unknown frequency
- Headache and dizziness
- Anxiety, restlessness, or agitation
- Tremor (shakiness)
- Weakness or fatigue
- Hallucinations (rare)
- Fainting (syncope)
Gastrointestinal & Respiratory Effects
Reported with unknown frequency
- Nausea and vomiting
- Sweating (diaphoresis)
- Difficulty breathing (dyspnoea)
Metabolic Effects
Laboratory changes
- Increased blood sugar (hyperglycaemia)
- Decreased potassium levels (hypokalaemia)
- Increased acid levels in blood (metabolic acidosis)
It is important to remember that anaphylaxis itself is a life-threatening condition, and the side effects of adrenaline are generally well-tolerated and temporary. The immediate, life-saving benefits of using Emerade in an anaphylactic emergency always outweigh the risks of potential side effects. Most cardiovascular effects resolve within minutes to hours after the injection.
If you experience any unusual or persistent symptoms after using Emerade, report them to your doctor. Healthcare professionals are encouraged to report suspected adverse reactions to their national pharmacovigilance authority.
How Should You Store Emerade?
Store Emerade at or below 25°C (77°F) in the protective plastic case provided. Do not freeze. Keep out of the sight and reach of children. Regularly inspect the solution and replace the pen before its expiry date.
Proper storage of Emerade is essential to ensure that the medication remains effective when you need it most. Adrenaline is sensitive to light, heat, and temperature extremes, and improper storage can cause the solution to degrade, reducing its potency.
- Temperature: Store at or below 25°C (77°F). Do not expose to extreme heat or direct sunlight for prolonged periods. Do not refrigerate or freeze, as freezing can damage the device mechanism and the adrenaline solution.
- Protective case: Always keep Emerade in the protective plastic case provided. The pen may also be stored in a specially designed carrying case. Always keep the patient information leaflet in the case.
- Regular inspection: Check the solution regularly through the viewing window (lift the label to access it). The solution must be clear and colourless. If the solution is discoloured (e.g., brown or pink), cloudy, or contains particles, discard the pen and obtain a replacement.
- Expiry date: Check the expiry date printed on the label and outer carton. The expiry date refers to the last day of the stated month. Replace expired pens promptly, as they may not function reliably.
- Damage inspection: Inspect the pen if it has been dropped. Replace it if you notice any damage or leakage.
- Disposal: Do not dispose of Emerade in household waste or via the water supply. Return used or expired pens to a pharmacy for safe disposal.
What Does Emerade Contain?
The active ingredient in Emerade is adrenaline (as adrenaline tartrate). Each pen delivers a precise, pre-measured dose of adrenaline in a clear, colourless solution for injection. The device is latex-free.
Emerade is available in three dose strengths, each delivering a different volume of the same 1 mg/ml adrenaline solution:
| Strength | Adrenaline Dose | Volume Delivered | Needle Length |
|---|---|---|---|
| Emerade 150 | 150 micrograms | 0.15 ml | 16 mm |
| Emerade 300 | 300 micrograms | 0.3 ml | 23 mm |
| Emerade 500 | 500 micrograms | 0.5 ml | 23 mm |
Excipients (Inactive Ingredients)
In addition to the active ingredient, Emerade contains the following excipients:
- Sodium chloride – used to make the solution isotonic (compatible with body tissues)
- Sodium metabisulfite (E 223) – an antioxidant preservative that prevents degradation of adrenaline. May rarely cause hypersensitivity reactions or bronchospasm in susceptible individuals
- Disodium edetate – a chelating agent that enhances the stability of the solution
- Hydrochloric acid – used to adjust the pH of the solution
- Water for injections – the solvent for the active ingredient
This medicine contains less than 1 mmol (23 mg) sodium per dose, meaning it is essentially sodium-free. Emerade is latex-free. The injection pen is a white cylinder with a needle guard that covers the needle and the activation mechanism. The adrenaline solution is contained in a glass syringe within the device. Pack sizes include 1 or 2 pre-filled injection pens.
The marketing authorisation for Emerade is held by Bausch Health Ireland Limited. The product is manufactured by Rechon Life Science AB.
Frequently Asked Questions About Emerade
Both Emerade and EpiPen are adrenaline (epinephrine) auto-injectors used for the emergency treatment of anaphylaxis. They contain the same active ingredient and serve the same life-saving purpose. The main differences are in the device design and activation mechanism. Emerade uses a simple push-to-activate design — you press the device against the thigh and the injection occurs automatically. EpiPen requires you to first remove a safety cap, then press firmly against the thigh. Emerade also offers a 500 µg dose option that is not available with all EpiPen formulations, and features a longer needle (23 mm for the 300 and 500 µg pens) which may provide more reliable intramuscular delivery in patients with a greater layer of subcutaneous fat.
Yes. If you witness someone having a severe allergic reaction and they become unconscious, you should administer their Emerade auto-injector immediately if available. Remove the cap, place the pen against the outer thigh at a 90-degree angle (through clothing is fine), press firmly and hold for 5 seconds. Then call emergency services immediately. Place the unconscious person in the recovery position (on their side) and monitor their breathing until help arrives. If symptoms do not improve within 5–15 minutes, administer the second pen if available.
Emerade should ideally be used before its expiry date, as the potency of adrenaline gradually decreases over time and the device mechanism may become less reliable. However, in a genuine life-threatening emergency where no in-date alternative is available, using an expired Emerade pen is better than not using any adrenaline at all. Research has shown that expired adrenaline auto-injectors retain some of their potency for months to years past the expiry date, though at reduced levels. Always replace expired pens as soon as possible and check expiry dates regularly.
Yes. Antihistamines (such as cetirizine or loratadine) and corticosteroid tablets may be taken alongside Emerade as part of your anaphylaxis action plan. However, antihistamines are not a substitute for adrenaline in treating anaphylaxis. Adrenaline (Emerade) must always be used first for severe allergic reactions. Antihistamines work too slowly to treat the life-threatening symptoms of anaphylaxis. They may help manage residual symptoms such as itching and hives after the acute emergency has been addressed with adrenaline.
Accidental injection of adrenaline into a finger, hand, or foot requires immediate medical attention. Adrenaline causes vasoconstriction (narrowing of blood vessels), which can severely reduce blood flow to the affected area, potentially causing tissue ischaemia (lack of oxygen to tissues). Go to your nearest emergency department immediately and inform them that you have accidentally injected adrenaline. Treatment may include local warming, topical nitroglycerin, or injection of phentolamine (an alpha-blocker) to reverse the vasoconstriction. Do not delay seeking treatment, as prolonged ischaemia can cause permanent tissue damage.
Yes. Exercise-induced anaphylaxis (EIA) is a recognised condition where physical exertion triggers anaphylactic symptoms. In some patients, this only occurs when exercise follows ingestion of a specific food (food-dependent exercise-induced anaphylaxis). If you have been diagnosed with EIA, your doctor may prescribe Emerade for use if symptoms of anaphylaxis develop during or after exercise. You should always carry your Emerade pens during physical activity and exercise with a companion who knows how to administer the injection.
References
This article is based on international medical guidelines, peer-reviewed research, and approved product information. All medical claims are supported by Level 1A evidence where available.
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- National Institute for Health and Care Excellence (NICE). Anaphylaxis: assessment and referral after emergency treatment (CG134). 2020. Available at: nice.org.uk
- World Health Organization (WHO). WHO Model List of Essential Medicines — 23rd List, 2023. Geneva: WHO; 2023.
- European Medicines Agency (EMA). Emerade — Summary of Product Characteristics. EMA; Updated 2024.
- Simons FER, Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organization Journal. 2015;8:32. doi:10.1186/s40413-015-0080-1
- British National Formulary (BNF). Adrenaline/Epinephrine — Emergency treatment of anaphylaxis. NICE BNF. Updated 2024.
- Pumphrey RSH. Lessons for management of anaphylaxis from a study of fatal reactions. Clinical & Experimental Allergy. 2000;30(8):1144-1150. doi:10.1046/j.1365-2222.2000.00864.x
- Turner PJ, Jerschow E, Umasunthar T, et al. Fatal Anaphylaxis: Mortality Rate and Risk Factors. Journal of Allergy and Clinical Immunology: In Practice. 2017;5(5):1169-1178. doi:10.1016/j.jaip.2017.06.031
About Our Medical Editorial Team
This article has been written and reviewed by our medical editorial team, comprising licensed physicians with specialist qualifications in emergency medicine, allergy and immunology, and clinical pharmacology. Our team follows international evidence-based guidelines (WHO, EAACI, WAO, NICE, BNF) and uses the GRADE framework to assess the quality of evidence.
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