What Are the Alternatives to an EpiPen? neffy?

Several years ago, there was quite a fuss about high prices and shortages affecting EpiPen emergency allergy injections. This epinephrine shot is used to avert anaphylactic shock that can be life threatening. Without rapid access to epinephrine (adrenaline), an affected person’s airways could constrict and she might collapse and even die. That is why doctors prescribe epinephrine auto-injectors for people to use themselves if they have known allergies like those to bee stings, peanuts or shellfish. There’s also a new nasal spray on the market called neffy. Readers want to know more about it.

Problem with Neffy Pricing:

Q. I have read that there is now an epinephrine nasal spray called neffy for severe allergic reactions or even anaphylaxis. It requires a prescription and is pricey. Why not use over-the-counter Primatene Mist instead? It’s far less expensive.

A. Anaphylaxis is a life-threatening allergic reaction. It must always be treated as a medical emergency.

Epinephrine auto-injectors such as EpiPen or Adrenaclick deliver a specified dose of epinephrine immediately into the bloodstream. German scientists studied Primatene Mist to see if it could be used as a substitute treatment for anaphylaxis and found it is not suitable (Journal der Deutschen Dermatologischen Gesellschaft, May 2009).

Neffy, on the other hand, was developed specifically to immediately provide an appropriate dose of epinephrine. Experimenting with a money-saving alternative may not be wise when the outcome could be death. We acknowledge, however, that it is very expensive. According to GoodRx, the lowest price is $686 for a prescription.

What Was the Problem with EpiPen?

Drug maker Mylan got its epinephrine auto-injectors from Pfizer. A plant in St. Louis that makes EpiPen had manufacturing difficulties. As a result, the generic epinephrine products were also in short supply.

A New Epinephrine Shot Costs Less:

At that point, Novartis announced a different version of the epinephrine shot. The company made the medication, known as Symjepi, available to pharmacies at the beginning of 2019. The wholesale price for a double pack of injectors was $250, lower than the $300 Mylan and Teva charged for their generic versions. Another form of injected epinephrine is called Auvi-Q. This has the advantage of offering audible instructions as you use it. Consequently, the likelihood of correct use is higher.

Neffy Is Epinephrine as a Nose Spray:

In 2024, FDA approved an entirely new form of epinephrine for treating severe allergic reactions. It is called neffy and is administered as a nasal spray. When we first wrote about it, we noted that people in the trial had not had anaphylactic (life-threatening) reactions. One reader thinks that was an oversight.

Q. A few months ago, you wrote about a new form of epinephrine for treating severe allergic reactions. It’s a nasal spray called neffy.

I am curious: how can “neffy” be approved to treat anaphylactic reactions although it has not been tested in people experiencing anaphylactic shock?

A. The FDA approved neffy in August 2024 to provide an alternative for people with allergies and fear of injections. Some people also have difficulty using an auto-injector correctly.

You are right that this new way of administering epinephrine was tested in healthy people, not in those suffering an anaphylactic reaction. FDA officials explained that it would be unethical to provoke a life-threatening crisis to test the effectiveness of the drug.

Regardless of the form of epinephrine used, after it is administered the patient should call 911. Reactions can come back quickly and may require a second dose as well as emergency medical treatment.