What to use instead of an EpiPen? Exploring life-saving epinephrine alternatives

October 9, 2025 •

4 min read

In 2024, the FDA approved Neffy, a needle-less nasal spray, as a new alternative for administering epinephrine. This development, alongside other market options, has provided a wider range of choices for people who need to carry this life-saving medication. Navigating what to use instead of an EpiPen involves considering device type, cost, features, and ease of use.

Quick Summary

This guide details epinephrine delivery options beyond the EpiPen, including alternative auto-injectors like Auvi-Q and Symjepi, and the innovative Neffy nasal spray. It compares their features and administration methods, helping individuals with severe allergies choose the right device with their doctor.

Key Points

Diverse Options: Beyond the EpiPen, alternatives like Auvi-Q, Adrenaclick, Symjepi, and Neffy offer various features and price points.
Neffy Nasal Spray: Neffy provides a needle-free epinephrine option, which is a major advantage for individuals with needle phobias.
Cost & Insurance: Generic auto-injectors and manufacturer programs can significantly lower the cost of epinephrine, which is a critical consideration for many.
Ease of Use: Devices vary in their administration method, from voice-guided auto-injectors (Auvi-Q) to manual syringes (Symjepi), impacting usability in a high-stress situation.
Consult a Doctor: The right choice depends on individual needs, comfort with the device, and insurance coverage, making a consultation with an allergist essential.
Expired Devices: In a life-threatening emergency, using an expired epinephrine device is better than using no epinephrine at all, though it should be replaced as soon as possible.

The shift from EpiPen exclusivity

For many years, the EpiPen was a ubiquitous name in emergency allergy care. However, the market has expanded significantly due to high costs and supply chain issues, prompting the development of effective alternatives. These options offer different features, price points, and administration methods, making it crucial for patients and caregivers to be aware of their choices.

Auto-injector alternatives to EpiPen

Several epinephrine auto-injectors (EAIs) are now available that perform the same life-saving function as an EpiPen. The core medication—epinephrine—is the same across these devices, but the delivery mechanism, size, and cost can differ. All EAIs require a prescription.

Auvi-Q

Auvi-Q offers a highly compact, rectangular design that is similar in size to a credit card or small cell phone. Its standout feature is its verbal instructions, which guide the user through the injection process with a voice prompt. This can be particularly helpful during the stressful moments of an allergic reaction. The needle also retracts automatically after injection, eliminating the risk of a post-injection sharps hazard. Auvi-Q is available in different doses for adults, children, and infants.

Adrenaclick and its generics

Adrenaclick is another auto-injector option, and its authorized generic version is often more affordable than the brand name EpiPen. Generic epinephrine auto-injectors contain the same active ingredient and dose as the brand name products but may have minor differences in their design or activation process. This can make them a cost-effective choice for many people, especially those with commercial insurance or limited budgets. It is important to familiarize yourself with the specific instructions for whichever generic device you obtain, as they may differ from EpiPen.

Symjepi

Symjepi is a pre-filled syringe rather than an auto-injector. While it delivers the same medication, it requires the user to manually depress a plunger to administer the dose. This makes it more labor-intensive than a spring-loaded auto-injector. However, its affordability and compact size can make it a suitable option for some individuals who are comfortable with the manual injection process.

The newest, needle-less alternative: Neffy Nasal Spray

Approved by the FDA in 2024, Neffy represents a major innovation in emergency epinephrine delivery. It offers a needle-free option for patients, which is a significant advantage for those with a fear of injections (trypanophobia) or for those who find auto-injectors difficult to use correctly.

Key features of Neffy:

Needle-free: Administered as a single spray into the nostril.
Longer shelf life: With a shelf life of 24 to 30 months, Neffy lasts significantly longer than the 12 to 18-month shelf life of most auto-injectors.
Temperature stability: Neffy is also more stable when exposed to extreme temperatures, making it a more robust option for storing in cars or other environments with fluctuating heat.
Ease of use: No special training is required to use the device, and the administration process is straightforward.

A comparison of epinephrine options


Feature	EpiPen	Auvi-Q	Neffy Nasal Spray
Administration Method	Spring-loaded auto-injector	Spring-loaded auto-injector	Needle-free nasal spray
Key Features	Standard cylindrical device.	Compact, cell-phone shape; voice-guided instructions; retracting needle.	Needle-free; longer shelf life (up to 30 months); better temperature stability.
Ease of Use	Standard two-step process; risk of accidental injection with improper handling.	Voice prompts and retracting needle minimize user error.	Very simple, spray into nostril; no needle involved.
Cost	Typically higher brand-name cost; generics available.	Can be costly but manufacturer assistance programs may offer reduced or no cost to eligible patients.	Often covered by insurance; price varies depending on plan and discounts.
Storage	Must be stored at room temperature (68-77°F); sensitive to heat and cold.	Similar temperature restrictions to EpiPen.	More stable across a wider range of temperatures.
Target Audience	General use for severe allergies.	Individuals who prefer a compact device, voice guidance, or needle retraction.	Anyone weighing over 60 lbs who fears needles or struggles with auto-injectors.

How to choose the right epinephrine delivery device

Selecting the best option for your emergency allergy plan is a personal decision that should be made in consultation with your allergist or other healthcare provider. Considerations include:

Patient preference and comfort: If a fear of needles is a major barrier to use, Neffy may be the most life-saving option. If dexterity issues are a concern, a voice-guided device like Auvi-Q may be best.
Cost and insurance coverage: Check with your insurance provider to see which auto-injectors are covered by your plan. Many manufacturers also offer coupons and patient assistance programs to reduce out-of-pocket costs.
Lifestyle and storage: For people who live in or travel to areas with extreme temperatures, Neffy's stability might be a significant advantage.
Training and education: No matter which device you choose, it is critical to know how to use it correctly. Many manufacturers provide training videos and trainer pens to help you practice.

Ultimately, the most important aspect is having a reliable and accessible epinephrine delivery device that you are prepared to use immediately in an anaphylactic emergency. For further resources and training on epinephrine delivery devices, visit the Food Allergy Research & Education (FARE) website.

Final considerations

When an anaphylactic reaction strikes, time is of the essence. Having an epinephrine device and knowing how to use it is critical. While brand recognition often leads people to default to the EpiPen, a range of effective and sometimes more affordable or easier-to-use alternatives are available today. Discussing these options with your doctor can help you find the best fit for your specific needs, ensuring you are prepared to act swiftly and confidently during an emergency. Always remember that any use of epinephrine for anaphylaxis requires immediate follow-up with emergency medical services.

Frequently Asked Questions

No. Antihistamines, such as Benadryl (diphenhydramine), are not a substitute for epinephrine during a severe allergic reaction (anaphylaxis). Epinephrine works on multiple systems in the body to reverse life-threatening symptoms, while antihistamines only treat less severe allergy symptoms like itching and hives.

Yes, Neffy is designed to deliver a dose of epinephrine comparable to auto-injectors for individuals weighing 60 lbs or more. For those who fear needles or may delay injection, the ease of use with the nasal spray could lead to quicker treatment, potentially making it more effective in a real-world emergency.

Generic epinephrine auto-injectors contain the same active ingredient (epinephrine) and deliver the same dose as their brand-name counterparts. While the device's design or activation steps might differ slightly, they are approved by the FDA as equivalent medications. They are often significantly cheaper, but you must know how to operate your specific generic device.

The shelf life varies by product. Auto-injectors typically have a shelf life of 12-18 months, whereas Neffy nasal spray lasts for 24-30 months. All epinephrine products should be stored at room temperature (68-77°F) and protected from extreme heat or cold. Neffy is somewhat more tolerant of temperature fluctuations.

Yes. If an expired device is all that is available during a life-threatening allergic reaction, use it. While the potency may have decreased over time, some medication may still be effective, and it is better than receiving no epinephrine at all. Always replace expired devices as soon as possible.

Auvi-Q is smaller, more compact, and provides voice-guided instructions to walk you through the injection process. It also features a retracting needle after the injection is complete, which can help prevent needle injuries. EpiPen is a more standard, cylindrical auto-injector without voice guidance.

Yes. Following the use of any epinephrine product for anaphylaxis, you must seek immediate emergency medical attention. Epinephrine is a first-line emergency treatment, but its effects are temporary, and symptoms can return. Medical professionals will need to monitor you and determine if a second dose or further treatment is necessary.