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This document outlines critical safety information and warnings for the use of epinephrine (Epipen). Please read the following points carefully and discuss any concerns with your healthcare provider.

• Immediate Medical Attention: After using epinephrine (Epipen), it is crucial to seek immediate medical assistance, even if your symptoms improve. Continuous monitoring by a healthcare professional is advised to manage any recurring symptoms or additional treatment needs. Remember, epinephrine (Epipen) is not a substitute for medical care.

• Proper Injection Method: Administer epinephrine (Epipen) exclusively by injection into the muscle or under the skin of the outer thigh. Avoid injecting it into any other body part or through any other route, as this could lead to serious medical complications.

• Risk of Skin Infection: Although rare, there is a potential for serious skin infections following the use of epinephrine (Epipen). To minimize this risk, do not inject the medication into the buttock area. Seek medical evaluation if the injection site shows signs of redness, warmth, swelling, or tenderness to test for and treat any potential infections.

• Sulfite Allergy Consideration: Epinephrine (Epipen) may contain sulfites. However, in instances of severe, life-threatening allergic reactions, it is vital to use epinephrine (Epipen) regardless of a sulfite allergy, as it is a life-saving intervention.

• Effects on Blood Pressure and Heart Rate: Epinephrine (Epipen) can increase blood pressure and heart rate. Notify your healthcare provider if you experience symptoms such as difficulty breathing, chest pain, dizziness, visual changes, or headaches, as these may indicate elevated blood pressure or heart rate, necessitating further medical treatment. The risk is heightened if epinephrine is administered intravenously, if there is a history of heart issues, or if you are taking medications that affect heart rate or blood pressure.

Please adhere to these guidelines to ensure safe and effective use of epinephrine (Epipen).

When using Symjepi, it's important to be aware of potential interactions with other medications and substances, as these can affect how the drug works or increase the risk of side effects. Here are some key interactions to consider:

Medications That May Increase Symjepi's Effects:

• Antidepressants: Certain medications used to treat depression, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs), can enhance the effects of Symjepi. This may lead to increased heart rate or elevated blood pressure.

• Thyroid Hormone Replacements: Medications like levothyroxine sodium, used for thyroid conditions, may amplify Symjepi's effects.

• Some Antihistamines: Certain antihistamines, including chlorpheniramine, tripelennamine, and diphenhydramine, can potentiate the effects of Symjepi.

Medications That May Decrease Symjepi's Effects:

• Beta-Adrenergic Blockers: Drugs such as Propranolol, commonly prescribed for high blood pressure and heart conditions, can counteract Symjepi's cardiostimulating and bronchodilating effects.

• Alpha-Adrenergic Blockers: Medications like Phentolamine may reduce Symjepi's vasoconstricting and hypertensive effects.

• Ergot Alkaloids: These substances can reverse the pressor effects of Symjepi.

Other Considerations:

• Cardiac Medications: If you're taking cardiac glycosides, diuretics, or anti-arrhythmic drugs, be cautious, as combining these with Symjepi may increase the risk of heart rhythm disturbances.

• Caffeine: Consuming large amounts of caffeine (found in coffee, tea, colas, chocolate, and some herbal supplements) while using Symjepi can heighten side effects like nausea, nervousness, palpitations, sleep disturbances, or rapid heartbeat.

Always inform your healthcare provider about all medications, supplements, and significant dietary habits to ensure safe and effective use of Symjepi.