Emerade (epinephrine) / Bausch Health - LARVOL DELTA

Adrenaline auto-injectors – ability to use and preferences of a population of portuguese beekeepers (EAACI 2024) - "These data highlight the importance of design and technical features of autoinjectors for effective self-administration. More intuitive devices could make a difference in the treatment of anaphylaxis in the community."

Clinical • Immunology

Frequencies and predictors of subcutaneous and intraosseous injection with four epinephrine autoinjector devices. (PubMed, Ann Allergy Asthma Immunol) - "Anapen associated with high subcutaneous-injection rates. EpiPen and Jext were projected to provide intramuscular injection in all men without risk of intraosseous injection. Emerade yielded the lowest subcutaneous-injection rates in women. Compression largely affected the muscle."

Journal • Genetic Disorders • Obesity

Detecting epinephrine auto-injector shortages in Finland 2016-2022: Log-data analysis of online information seeking. (PubMed, PLoS One) - "This study shows that (1) epinephrine shortages related to professionals' searching for auto-injectors, and (2) citizens' information seeking on anaphylaxis related to summertime and shortages with lesser prescriptions. Therefore, the dedicated internet databases aimed at professionals and citizens could be used as additional information sources to detect anaphylactic reactions and auto-injector shortages."

Journal • Allergy • Infectious Disease • Novel Coronavirus Disease

Adrenaline auto injectors pharmacokinetic/pharmacodynamic studies and potential consequences for clinical practice. (PubMed, Clin Transl Allergy) - "However, the differences in functional properties across these devices may play a critical role in achieving these requirements as well as the differences in ergonomics in the handling of these devices. Considering the dynamic pharmacokinetic/pharmacodynamic (PK/PD) profiles of different AAIs marketed in Europe and their effect on adrenaline delivery, the expert panel, also serving as author for this paper have carried out a detailed analysis of the PK/PD profiles of four AAIs, namely, Anapen, Emerade, EpiPen, and Jext, to delineate the adrenaline delivery and their subsequent physiological effects on the backdrop of device characteristics, dose strength, and the skin-to-muscle distances of the participants."

Journal • PK/PD data • Review • Allergy • Cardiovascular • Obesity

Optimal dose of adrenaline auto-injector for children and young people at risk of anaphylaxis: a phase IV randomised controlled crossover study. (PubMed, Allergy) - P4 | "These data support a 500μg dose of adrenaline to treat anaphylaxis in individuals >40kg in the community. The contrasting effects on stroke volume between Epipen® and Emerade®, despite similar peak plasma adrenaline levels, is unexpected. There is an urgent need to better understand differences in pharmacodynamics following adrenaline administration by autoinjector. In the meantime, we recommend adrenaline injection by needle/syringe in the healthcare setting in individuals with anaphylaxis refractory to initial treatment."

Journal • P4 data • Cardiovascular

"#ASK22 Finally a quick run through of the currently available autoinjectors - dosing is 0.1mg/kg as per CSACI guidelines so if patient is 50kg or more consider the Emerade 0.5mg device" (@DrAnneEllis)

Clinical

Brands of Adrenaline Auto Injector in Ireland: What Brands do Caregivers use and are they Adequately Trained in their Administration? (EAACI 2022) - "Children and adolescents are reliant on their parents to recognize the signs and symptoms of anaphylaxis, and to remember the management plan, and therefore it is important that due to the common occurrence of AAI brand switching that all parents are adequately and regularly trained in all brands of AAI. Further study should be carried out on caregivers' ability to administer AAI devices and to design and evaluate educational interventions for parents and children on AAI administration."

Allergy • Food Hypersensitivity • Immunology

Brands of adrenaline auto injector in Ireland: What brands do caregivers use and are they adequately trained in their administration (BSACI 2022) - "Children and adolescents are reliant on their parents to recognize the signs and symptoms of anaphylaxis, and to remember the management plan, and therefore it is important that due to the common occurrence of AAI brand switching that all parents are adequately and regularly trained in all brands of AAI. Further study should be carried out on caregivers' ability to administer AAI devices and to design and evaluate educational interventions for parents and children on AAI administration."

Allergy • Food Hypersensitivity • Immunology • Pediatrics

"#ASK2021 we now have 3 epinephrine autoinjectors available on the Canadian Market: EpiPen (0.15mg, 0.3mg) Allerject (0.15mg, 0.3mg) Emerade (0.3mg, 0.5mg)" (@DrAnneEllis)

Emerade (epinephrine 0.3 mg and 0.5 mg) now available in Canada (Canada Newswire) - "Bausch Health...announced today that Emerade™ (sterile epinephrine solution for injection in a pre-filled pen) is now available across Canada for the emergency treatment of anaphylactic reactions in patients who are determined to be at increased risk for anaphylaxis...Emerade is intended for immediate self-administration for emergency treatment of severe allergic reactions (Type I), including anaphylaxis associated with peanuts, tree nuts, shellfish, fish, milk, eggs, and wheat, stinging insects and medications....Emerade is currently available in a 0.3 mg dose for children over 30 kg bodyweight, adolescents and adults."

Launch Canada • Allergy • Food Hypersensitivity

[VIRTUAL] Myxedema Coma: A Fatal Diagnosis in a Patient with No Known History of Hypothyroidism (ENDO-I 2020) - "Home medications included Lasix, digoxin, isosorbide mononitrate, and atenolol...The patient was given levothyroxine 200 mcg IV in the AM on Day 2 of admission and was started on antibiotics with azithromycin, cefepime, vancomycin, and metronidazole given concern for sepsis...She was initially stabilized after a dose of bicarb, atropine, and epinephrine. However, her BP and respiratory status continued to decline, and the patient passed away. In conclusion, myxedema coma should be suspected in patients presenting with typical symptoms and should be tested for on presentation even when no prior history of hypothyroidism exists."

Clinical • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Diabetes • Endocrine Disorders • Epilepsy • Hypertension • Hypoglycemia • Infectious Disease • Metabolic Disorders • Renal Disease • Septic Shock

[VIRTUAL] A Case of Metastatic Pheochromocytoma Associated with Beckwith-Wiedemann Syndrome (ENDO-I 2020) - "Laboratory investigations revealed an elevated plasma normetanephrine [10445 pg/ml (normal: <148)], metanephrine [93 pg/ml (normal: <57)], total metanephrine [10538 pg/ml (normal: <205)], epinephrine [134 pg/ml (normal:<50)], norepinephrine [23526 pg/ml (normal: 112-658), total catecholamine level [23660 (normal: 123-671pg/ml)] and dopamine [403 pg/ml (normal<30)] levels...He was treated with phenoxybenzamine, diltiazem and lisinopril. He underwent cycles of cyclophosphamide, vincristine and dacarbazine... This is an unusual case of malignant pheochromocytoma in the absence of SDHB mutation in a patient with BWS. Genetic causes in these patients are yet to be determined. However, genes H19 and KCNQ1OT1 have been implicated in addition to IGF-2 and CDK1NC"

Clinical • Endocrine Disorders • Gastrointestinal Cancer • Hepatocellular Cancer • Hypertension • Neuroendocrine Tumor • Oncology • Renal Disease • Solid Tumor • Thyroid Cancer • CGA, CHGA • GAST • IGF2 • MRI • Synaptophysin

[VIRTUAL] Steroid Induced Pheochromocytoma Crisis (ENDO-I 2020) - "Clinical Case: 58 year-old female with history controlled hypertension on Lisinopril 10 mg daily, presented to hospital with two day history of fatigue, shortness of breath, and abdominal pain...Ten hours after the start of prednisone the patient developed sudden onset hypertension with BP >200/100 mmHg for which she was given labetalol intravenously...Orthostatic hypotension here was related to epinephrine predominance pattern of secretion and volume depletion. Steroids should be avoided in patients with known pheochromocytoma or in those with an adrenal adenoma without a negative biochemical workup for a pheochromocytoma as it could precipitate an adrenergic crisis possibly by inducing catecholamine synthesis and release and sensitizing target organs to the effects of catecholamines."

Anesthesia • Fatigue • Hypertension • Hypotension • Neuroendocrine Tumor • Oncology • Pain • Respiratory Diseases • Solid Tumor

Simultaneous administration of imipenem/cilastatin/relebactam with selected intravenous medications, a stewardship approach (ECCMID 2019) - "Based on change of ≥ 0.5 nephelometric turbidity units (NTU) cut-off point, imipenem/cilastatin/relebactam was compatible with; albumin, amphotericin B, calcium gluconate, caspofungin, colistimethate, dexamethasone, dobutamine, epinephrine, eptifibatide, esmolol, furosemide, gentamicin, hydrocortisone, labetolol, levofloxacin, magnesium sulfate, mesna, metoprolol, metronidazole, vasopressin...Imipenem/cilastatin/relebactam at the clinically utilized concentration was compatible with all the tested drugs that included antibiotics, cardiovascular and anti-inflammatory agents administered in acute/urgent situations. These data serve to facilitate the administration of imipenem/cilastatin/relebactam to patients receiving other intravenous medications in the acute care setting and lessen the need for a dedicated intravenous line."

Cardiovascular

[VIRTUAL] Thyroid Abscess Due to Intravenous Drug Use: A Rare Cause of Thyroid Storm (ENDO-I 2020) - "She suffered a cardiac arrest, was intubated, and resuscitated with defibrillation and epinephrine...She was treated with propylthiouracil (PTU) and hydrocortisone...Patient was treated with vancomycin, clindamycin, and metronidazole...She was initiated on levothyroxine 50 mcg daily with follow up testing for possible resolution of thyroiditis-induced hypothyroidism... Thyroid abscess resulting in thyroiditis can be a rare cause of thyroid storm that resolves following I&D. Successful management includes use of antibiotics, steroids, and ATD for thyroid infection, thyroid inflammation and thyroid hormone levels."

Cardiovascular • Endocrine Disorders • Immunology • Pain

[VIRTUAL] Case Series of ACTH-Secreting Pheochromocytoma: Diagnosis and Management (ENDO-I 2020) - "Pre-op 24-hour urine cortisol was checked as part of secondary HTN evaluation and found to be elevated at 219 (3.5-45mcg)...Due to persistent post-op hypotension and a low 10PM random cortisol level of 3.4mcg/dL, which was inappropriate given patient’s clinical status, hydrocortisone was started with subsequent hemodynamic improvement...Her labs showed elevated 24-hour urine epinephrine 115 (0-20mcg), norepinephrine 366 (0-135mcg), plasma M 288 (0-62pg/mL) and NM 475 (0-145pg/mL), and an AM cortisol was 47.9mcg/dL...AM cortisol level post 1mg dexamethasone was 62.6mcg/dL with an ACTH level of 222pg/mL...Failure to recognize ectopic ACTH pre-op can lead to post-op complications such as AI. Patient 2 demonstrates that treatment of the hypercortisolemia may be necessary in order to adequately control BP and glucose levels prior to surgery."

Clinical • Basal Cell Carcinoma • Cardiovascular • Hypotension • Movement Disorders • Neuroendocrine Tumor • Oncology • Solid Tumor

[VIRTUAL] Development of a Protocol for Stellate and Celiac Ganglia Dissection for Characterization of Pituitary Adenylate Cyclase Activating Polypeptide (PACAP) Protein and Receptor Expression in Male and Female Mice Following Cold Acclimation (ENDO-I 2020) - "PACAP is expressed in the sympathetic nervous system and is required at the adrenomedullary synapse to maintain epinephrine secretion from the adrenal medulla in response to physiological stress (3)...PACAP receptor expression (VPAC1, VPAC2, PAC1) was examined in the ganglia utilizing real-time PCR, and PACAP protein was visualized in the ganglia of transgenic mice that express eGFP under the control of the PACAP promoter (PACAP-eGFP mice) (5). This research demonstrates the expression of PACAP receptors in ganglia whose postganglionic fibres innervate adipose tissue, enhancing our understanding of PACAP’s role in the SNS, and its contribution to the regulation of adaptive thermogenesis."

[VIRTUAL] Discovery of new olfactory receptors in human keratinocytes: A potential role on skin stress response (SID 2020) - "For the first time, we showed the presence of OR10A6, OR2AG2 and OR11H4 in human primary keratinocytes cells and on human skin.n ex-vivo skin model stressed with high levels of epinephrine, a stress hormone, during 9 days was developed...These agonists allowed to protect the skin against the impact of stress but also to restore ORs level of expression, especially for OR2AG2. Overall, these finding suggest that OR10A6, OR2AG2 and OR11H4 are involved into stress response mechanisms and demonstrate that olfactory receptors activation may serve as a new target to fight skin stress."

[VIRTUAL] Adrenal Venous Sampling in the Lateralization of Acth-Independent Cushing Syndrome With Bilateral Adrenal Masses: A Case With a 5-Year Follow-Up (ENDO-I 2020) - "Preoperative AVS was performed and 8mg of dexamethasone was administered the night prior to ensure ACTH suppression during the procedure, and epinephrine was measured to ascertain adequate adrenal vein cannulation...She was placed on hydrocortisone and tapered over a 10-month period with remission maintained for more than 3.5 years post-operatively...In addition, this case suggests that the use of high dose dexamethasone and measurement of catecholamines may be helpful for more accurate interpretation. More data on AVS in CS patients with bilateral adrenal masses is needed so a well-validated and standardized CS-specific ACS protocol can be developed."

Clinical • Late-breaking abstract • Back Pain • Dyslipidemia • Hypertension • Metabolic Disorders • Pain

[VIRTUAL] High Enhancement Washout by CT Imaging Does Not Exclude Pheochromocytoma/Paraganglioma: Review of Two Cases (ENDO-I 2020) - "Urinary catecholamine levels were elevated with an epinephrine (E) 38 mcg (2–24), norepinephrine (NE) 388 mcg (15–100), dopamine (DOPA) 175 mcg (52–480), metanephrine (MN) mcg 620 (90–315), normetanephrine (NMN) 1553 mcg (122–676) and vanillylmandelic acid 12.5 mg (60% is most consistent with an adenoma. However, as demonstrated by these two cases, washout exceeding 60% can also be seen in non-adenomas, perhaps secondary to degeneration of the nodule causing necrotic or cystic changes or uncommonly, the presence of a high lipid content in the tumor [1]."

Clinical • Cardiovascular • Glioma • Neuroendocrine Tumor • Oncology • Solid Tumor • MRI

[VIRTUAL] Epinephrine Is Essential for Normal Renal Glucose Reabsorption via the Glucose Transporter GLUT2 (ENDO-I 2020) - "Our findings establish the essential role of epinephrine in glucose reabsorption via the renal glucose transporter GLUT2. Therefore, modulating the renal adrenergic system, or, kidney-specific GLUT2 may afford alternative strategies to regulate glycosuria and ultimately mitigate diabetes."

Diabetes • Genetic Disorders • Metabolic Disorders • Obesity

[VIRTUAL] A Severe Case of Pheochromocytoma Presenting as Classic Takotsubo’s Cardiomyopathy With Rapid Resolution (ENDO-I 2020) - "A 24-hour urine collection included urine volume of 3500 ml, urine creatinine 7.2 mmol/day, elevated urine norepinephrine 1199 nmol/day, elevated urine epinephrine 888 nmol/day, and normal urine dopamine 335 nmol/day...Doxazosin 1 mg daily was initiated and she had clinical improvement next day and came off ECMO... Classic Takotsubo’s cardiomyopathy is a possible presentation of pheochromocytoma with rapid resolution with alpha blockade."

Clinical • Late-breaking abstract • Cardiomyopathy • Cardiovascular • Neuroendocrine Tumor • Oncology • Respiratory Diseases • Solid Tumor

[VIRTUAL] A Phase 2 Evaluation of a Ready-To-Use Liquid Stable Continuous Subcutaneous Glucagon Infusion for the Treatment of Hypoglycemia Associated Autonomic Failure (ENDO-I 2020) - "In this proof-of-concept study, CSGI did not demonstrate statistically significant improvements in plasma epinephrine concentration when compared to placebo at 4 weeks. While there were positive epinephrine and improved hypoglycemia awareness responses observed in some subjects, the equivocal efficacy results observed may be explained by the unanticipated and incomplete elimination of hypoglycemia on CSGI therapy, and those on placebo therapy experienced hypoglycemia improvement. CSGI can be safely used with concomitant diabetes medications, and there were no SAEs related to CSGI."

Late-breaking abstract • P2 data • Diabetes • Hypoglycemia • Metabolic Disorders • Pain • Type 1 Diabetes Mellitus

[VIRTUAL] Acute GI Bleed Associated with Myxedemic Coma: Yes It Still Exists! (ENDO-I 2020) - "He underwent emergent upper GI endoscopy, which found the Dieulafoy’s lesion at cardiac end of stomach & treated with a combination of epinephrine injection, argon laser, & 3 hemo-clips...He was started on IV Thyroxine, Liothyronine and Hydrocortisone...We present an interesting case of GI bleed associated with myxedemic coma now relatively uncommon with advancement in healthcare. It provides an excellent learning opportunity for clinicians to consider while managing these patients."

Cardiovascular • Endocrine Disorders • Gene Therapies • Heart Failure • Hematological Disorders • Hemophilia • Hypertension • Ischemic stroke • Palliative care • Reperfusion Injury • Respiratory Diseases

[VIRTUAL] Is Doxazosin the Right Choice for Preoperative Management of Pheochromocytoma in Pregnancy? (ENDO-I 2020) - "Repeat labs showed: plasma metanephrines 2.071pg/mL(0-62), normetanephrine 6.289pg/mL(0-145), norepinephrine 4.268pg/mL(0-874), epinephrine 555pg/mL(0-62)...Due to the lack of presynaptic a2-adrenoceptor blockade there is less reflex tachycardia, reducing the use of Beta-blockers (8). Doxazosin seems to be a safe, affordable alternative for preoperative management of PCC in pregnant patients."

Cardiovascular • CNS Disorders • Depression • Hypertension • Hypotension • Movement Disorders • Neuroendocrine Tumor • Oncology • Renal Disease • Solid Tumor