Anaphylaxis occurs from an allergic response to a bug sting or bite, food, medicines and exercise, among other sources. It can lead to a severe reaction that can make breathing difficult and can cause a sudden drop in blood pressure and severe swelling, all having potentially fatal effects.  If this happens to you, having a Twinject® (epinephrine injection, 1:1000) auto-injector on hand can save your life. 


Twinject® is a prescription medicine for emergency use to stop life-threatening allergic reactions. Twinject® can be administered while waiting for medical treatment. If you have a Twinject® prescription and you feel you are having a severe allergic reaction, administer Twinject® by following the instructions below.  Always follow use of Twinject® with emergency medical care. 


Consult with your doctor before deciding if Twinject® is right for you. Ask your doctor or pharmacist about possible side effects of the Twinject®. People who are pregnant, allergic to any of the ingredients in Twinject® or who have certain medical conditions such as diabetes, heart disease, high blood pressure, thyroid conditions, asthma, depression or Parkinson’s disease have a higher chance of suffering from serious side effects from Twinject®. 

How to Use Twinject®
Check your Twinject® unit often to make sure the medicine is fresh and ready to use when you need it. Look at the medicine in the Twinject® regularly, and if it looks cloudy, is discolored, has particles in it or if the expiration date has passed, replace the unit. Do not remove the green caps until you are ready to use the Twinject®. The following instructions should be followed for both Twinject® units (0.15 mg for patients who weigh 33-66 pounds and 0.30 mg for patients who weigh 66 pounds (30kg) or greater).

Always remember to call 911 for emergency help if you or someone else is suffering from anaphylaxis.



1.  First Dose

• Pull off the Green end cap labeled “1”. You will see a red tip. Never put your thumb, finger or hand over the red tip. 
• Pull off the Green end cap labeled “2”.
• Place the rounded Red tip against the middle of the outer side of your thigh.  The needle can pass through clothing.
• Press down hard until the needle enters your thigh through your skin.  Hold it in place while slowly counting to 10.
• Remove the Twinject® from your thigh.
• Check the Red tip.  If the needle is exposed, you received the dose. If the needle is not visible, repeat above steps.
• After you received the first dose, immediately prepare for the second dose.

It is important to monitor symptoms closely after the first dose is given, including watching for new symptoms. If new symptoms have appeared, or symptoms have not improved within about 10 minutes, a second dose is needed. 


If a second dose is not needed, and after medical attention has been received, throw away the unused medicine as explained in the after use/disposal section.

2.  Second Dose
Preparation for Second Dose
• Unscrew and remove the Red tip. Be careful of the exposed needle.
• Grab the Blue plastic to pull the syringe out of the barrel, making sure you do not touch the needle.
• Slide the Yellow collar off the plunger. Be careful not to pull up on the plunger while removing the yellow collar.


Administer the Second Dose

If symptoms have not improved within 10 minutes of the first injection, you need a second dose.
• Put the needle into your thigh through the skin.
• Push the plunger down all the way until it cannot go any further.
• Remove the Twinject® from your skin.
• Get emergency medical help right away.


After the first and second doses are administered, liquid that cannot be used will remain in the syringe. Always follow the use of Twinject® by seeking emergency medical care. 


After Use/Disposal
• Put the syringe, needle first, into the carrying case that the product comes in.
• Put the other half of the carrying case on and close it.
• Give your used Twinject® to a healthcare worker for proper disposal. Do not throw it away in a regular trash can.


Additional video instructions on how to use Twinject® are available at


Twinject® is indicated in the emergency treatment of severe allergic reaction (type 1) including anaphylaxis to stinging insects and biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as anaphylaxis to unknown substance or exercise-induced anaphylaxis.


Important Safety Information
Twinject® should only be injected into the anterolateral aspect of the thigh. Accidental injection into the hands or feet may result in loss of blood flow to the affected area and should be avoided. DO NOT INJECT INTO THE BUTTOCK. DO NOT INJECT INTRAVENOUSLY.


Epinephrine should be administered with caution to patients with cardiac arrhythmias, coronary artery or organic heart disease, or hypertension. In patients with coronary insufficiency or ischemic heart disease, epinephrine may precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias. It should be recognized that the presence of these conditions is not a contraindication to epinephrine administration in an acute life-threatening situation.


Adverse reactions to epinephrine may include flushing; apprehension; syncope; tachycardia; thready pulse with a fall in blood pressure; convulsions; respiratory difficulties; vomiting, diarrhea or cramps; pruritus; or angioderma. Twinject® is designed as an emergency supportive therapy only and is not a replacement or substitute for medical care.


Since the doses of epinephrine delivered from Twinject® are fixed, the physician should consider other forms of injectable epinephrine if doses lower than those available from Twinject® are felt to be necessary (e.g., patients who weigh less than 15 kilograms approximately 33 pounds). IN ALL CASES, THE PHYSICIAN SHOULD INSTRUCT THE PATIENT AND/OR ANY OTHER PERSON WHO MIGHT BE IN A POSITION TO ADMINISTER THE EPINEPHRINE, IN THE PROPER USE OF Twinject®.


Please see full prescribing information.


Report Adverse Events
You are encouraged to report negative side effects of prescription drugs to the FDA.  Visit or call 1-800-FDA-1088.