Mac,
Inhalers flow among the three of us in this household. If DD forgets her inhaler, she's able to borrow mine. I hate to admit that right now DD's set is the only set of unexpired Epis we have. I need to stop by the pharmacy to get them filled and her set expires next month.

I've already warned my daughter that if the voice isn't working, the pen still works. She has played with the trainer enough that she wouldn't need the voice but hopefully anyone else administering it would be able to see the label. Since she carries them in her purse, they shouldn't fade or rub away. 

  The label is inexcusable. I haven't had that problem yet because I carry the Auvi differently but their flagship feature is form factor for boys/men. For the device cost and importance of labeling it needed to be fixed yesterday.

Us, too, Mac-- we have a number of devices, and since they are interchangeable... well, we try to mix lot numbers, so I often have "half" of "DD's" set, and she has "half" of mine.

To me, the major design flaw for AuviQ is extremely low tech. The pictograms run off because boys keep them in pockets.

But the next set (and DS will have another set even though his insurance doesn't cover it) he will out his contact info (or mine) under packing tape around the body of the AuviQ.

[spoiler]My insurance covers them and it will cost me $50 with my script (sometimes it's a good thing to have my own set of FAs). DS will also have a script. Our epis historically have flowed back and forth between each other. Shrug. [/spoiler]

Any autoinjector is dependent on a more complex mechanical platform for delivery over a syringe and plunger. What any autoinjector does is provide convenience and reduce human error in dose and delivery of epinephrine especially when delivered under duress. Needle length, dose is predetermined.

Now, any autoinjector is also going to require some training because what any autoinjector does not do by design alone to reduce human error is where to deliver the dose and under what circumstance.

The sensible argument here is What happens if patients without training on autoinjectors don't (or can't) read the outside label at any point and will only be able to use the device by voice feature? The sensible response is Training, the same with any autoinjector.

Any autoinjector must

1. be carried at all times.
2. be intramuscularly injected in the THIGH (not vein, buttocks)
3. be used at the right time, sooner than later

So really, any autoinjector requires a patient to be familiar with more than just the mechanism therefore training is a must. For a bystander who knows nothing of any autoinjector in order to use one the label would need to be read in order to not inject in the arm, vein, assuming it's someone who knows the autoinjector must be used in the first place.

Over relying on the singular voice component would be a problem. I have not experienced or heard of that problem, but it's a new product. Because EpiPen has been around for longer I have heard numerous problems such as individuals believing no matter what the outside of the label says to inject in the arm, buttocks, or not to use it at all unless or until breathing is affected. And going by Mylan's ad that was pulled for misbranding they claimed you could eat what you want as long as you had an EpiPen which we all know wasn't true.

I haven't seen any sort of claims from Intelliject or Sanofi that goes beyond what the Auvi-Q's features are which do include form factor for carrying and a voice feature that runs independently from its autoinjector mechanics.

Having said that I'm for choices because I do not believe one size fits all here. Rather than nit and pick on who should carry which injector I'd like to see even MORE on the market. Aside from the previously mentioned Twinject I'm interested in the Emerade and find some of their points about needle length and dose quite compelling. The device is a discreet size and looks like they put thought into the form factor.

Quote from: LinksEtc on January 07, 2014, 11:17:39 AM

Quote from: GST on January 07, 2014, 10:20:43 AM
Whereas both have the minute chance of not injecting when they are supposed to, the Auvi-Q has the additional risk of the voice part of it failing.  Then you have a device that would work perfectly fine, but for the fact that the user does not know how to use it because they were relying on the voice to talk them through it.  This is the reason that my daughter`s allergist and I both consider it less safe than the Epipen, more things that can go wrong, as I said in my earlier post. 

I think this is a reasonable POV to consider ... it would probably not cause problems for active allergy folks like us  , but I could see a newbie maybe getting flustered if voice failed.  I don't have an opinion yet on which I prefer ... sometimes I like to sit things out for a while and hear about other people's experiences.  I do think some competition is good and may lead to better designs and more company responsiveness to consumer needs/preferences.

Yes-- this is a great point.  Honestly, we (barely) see the point of the AuviQ.  For us.  I definitely agree that more bells and whistles = more options for failure.

On the other hand, I'd love if my newly independent teen could carry one-- that way there's a MUCH better chance that a bystander could administer than with an epipen (which doesn't have the auditory instructions).  Again, this is something that those without adolescents probably aren't thinking about-- yet.

Neither device is perfect.  Nor was the Twinject (as noted), but boy how I wish that there were more choice in this particular market... because IMO, none of the current devices is very convenient or fail-safe.  It's just a difficult drug-delivery problem to solve.

I just wish my insurance would allow me options that are available,

I liked the idea of the twinject, although school would only administer first dose from it.  I was OK with that.

But as with auviQ, my insurance wouldn't cover it.

Quote from: GST on January 07, 2014, 10:20:43 AM
Whereas both have the minute chance of not injecting when they are supposed to, the Auvi-Q has the additional risk of the voice part of it failing.  Then you have a device that would work perfectly fine, but for the fact that the user does not know how to use it because they were relying on the voice to talk them through it.  This is the reason that my daughter`s allergist and I both consider it less safe than the Epipen, more things that can go wrong, as I said in my earlier post. 

I think this is a reasonable POV to consider ... it would probably not cause problems for active allergy folks like us  , but I could see a newbie maybe getting flustered if voice failed.  I don't have an opinion yet on which I prefer ... sometimes I like to sit things out for a while and hear about other people's experiences.  I do think some competition is good and may lead to better designs and more company responsiveness to consumer needs/preferences.

Me, too.  That was DEFINITELY my personal preference. 

Not for fear of design but for purpose of choice I wish Twinject would make a return from some manufacturer. The second dose doesn't meet the definition of autoinjector because it's a syringe with plunger but having that small, autoinjector/syringe two-dose combo in one small tube was great for myself. In a sense I guess any autoinjector is a technological advancement from syringe and plunger. I think the benefits of the Twinject far exceeded the limits for me. I hope it finds a way back to market.

Quote from: GST on January 07, 2014, 10:20:43 AM
  Then you have a device that would work perfectly fine, but for the fact that the user does not know how to use it because they were relying on the voice to talk them through it.

If the voice does not work, the person/family will hopefully familiarized themselves through the trainer.

For all others, there are pictograph instructions.  Same as someone unfamiliar with an epi-pen.

Yeah-- I think that those of us with daughters probably have a hard time understanding just how much better the AuviQ is for teenaged BOYS.

The smaller size and more discreet carrying possibilities are hard to overstate for that age group.

Dey/Mylan have demonstrated that they simply don't really care that much about what research-research (as opposed to poorly selected MARKET research) suggests is The Single Biggest Problem with the highest risk age cohort-- they don't CARRY autoinjectors.

While the powers that be at Mylan have been busy trying to ADVERTISE their way out of this by targeting the parents of preschoolers, those of us who have been FA advocates and parent-coaches in this community for years are left scratching our heads-- because THAT doesn't solve the real problem.  We all know WHY boys don't self-carry in their teens, and it's mind-boggling to consider that the device-maker does not.  But apparently this is true.  They've chosen to advertise to parents of 0-5yo, and sell a lot more devices to this cohort.  Without actually improving fatality stats in teens.       If I sound bitter, read through the food allergy death thread a bit.  Adolescents MUST self-carry if those stats are ever going to change.  They aren't going to do that if "self-carry" means "hang a big old sign around my neck that says I'm a freak."


So yeah-- Epipen's redesign was an EPIC fail there; it made the devices larger, and did NOTHING to improve the profile for more discreet self-carry.  Not that big a problem for girls and women, just continue sizing purse/bag purchases with devices in hand, YK?  But the issue for guys is even worse than it's ever been.   

I am not confused at all. The process with the trainer is nearly identical, and considering Sanofi was in court with Mylan over device patent issues (which Sanofi lost) The mechanical portion shares quite a bit of heritage.

What portion are you claiming I would not understand as a user if I don't hear a voice command? Maybe we could allay the fears here.

They both can malfunction, both Epipen and Auvi-Q.  My point was not that Auvi-Q can malfunction and Epipen cannot (nor did I say that), but rather that the more technology you have, the more that can malfunction.  Whereas both have the minute chance of not injecting when they are supposed to, the Auvi-Q has the additional risk of the voice part of it failing.  Then you have a device that would work perfectly fine, but for the fact that the user does not know how to use it because they were relying on the voice to talk them through it.  This is the reason that my daughter`s allergist and I both consider it less safe than the Epipen, more things that can go wrong, as I said in my earlier post.  No mechanism is perfect, but it is higher risk than the Epipen because it has the added risk of the voice failure and the user having no idea how to use it.  BTW, the Epipen recall many years ago was just a precaution.  When the list came out of the lot numbers that were recalled, I checked the Epipen I had successfully used to see if it was on the recall list and it was.  It worked perfectly fine and saved my daughter`s life.