Allergy patients who carry Emerade 500 microgram adrenaline auto-injector pens should contact their prescriber and seek replacement pens of a different brand.

Healthcare professionals are being asked to contact patients who use Emerade 500 microgram pens following notification by the Medicines and Healthcare products Regulatory Agency (MHRA).

Patients and/or carers should return all Emerade 500 micrograms auto-injectors to their local pharmacy once they have obtained a prescription for, and been supplied with, an alternative brand.

The recall is due to reports of difficulty in activating the pens, meaning the dose of adrenaline may not be delivered when needed by a patient for a severe, acute allergic reaction (anaphylaxis). Most of the pens will still activate, but more force may need to be applied.

The recall of Emerade 500 microgram auto-injectors follows the previous recalls of Emerade 150 and 300 microgram auto-injectors. More information on the previous alerts can be found on the following links: 150mcg recall and 300 mcg recall.

The pens were recalled in three phases to ensure there would be enough supplies of the alternative pens, EpiPen or Jext, available for patients.

Alternative brands of adrenaline auto-injector (EpiPen and Jext) are available in a maximum strength of 300 micrograms.

There are data to show that a single EpiPen (300 microgram) or Jext (300 microgram) pen will be a suitable replacement for a single Emerade 500 microgram pen.

This is based on recently available results from a study that compared blood levels of adrenaline following EpiPen 300 micrograms or Jext 300 micrograms with that following Emerade 500 micrograms. Patients should always carry two pens.

A MHRA spokesperson, said:

Action has been taken to protect patients, following detection of a fault in one component of the Emerade adrenaline auto-injector pens.

Patients should return all Emerade 500 microgram pens to their local pharmacy once they have a new prescription and have been supplied with pens of an alternative brand.

It is vital that patients follow existing advice to carry two pens with them at all times and to contact their doctor when a replacement is due.

When switching to a different brand of adrenaline pen the patient must ensure they are familiar with how to use the pen as each brand is administered differently.

Given the current COVID-19 pandemic, the MHRA in line with NHS guidance, is urging patients who need to return auto-injector pens to minimise additional burden on healthcare professionals and heed the advice on social distancing.

• a patient or carer should make a telephone appointment with their doctor to request a prescription for replacement pens of a different brand. Unless their doctor advises otherwise, they should not visit the GP surgery in person

• request the prescription is sent to a pharmacy to avoid collecting in-person from the surgery

• if a patient and/or their household is self-isolating, ask a friend or relative to collect the replacement pens from the pharmacy. Some pharmacies offer a home delivery service

• once the patient has the replacement auto-injector pens return Emerade 500 mcg pens to the pharmacy. Some pharmacies have drop-off boxes to facilitate distancing.

At present, healthcare professionals are unlikely to be able to help with face to face training but there may be opportunities for remote consultations. Patients must take particular care to read the instructions on how to use the pen which are in the leaflet contained in the box.

The manufacturers’ websites for each brand of pen have information and training videos on how to use the auto-injector.

Trainer pens can be obtained from the manufacturer and patients are strongly urged to get these so they can practise with the new device.

If an Emerade pen does need to be used before a patient is able to obtain an alternative pen, it should be pressed very firmly against the thigh. If this does not result in activation, the patient should immediately use their second pen.

It is vital that we take the necessary steps to protect the services which our critical workers, such as NHS staff, rely on – both in London and all across the country.

So far, we have invested billions into maintaining essential services across rail, buses, trams and ferries outside London, including £30 million over 12 weeks for light rail services in Sheffield, Manchester, West Midlands, Tyne and Wear, and Nottingham; almost £400 million to protect vital bus routes and temporarily suspended rail operators’ franchise agreements to transfer all revenue and cost risk to government so that services continue to run.

This is alongside our wider agenda to level up transport networks across the whole country, including £5 billion for buses and bikes announced back in February (2020), £4.2 billion for local transport settlements for 8 Mayoral Combined Authorities subject to negotiations, a £1.7 billion Transport Infrastructure Investment Fund to improve roads, repair bridges and fill millions of potholes; and the decision by government to take over the Northern network to protect services, drive up performance and rebuild passenger confidence.

We will continue to work with metro mayors, local authorities and transport operators all across the country to ensure that public transport is available for those who need it, including any ramp up in services required as people slowly start to return to work.

In order to keep vital public transport services running in London and further ramp up services to support social distancing, the government agreed on Thursday 14 May a package of support for Transport for London (TfL). It comprises £1.095 billion of new grant and a further loan facility of £505 million. The support can be increased by a further £300 million of grant and loan if revenue loss is higher than forecast at this time.

The settlement for TfL was needed for two reasons. Most important is the significant fall in revenue caused by COVID-19. However, an important secondary factor was the pre-existing poor condition of TfL’s financial position as a result of decisions made over the last 4 years. Combined with significant cost increases and delays to Crossrail, this left TfL in serious financial difficulty even before the public health emergency.

It’s important to note that around half of all bus and rail journeys in England are made on its services and that London is by far the most public transport-dependent place in the UK. Almost half of all Londoners, more in inner London, do not have access to cars. London’s roads are the most congested in the UK; even with reduced passenger numbers and capacity, TfL’s services are still essential to allow critical workers to travel and the city to operate.

Unlike local transport authorities in other towns and cities across England, TfL is responsible for London’s bus network, principal road routes, various rail networks including the London Underground, London Overground, Docklands Light Railway and TfL Rail, as well as trams, cycling provision, and river services. To protect these services, It is important therefore that the rescue package takes steps to put TfL back on a sustainable footing while ensuring fairness for the wider British taxpayer. As result, the mayor intends to adhere to the proposal in TfL’s own business plan that fares should increase by RPI plus 1% on all modes in January.

We have also set a number of other conditions, including: restoring services to 100% of pre-COVID levels as soon as possible; requiring TfL to collect fares on buses while ensuring driver safety, which it had stopped doing during the crisis; easing congestion by the temporary suspension of free travel for over-60s in the morning peak and temporarily suspending free travel for under-18s all day. Disabled people will still be able to make use of their concession passes all day, and special arrangements will be made for those children who qualify for free travel to schools.

These conditions are needed to avoid crowding and reduce the exposure of vulnerable groups.The mayor has subsequently announced that the Congestion Charge will increase to £15, with extended hours of operation and has withdrawn the residents’ discount for new applications.

The Congestion Charge will continue to have exemptions for NHS and care workers and Blue badge holders. Local residents will continue to receive discounts.

To help avoid such drastic action in the future there will be an immediate and broad ranging government-led review of TfL’s future financial position and structure.

The decision to offer support was not taken lightly, but reflects the exceptional circumstances the country finds itself in. I consider it vital to keep services in London running to the maximum levels possible to allow safe transport of passengers. Our messaging remains that people should avoid using public transport and work from home wherever possible, but as measures are slowly lifted it is vital that Londoners who need to use TfL services feel safe and secure.

This deal will encourage help protect those who need to use public transport and help us move towards greener and healthier walking and cycling options. Importantly, it will also provide certainty and stability for London’s transport services in the future.