A groundbreaking development in anaphylaxis treatment has arrived! Australia has approved a game-changing nasal spray called neffy, offering a new way to administer adrenaline. This is a significant milestone, as it's the first new adrenaline delivery method in over three decades. But here's where it gets controversial: is this innovative approach truly a game-changer, or just a pricey alternative? Let's dive in and explore its potential impact.
Professor Connie Katelaris, a renowned allergist, welcomes neffy as an additional treatment option for anaphylaxis, a challenging condition to manage. She highlights that neffy has been successfully used overseas and is now accessible to Australian patients. But is it worth the price tag? Let's find out.
How does neffy differ from EpiPen?
Neffy, like EpiPen, delivers adrenaline, the key ingredient for treating anaphylaxis. However, neffy doesn't require a needle or injection, which sets it apart. It uses a similar delivery system as opioid reversal medicines, administering adrenaline through the nasal mucosa for rapid absorption into the bloodstream.
Can neffy be included in resuscitation kits?
This is a tricky question with a yes-and-no answer. While neffy contains adrenaline for the same purpose as injectable adrenaline in resuscitation kits, there's a crucial difference. Resuscitation kits typically stock Schedule 3 medications, whereas neffy is currently a Prescription-only (Schedule 4) medication. So, while it serves the same purpose, its availability in emergency kits is limited.
Who benefits most from neffy?
Adrenaline nasal spray is designed for emergency anaphylaxis treatment in patients aged 4 years and older, weighing 15 kg or more. It offers an alternative to needle-based administration, which can be particularly beneficial for young children who may be needle-phobic. The medicine comes in two strengths: 1 mg for patients weighing 15-30 kg and 2 mg for those 30 kg and above.
What should pharmacists know about neffy's use?
Pharmacists should note that adrenaline nasal spray is not suitable for children under 4 years or weighing less than 15 kg. In these cases, adrenaline auto-injectors, like EpiPen, provide a treatment option with a 0.15 mg dose for children weighing between 7.5 kg and 20 kg. It's important to recognize that even with certain medical conditions that increase the risk of adverse reactions, adrenaline administration is not contraindicated in life-threatening anaphylactic situations.
Who might experience adverse effects with neffy?
In practice, certain individuals may be more susceptible to adverse effects from adrenaline nasal spray. This includes people with raised intraocular pressure, severe renal impairment, prostatic adenoma with residual urine, hypercalcaemia, or hypokalaemia. Those with hyperthyroidism, cardiovascular disease, hypertension, or diabetes, as well as older adults and pregnant individuals, may also face an increased risk. Patients with Parkinson's disease may experience temporary worsening of symptoms like rigidity or tremor.
Who might find it challenging to use neffy?
The nasal route of administration may present difficulties for certain patient groups. While clinical studies included people with allergic rhinitis, those with structural or anatomical nasal issues, such as polyps, previous fractures or injuries, or nasal surgery, were not part of the trials. It's unclear how these conditions might impact neffy's absorption.
Could neffy be made more accessible?
Potentially. CSL Seqirus, the product sponsor, has applied to the TGA to register both the 1 mg and 2 mg doses as Schedule 3 medications. This would make neffy more widely available and potentially reduce its cost.
How much does neffy cost?
The recommended retail price for one box of neffy (containing two nasal sprays) is $194, which is approximately 20% more expensive than EpiPen, excluding prescription consultation fees.
Will neffy be subsidized?
CSL Seqirus has applied for adrenaline nasal spray to be listed on the Pharmaceutical Benefits Scheme, with the application under consideration at the March 2026 Pharmaceutical Benefits Advisory Committee meeting. If approved, this could make neffy more affordable for patients.
Where can I find more information?
The PSA is updating the Australian Pharmaceutical Formulary and Handbook, including the adrenaline treatment guideline. Stay tuned for the latest developments! This new treatment option raises important questions. Is neffy a necessary advancement, or just an expensive alternative? What are your thoughts? Feel free to share your opinions and experiences in the comments below!
