The neffy^® Mega FAQ: Everything to Know About the World’s First Needle-Free Emergency Epinephrine Alternative

Here is our comprehensive list of Frequently Asked Questions for all things neffy—the world’s first needle-free emergency epinephrine alternative.

If you’ve been wondering whether it’s time to switch from your current auto-injector, or if you aren’t carrying your prescribed epinephrine because of the high cost, bulkiness, or fear of needles, this guide is for you. Let’s dive into what you and your allergist need to know about this game-changing option.

The Basics

What is neffy?
neffy is a needle-free nasal spray that delivers epinephrine for the emergency treatment of severe allergic reactions, including anaphylaxis, in adults and children who meet the weight requirements.
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How does neffy work?
neffy delivers epinephrine through the nasal lining, where it is rapidly absorbed into the bloodstream to reverse symptoms of anaphylaxis.
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Does neffy contain epinephrine like traditional auto-injectors?
Yes, neffy contains the same active medication (epinephrine) used in auto-injectors, but it is delivered through the nose instead of an injection.
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Are there side effects from using neffy?
Common side effects include nasal discomfort, headache, throat irritation, and typical epinephrine effects such as feeling jittery or having an increased heart rate.
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How many doses come in a box?
Each neffy device contains a single dose, two devices per box, and patients are typically prescribed and advised to carry at least two devices at all times.
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How long is the time-to-expiration of neffy when purchased?
The shelf life is 24 months for the 1mg dose and 30 months for the 2mg dose, generally twice that of traditional auto-injectors.
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Is neffy available in adult and child doses?
Yes, neffy is available in different strengths based on weight, including a lower dose (1 mg) for children weighing at least 33 lbs (15 kg) and less than 66 lbs (30 kg), and a higher dose (2 mg) for adults and children weighing 66 lbs (30 kg) or more.
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Is neffy temperature sensitive?
Yes, like all epinephrine products and medications in general, neffy should be stored within recommended temperature ranges to maintain effectiveness.
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What are the temperature excursion limits (how hot or cold can it get)?
neffy is significantly less temperature sensitive than traditional auto-injectors. Short temperature excursions are permitted up to 122°F (50°C). neffy should not be used if frozen, but can be used once thawed.
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Administration

How is neffy administered?
neffy is administered by inserting the nozzle fully into one nostril and pressing the plunger to deliver a single dose.
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Do I need to prime or test neffy before using it?
No, neffy is a single-use device that is ready to use and should not be primed before administration.
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Which direction should the nozzle be pointed?
The nozzle should be inserted straight into the nostril and not angled toward the septum or outer wall.
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Should I inhale or sniff during administration?
You should not sniff the medication during administration, as it is designed to be absorbed without inhalation, though clinical studies show that inhaling or sniffing will not compromise the medication’s effectiveness.
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How do I know if the full dose was delivered?
Each device is designed to deliver the full dose automatically with a single press.
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What if I sneeze or the medication drips out after use?
Even if some liquid is lost, the medication is absorbed quickly.
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Will neffy work if my nose is congested due to hayfever or cold?
Nasal congestion (e.g., from allergic rhinitis) does not prevent neffy from working, as studies confirm it remains safe and effective in such cases.
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What if I’m unconscious—can someone else administer neffy?
Yes, neffy is designed so that caregivers can administer it to someone who is unable to self-administer.
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How long should you wait before administering a second dose if symptoms don’t resolve?
If symptoms persist or worsen, a second dose can be given in the same nostril starting about 5 minutes after the first dose, and emergency services should be summoned.
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Comparison to Traditional Epinephrine Auto-Injectors

Is neffy as effective as an auto-injector?
Clinical studies show that neffy produces epinephrine levels in the bloodstream comparable to those achieved with injected epinephrine.
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Does neffy work as quickly as an auto-injector?
neffy provides rapid absorption of epinephrine, with pharmacokinetics similar to intramuscular injection.
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Can neffy replace carrying an auto-injector?
neffy is approved for treating anaphylaxis and can replace traditional auto-injectors.
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Can I carry both neffy and an auto-injector?
Some healthcare providers may recommend carrying both, especially for patients with complex medical situations, concerns about nasal delivery, or transitioning to neffy.
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Are there situations where an auto-injector may be preferred?
An auto-injector may be preferred if there is severe nasal obstruction or uncertainty about nasal absorption.
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Is neffy easier for children or untrained caregivers to use?
neffy may be easier for some users because it eliminates needles and simplifies administration steps.
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Does neffy reduce hesitation or delays in administering epinephrine?
neffy’s needle-free delivery may reduce hesitation, a significant barrier to timely epinephrine use.
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Emergency Use & Safety

Do I still need to go to the ER after using neffy?
While you should seek emergency medical attention if symptoms are severe or do not improve, current guidelines indicate that many individuals can safely stay at home after a dose of epinephrine if symptoms resolve, as long as they have a second dose available, someone to monitor them, and live near a hospital.

You do need to seek emergency care immediately if:

• Symptoms continue, get worse, or return;
• You require a second dose of neffy (or any epinephrine);
• You are having trouble breathing, experience throat/heart symptoms, or have poor alertness;
• You are alone or do not have a second dose available.

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What if symptoms return after they improve?
If symptoms return, a second dose should be administered and your should seek emergency care immediately.
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What if neffy doesn’t seem to work?
If there is no improvement, administer a second dose and seek emergency medical care immediately.
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How many doses should I carry?
Patients should carry at least two doses at all times because a single dose may be insufficient.
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Filling a Prescription

Can pharmacists substitute neffy for an auto-injector prescription?
No, pharmacists cannot substitute neffy for an auto-injector because it requires its own specific prescription.
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What should I do if my pharmacy is unfamiliar with neffy?
You can schedule a virtual visit with a prescriber and have neffy delivered to your door or a nearby pharmacy via getneffy.com.
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Insurance and Out-of-Pocket

Those with commercial insurance can often get neffy with $0 copay, depending on coverage. Copays for those covered by government-sponsored insurance, like Medicare, Medicaid, VA benefits, CHAMPVA, CHIP, etc, depend on your coverage and residence. Those without coverage may be eligible for assistance. The easiest way to determine your costs, schedule a virtual visit with a prescriber, and have neffy delivered is via their website getneffy.com.

In any event, you should NEVER pay more than $199 out of pocket. Visit getneffy.com if you have been quoted more by your pharmacy or have been denied neffy by your insurance company or doctor.
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Travel & Public Use

Can I bring neffy internationally?
Yes, you can bring neffy when traveling internationally, but check the medication regulations of your destination country in advance.
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Does neffy require documentation for travel?
It is recommended to carry your prescription label or a doctor’s note when traveling, especially internationally, to avoid issues at security or customs.
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School & Public Settings

Is neffy approved for stock epinephrine programs?
Many stock epinephrine laws currently reference auto-injectors specifically, so policies for stocking neffy are still evolving at the state and institutional level. For those school districts that allow it, the “neffy in Schools” program may provide devices for free.
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Can school nurses administer neffy without a student-specific prescription?
This depends on state laws and school district policies, as many current regulations are written specifically for auto-injectors. Check with your school district.
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Are there liability protections (like stock epinephrine laws) for neffy?
Liability protections may not yet explicitly include nasal epinephrine products, and laws are still catching up to newer delivery methods. Check with your state or local Department of Health.
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Can camps, restaurants, or airlines stock neffy?
Policies vary widely, and most current protocols are built around auto-injectors, though this is changing over time as neffy adoption increases. AZ, CT, MD, VA, NC, LA, TX & WI all have updated legislation allowing neffy to be stocked for camps.
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Family Guidance

Should we switch to neffy now or wait?
Whether to switch to neffy should be a shared decision with your allergist.
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How should we update our Emergency Care Plan to include neffy?
You should absolutely update your Emergency Care Plan to include neffy as a first-line treatment option, clearly outlining when to give a second dose and when to seek emergency care. Click here for such a plan from AAAAI.
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Where should neffy be stored at home, school, and during activities?
neffy should be stored in an easily accessible location at all times while staying within recommended temperature limits, just like traditional epinephrine products, but with greater leeway in terms of temperature excursions.
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