Published September 15, 2025
On August 9, 2024, the US Food and Drug Administration (FDA) approved Neffy (epinephrine), the first nasal spray for treating severe allergic reactions (anaphylaxis) and offered as a different option than using an EpiPen (epinephrine), which is an injection. However, it looks similar to Narcan (naloxone), which is also a nasal spray that is used to reverse opioid (e.g., oxycodone, heroin, fentanyl) overdoses. Both medicines can be lifesaving. But because of their similar packaging, there is concern that they may be confused especially if both medicines are available for at home use or in schools.
Neffy is only available by prescription. It comes in a box with two single-use spray devices, each containing 2 mg of epinephrine (Figure 1). Neffy is for adults and children who weigh 30 kg (about 66 pounds) or more who have experienced a severe allergic reaction in the past. Each device is used once and should be thrown out after it is sprayed into one nostril. If the first dose does not help after 5 minutes, you can use the second device in the same nostril. If Neffy is used to treat an allergic reaction, the person should still seek emergency help to make sure their allergic reaction is treated properly.
Narcan also comes as a single-use nasal spray (Figure 2). It is used for all ages, even babies, to treat opioid overdoses. If the person does not wake up or stops breathing after one dose is given, you can give another dose, alternating nostrils, every 2 to 3 minutes with a new device until help arrives. There are different brands and types of sprays, and they come in different strengths. Narcan is available both as a prescription and as an over-the-counter (OTC) medicine.
Neffy and Narcan have similar features:
As Narcan and Neffy become more available, we are concerned that these medicines will get mixed up and could delay important treatment. This can result in serious harm or death. In addition, there are other medicines that are nasal sprays and come in a similar device. For example, there is a nasal spray, Imitrex (sumatriptan), used to treat migraines, and another, Nayzilam (midazolam), used to treat seizures (which also begins with the letter “N”). Both of these medicines require a prescription. However, having multiple medicines in similar looking devices will increase the risk of an error especially in an emergency situation. It is important to make sure if more than one product is in your home or at school, that they are clearly labeled and separated so they are not mixed up.
Here’s what you can do: To prevent mix-ups with these medicines, be sure to store look-alike sprays in different places, up and out of reach from children. Make sure you know what each one is for and how to use it. Always check the label before using it. Teach your family members or those who may need to give the medicine about the differences. It may be helpful to add a visual clue to help identify the correct medicine. For example, place each product in a separate baggie and write what it should be used to treat across the front: “allergic reaction” or “overdose.” Never store these medicines (or any medicine) in a car where they can get too hot or too cold.
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