Could this be a game-changer for anaphylaxis treatment? For the first time in over three decades, Australia has approved a new way to administer adrenaline, and it’s not an injection. The Therapeutic Goods Administration (TGA) has given the green light to Neffy, an adrenaline (epinephrine) nasal spray, sparking both excitement and questions in the medical community. But here's where it gets controversial: while some hail it as a breakthrough, others wonder if it’s truly a step forward or just a pricey alternative. Let’s dive in.
Neffy’s arrival is significant because it offers a needle-free option for delivering adrenaline, the lifesaving treatment for anaphylaxis. For those who dread injections or have needle phobia—especially young children—this could be a welcome relief. Professor Connie Katelaris AM, a leading allergist in NSW, applauds the addition: ‘Anaphylaxis is notoriously challenging to manage, and having another tool in our arsenal is a positive step.’ But is it as effective as the tried-and-true EpiPen? And is it worth the higher cost?
And this is the part most people miss: Neffy isn’t just a drop-in replacement for injectable adrenaline. While it delivers the same active ingredient, its administration method—via the nasal mucosa—means it’s absorbed differently. This raises questions about its suitability for resuscitation kits, which typically contain Schedule 3 medications. Neffy, however, is currently classified as a Prescription-only (Schedule 4) medication, creating a regulatory hurdle. Could this change? CSL Seqirus, the manufacturer, has applied to downschedule Neffy to Schedule 3, but the outcome remains uncertain.
Who stands to benefit most from Neffy? It’s approved for patients aged 4 and older, weighing at least 15 kg, making it a potential game-changer for needle-averse individuals. Available in two strengths—1 mg for 15–30 kg patients and 2 mg for those over 30 kg—it’s tailored to different age and weight groups. But here’s the catch: it’s not suitable for children under 4 or those under 15 kg, a gap where adrenaline auto-injectors still reign supreme.
Now, let’s talk cost. At $194 for a box containing two sprays, Neffy is roughly 20% pricier than an EpiPen. Will it be subsidized under the Pharmaceutical Benefits Scheme (PBS)? CSL Seqirus has submitted an application, but a decision isn’t expected until March 2026. Until then, patients will need to weigh the benefits against the expense.
But here’s a thought-provoking question: Is Neffy’s higher price justified by its convenience, or does it risk becoming a luxury option for those who can afford it? Share your thoughts in the comments—we’d love to hear your perspective.
Finally, who might struggle with Neffy? While it’s designed for ease of use, patients with nasal issues—like polyps or previous nasal injuries—may face absorption challenges. Additionally, certain groups, including those with cardiovascular disease, diabetes, or pregnancy, could be at higher risk of adverse effects. Pharmacists and healthcare providers will need to carefully consider these factors when recommending Neffy.
As the Australian Pharmaceutical Formulary and Handbook updates its adrenaline treatment guidelines, one thing is clear: Neffy is a significant development, but it’s not without its complexities. Is it the future of anaphylaxis care, or just another option in the toolbox? Let us know what you think—the conversation is just getting started.
