If you or your child has moderate to severe eczema, your dermatologist might prescribe dupilumab (Dupixent). This medication is different from other eczema treatments because you have to inject it subcutaneously (under your skin).

Two kinds of devices are available for injecting dupilumab — a prefilled syringe and a prefilled pen. This article will help you understand the difference between these two devices so you and your doctor can make an informed decision about which treatment option is right for you.

What Is Dupixent?

Dupixent is a prescription eczema treatment. Dupixent is the brand name for a medication called dupilumab. The U.S. Food and Drug Administration (FDA) has approved dupilumab to treat moderate to severe atopic dermatitis (a severe, chronic form of eczema) in adults and children 6 months and older when prescription skin treatments don’t work well enough or can’t be used.

The manufacturer makes two types of devices to inject dupilumab — a prefilled syringe and a prefilled pen.

Dupilumab is also FDA-approved to treat other conditions, including:

• Asthma — A lung disease
• Chronic rhinosinusitis with nasal polyps — Inflammation of membranes within the sinuses with soft growths inside the nose
• Eosinophilic esophagitis — An allergic condition in the esophagus
• Prurigo nodularis — A skin condition that causes itchy bumps on the skin
• Chronic obstructive pulmonary disease, also called COPD — A progressive lung disease, when it’s hard to treat and doesn’t respond well to other medicines
• Urticaria — A condition that causes itchy hives or welts on the skin

Dupilumab is a biologic drug that’s manufactured using lab-created proteins called antibodies. It works by blocking specific parts of the immune system to prevent inflammation that can make eczema worse. Because dupilumab is made of proteins, it must be given by subcutaneous injection. If you take it by mouth, your digestive system will break it down before it has a chance to work.

The manufacturer makes two types of devices to inject dupilumab — a prefilled syringe and a prefilled pen.

What Is a Prefilled Syringe?

A prefilled syringe already contains a single dose of medicine. This helps you or your healthcare provider deliver the right dose of medicine without needing to measure it first. When you use a dupixent syringe, you’re in control of pushing the plunger down to inject the medication.

What Is a Prefilled Pen?

Like the prefilled syringe, a prefilled pen comes filled with a single dose of medication. The device will inject the medication for you at a controlled rate after you activate it. You don’t have to press a plunger the whole time when you use a pen device.

What’s the Difference?

If your doctor prescribes dupilumab, you may wonder what the differences are between the syringe and the pen.

Although using a prefilled pen might be easier, some people may find it more painful.

The prefilled syringe and the prefilled pen deliver the same medication. The medication will work the same way and be just as effective regardless of whether you use the dupixent pen or syringe. However, who can use each device and how each one is used is slightly different.

Doses Available

Prefilled syringes are available in doses of 100 milligrams, 200 milligrams, and 300 milligrams. Prefilled pens are available in 200-milligram and 300-milligram doses.

The usual dose for adults is 300 milligrams every other week. When you first start the medication, however, you’ll receive a larger dose — known as a loading dose — of 600 milligrams. This will be given as two 300-milligram injections.

The dose for children aged 6 months to 17 years is based on their weight and age. For children with atopic dermatitis, doses can range from 200 milligrams to 600 milligrams every two to four weeks. The 100-milligram prefilled syringe is reserved for treating asthma in children ages 6 to 12 years old who weigh less than 30 kilograms (around 66 pounds).

Approved Age

The prefilled syringe is FDA-approved for people ages 6 months and older. The prefilled pen is FDA-approved for ages 2 and up. Children under the age of 12 should have a parent or caregiver administer their injection. Once children turn 12, they may choose to start giving it to themselves, under the supervision of an adult.

Needle Visibility

When you use the prefilled syringe, you can see the needle before the injection. After the injection, the needle will automatically be covered with a needle shield to protect you from accidental needle sticks.

The prefilled pen has a needle cover, so you don’t see the needle before you inject. You’ll place this needle cover against your skin at the injection site when you’re ready to activate the dose.

Instructions for Use

Your doctor will teach you how to inject dupilumab before you start doing it yourself. Although your preparation is similar for both types of devices, there are some key differences in the way you inject them.

Following are the manufacturer’s recommended steps for using a prefilled syringe:

1. Wash your hands with soap and water.
2. Choose your injection location, which could be your thigh or your stomach. However, you’ll want to avoid the 2-inch area around your belly button. A caregiver also may inject the medication into the outer portion of an upper arm.
3. Use an alcohol wipe to clean the injection site, then give it time to dry.
4. Carefully remove the cap with the needle pointing away from you.
5. Pinch a fold of skin at the injection site.
6. Insert the needle into your skin at a 45-degree angle.
7. Ease up on the pinch as you slowly press the plunger as far as it goes to inject all of the medication.
8. Release the plunger until the needle shield covers the needle, at which point you can remove it.

For a prefilled pen, the company recommends the following:

1. Wash your hands with soap and water.
2. Choose your injection location, which could be your thigh or your stomach. You’ll want to avoid the 2-inch area around your belly button. A caregiver also may inject the medication into the outer portion of an upper arm.
3. Use an alcohol wipe to clean the injection site, then give it time to dry.
4. Pull off the cap when you’re ready to make the injection.
5. If the person receiving the injection is 12 or under, pinch the skin of the injection site before and during the injection.
6. Place the needle cover onto the injection site at a 90-degree angle to your skin.
7. To inject the medication, press and hold the pen firmly into your skin until you can’t see the needle cover. You’ll know the injection has started when you hear a click.
8. Continue pressing for a count of five. You should hear another click to signal the injection is complete. Wait until all of the medication has been injected (or for the window to turn completely yellow) before pulling away the prefilled pen.

Ease of Use

The prefilled pen may be easier to use for some people. In a 2023 study, researchers found that compared to the dupilumab prefilled syringe, the prefilled pen was easier to use and led to higher satisfaction.

Researchers have found that prefilled pens with medications for other conditions are easier to use as well. A 2020 study of people taking subcutaneous methotrexate to treat juvenile idiopathic arthritis (a condition that causes joint inflammation) found that most caregivers and children preferred a prefilled pen over a prefilled syringe.

Tips for Using Dupilumab

Giving yourself or your child an injectable medication can take some time getting used to. You shouldn’t self-inject dupilumab without being trained by a healthcare provider first. MyEczemaTeam members have learned how to give themselves dupilumab injections, “I’m on Dupixent and learning how to give my own injection as well, so let’s see how that goes,” shared one member.

Is the Dupixent Pen or Syringe Less Painful?

Other members have complained that dupilumab injections can sometimes be painful. One said, “I just did my Dupixent injection, and, as usual, it hurt. I’m wondering if anyone has tips or tricks to make the injection less painful.”

Although using a prefilled pen might be easier, some people may find it more painful. However, studies with other medications for different conditions have found that prefilled pens can make injections less painful. If you’re concerned about the pain associated with a dupilumab injection, talk to your doctor about the best treatment option for you.

Where Is the Least Painful Place To Inject Dupixent?

Whether you’re using a prefilled syringe or a prefilled pen, you have a few options for where to give the injection:

• You can inject it into your thigh or stomach, but be sure to avoid the 2-inch area around your belly button.
• A caregiver can also inject the medicine into the outer part of your upper arm.

To help make your injection less painful, you can try the following tips:

• Warm your medication to room temperature before injecting.
• Allow the alcohol used to clean your injection site to dry completely before injecting.
• Rotate among injection sites.
• Enlist the help of family and friends for support.

Is There a Wrong Way To Inject Dupixent?

Using Dupixent the wrong way could make the medicine less effective or cause pain or injury. Some common mistakes include:

• Not letting the alcohol on your skin dry before injecting
• Injecting into the wrong spot, like too close to your belly button
• Not holding the pen or syringe at the correct angle
• Pulling the pen away before the injection is finished

Talk With Your Doctor

If you’re not sure which injection device is right for you or your child, your doctor or pharmacist can help you weigh the options. They can also answer any questions you have about technique, comfort, or managing side effects — so you feel more confident with your treatment plan. Follow-up visits can help your doctor see if the treatment is still helping.

Find Your Team

On MyEczemaTeam, the social network for people with eczema and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Do you use Dupixent? Do you use the prefilled syringe or the prefilled pen? Share your experience in the comments below, or start a conversation by posting on your Activities page.