A pharmaceutical delivery device with triggered automatic needle insertion and manually controlled pharmaceutical injection. The pharmaceutical delivery device includes a housing, a pharmaceutical containing needled syringe having an injection tip that is recessed within the housing when the syringe is in a first position and which projects from the housing when the syringe is in a second position, a syringe advancing assembly operable to automatically advance the needled syringe from the first position to the second position, a plunger including an input portion projecting from the housing for manual access by a user, wherein the plunger is operable by the user directly shifting the input portion when the syringe is disposed in the second position to inject pharmaceutical from the syringe through the needle at a rate adjustably controlled by a user during the injection, and wherein the plunger includes a plunger extender automatically movable within the housing from a first location to a second location upon the needled syringe advancing from the first position to the second position, wherein the plunger extender, when in the second location, occupies a space vacated by the needled syringe during advancement from the first position to the second position, whereby the plunger input portion remains stationary relative to the housing during the advancement of the needled syringe.