High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients.
Use ISMP's List of High-Alert Medications in Community/Ambulatory Settings to determine which medications in your practice site require special safeguards to reduce the risk of errors and minimize harm. Strategies may include:
- Standardizing the prescribing, storage, preparation, dispensing, and administration of these medications
- Improving access to information about these drugs
- Using auxiliary labels and automated alerts
- Employing redundancies
- Providing mandatory patient education
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| Classes/Categories of Medications |
|---|
| antiretroviral agents (e.g., efavirenz, lamiVUDine, raltegravir, ritonavir, combination antiretroviral products) |
| chemotherapeutic agents, oral (excluding hormonal agents) (e.g., cyclophosphamide, mercaptopurine, temozolomide) |
| hypoglycemic agents, ora |
| immunosuppressant agents (e.g., azaTHIOprine, cycloSPORINE, tacrolimus) |
| insulin, all formulations |
| opioids, all formulations |
| pediatric liquid medications that require measurement |
| pregnancy category X drugs (e.g., bosentan, ISOtretinoin) |
| Specific Medications |
|---|
| carBAMazepine |
| chloral hydrate liquid, for sedation of children |
| heparin, including unfractionated and low molecular weight heparin |
| metFORMIN |
| methotrexate, non-oncologic use |
| midazolam liquid, for sedation of children |
| propylthiouracil |
| warfarin |
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Also known as the Look-alike and sound-alike (LASA) list.
Medications requiring special safeguards to reduce the risk of errors and minimize harm.
Medications that should not be crushed because of their special pharmaceutical formulations or characteristics.