Medication safety group revises its list of high-risk medications

Patient Safety Monitor Insider

February 18, 2004

The Institute for Safe Medication Practices (ISMP) has updated its list of high-alert medications. Its new list identifies 33 different drugs or drug classifications that practitioners have frequently considered to be high-alert medications (

A high-alert medication is a drug that has a high risk of causing injury to patients when misused. Errors with the drugs are not necessarily more common than with other drugs, but their consequences can be more devastating.

The ISMP expects organizations to use the list to identify medications that require special safeguards to reduce the risk of errors. Safeguards may include limiting access to certain drugs, using auxiliary labels and automated alerts, and standardizing how the drugs are ordered, prepared, and administered.

The updated list includes the following:

Class/category of medications

  • adrenergic agonists, IV (e.g., epinephrine)
  • adrenergic antagonists, IV (e.g., propranolol)
  • anesthetic agents, general, inhaled and IV (e.g., propofol)
  • cardioplegic solutions
  • chemotherapeutic agents, parenteral and oral
  • dextrose, hypertonic, 20% or greater
  • dialysis solutions, peritoneal and hemodialysis
  • epidural or intrathecal medications
  • glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)
  • hypoglycemics, oral
  • inotropic medications, IV (e.g., digoxin, milrinone)
  • liposomal forms of drugs (e.g., liposomal amphotericin B)
  • moderate sedation agents, IV (e.g., midazolam)
  • moderate sedation agents, oral, for children (e.g., chloral hydrate)
  • narcotics/opiates, IV and oral (including liquid concentrates, immediate- and sustained- release)
  • neuromuscular blocking agents (e.g., succinylcholine)
  • radiocontrast agents, IV
  • thrombolytics/fibrinolytics, IV (e.g., tenecteplase)
  • total parenteral nutrition solutions
Specific medications
  • IV amiodarone
  • colchicine injection
  • heparin, low molecular weight, injection
  • heparin, unfractionated, IV
  • insulin, subcutaneous and IV
  • IV lidocaine
  • magnesium sulfate injection
  • methotrexate, oral, non-oncologic use
  • nesiritide
  • nitroprusside, sodium, for injection
  • potassium chloride for injection concentrate
  • potassium phosphates injection
  • sodium chloride injection, hypertonic, more than 0.9% concentration
  • warfarin