High-alert medications
The Institute for Safe Medication Practices (ISMP) names the drugs and drug categories most likely to cause serious harm when given in error in acute care. A drug is flagged here only when that list names it or its category.
Each row quotes the list entry and the routes it covers, since several entries apply only to IV use.
On the ISMP list (23)
AdenosineAntiarrhythmics
ISMP entry: “antiarrhythmics, IV (e.g., lidocaine, amiodarone)”
Routes: all forms this database covers
IV antiarrhythmics are on the ISMP acute care high-alert list. Adenosine is not among the named examples, but this record covers only its IV use as an antiarrhythmic.
Sources: [1]
AlteplaseThrombolytics (fibrinolytics)
ISMP entry: “thrombolytics (e.g., alteplase, reteplase, tenecteplase)”
Routes: all forms this database covers
Thrombolytics, with alteplase named, are on the ISMP acute care high-alert list under antithrombotic agents.
Sources: [1]
AmiodaroneAntiarrhythmics
ISMP entry: “antiarrhythmics, IV (e.g., lidocaine, amiodarone)”
Routes: IV only
IV antiarrhythmics, with amiodarone named, are on the ISMP acute care high-alert list. Oral amiodarone is not listed.
Sources: [1]
ApixabanDirect factor Xa inhibitors
ISMP entry: “direct oral anticoagulants and factor Xa inhibitors (e.g., dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, fondaparinux)”
Routes: all forms this database covers
Direct oral anticoagulants and factor Xa inhibitors, with apixaban named, are on the ISMP acute care high-alert list.
Sources: [1]
Buprenorphine-naloxoneOpioid partial agonists
ISMP entry: “opioids, including:”
Routes: all forms this database covers
Opioids are on the ISMP acute care high-alert list, which names IV, oral, and transdermal forms. Sublingual and buccal film is not named separately and is treated here as an oral-cavity form within the opioid class.
Sources: [1]
EnoxaparinHeparins
ISMP entry: “anticoagulants (e.g., warfarin, low molecular weight heparin, unfractionated heparin)”
Routes: all forms this database covers
Low molecular weight heparin is named on the ISMP acute care high-alert list under anticoagulants.
Sources: [1]
EpinephrineAdrenergic agonists (sympathomimetics)
GlipizideSulfonylureas
ISMP entry: “sulfonylurea hypoglycemics, oral (e.g., chlorproPAMIDE, glimepiride, glyBURIDE, glipiZIDE, TOLBUTamide)”
Routes: all forms this database covers
Oral sulfonylureas, including glipizide, are on the ISMP acute care high-alert list.
Sources: [1]
Heparin (unfractionated)Heparins
ISMP entry: “anticoagulants (e.g., warfarin, low molecular weight heparin, unfractionated heparin)”
Routes: all forms this database covers
Unfractionated heparin is named on the ISMP acute care high-alert list under anticoagulants.
Sources: [1]
HydromorphoneOpioid agonists
ISMP entry: “opioids, including:”
Routes: all forms this database covers
Opioids, including IV and oral forms, are on the ISMP acute care high-alert list.
Sources: [1]
Insulin glargineLong-acting insulins
ISMP entry: “insulin, subcutaneous and IV”
Routes: all forms this database covers
Insulin, subcutaneous and IV, is on the ISMP acute care high-alert list as a class.
Sources: [1]
Insulin lisproRapid-acting insulins
ISMP entry: “insulin, subcutaneous and IV”
Routes: all forms this database covers
Insulin, subcutaneous and IV, is on the ISMP acute care high-alert list as a class.
Sources: [1]
Insulin NPH (isophane)Intermediate-acting insulins
ISMP entry: “insulin, subcutaneous and IV”
Routes: all forms this database covers
Insulin, subcutaneous and IV, is on the ISMP acute care high-alert list as a class. This record covers subcutaneous use only.
Sources: [1]
Insulin regular (human)Short-acting insulins
ISMP entry: “insulin, subcutaneous and IV”
Routes: all forms this database covers
Insulin, subcutaneous and IV, is on the ISMP acute care high-alert list as a class.
Sources: [1]
LabetalolBeta blockers
ISMP entry: “adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)”
Routes: IV only
IV adrenergic antagonists, with labetalol named, are on the ISMP acute care high-alert list. Oral labetalol tablets are not listed.
Sources: [1]
LorazepamBenzodiazepines
ISMP entry: “moderate sedation agents, IV (e.g., dexmedetomidine, midazolam, LORazepam)”
Routes: IV only
IV moderate sedation agents, with lorazepam named, are on the ISMP acute care high-alert list. Oral lorazepam for adults is not listed.
Sources: [1]
Magnesium sulfateMagnesium salts
ISMP entry: “magnesium sulfate injection”
Routes: all forms this database covers
Magnesium sulfate injection is on the ISMP acute care high-alert list.
Sources: [1]
MethotrexateAntimetabolites (folic acid antagonists)
ISMP entry: “methotrexate, oral, nononcologic use”
Routes: all forms this database covers
Oral methotrexate for nononcologic use is named on the ISMP acute care high-alert list, and oral chemotherapeutic agents are listed as a class, so the oral tablet is high-alert for every labeled use.
MorphineOpioid agonists
ISMP entry: “opioids, including:”
Routes: all forms this database covers
Opioids, including IV and oral forms, are on the ISMP acute care high-alert list.
Sources: [1]
NorepinephrineAdrenergic agonists (sympathomimetics)
ISMP entry: “adrenergic agonists, IV (e.g., EPINEPHrine, phenylephrine, norepinephrine)”
Routes: all forms this database covers
IV adrenergic agonists, with norepinephrine named, are on the ISMP acute care high-alert list. This record covers only IV infusion.
Sources: [1]
OxytocinOxytocics (uterine stimulants)
ISMP entry: “oxytocin, IV”
Routes: IV only
IV oxytocin is on the ISMP acute care high-alert list. IM postpartum doses are not named.
Sources: [1]
Potassium chloridePotassium supplements
ISMP entry: “potassium chloride for injection concentrate”
Routes: IV only
Potassium chloride for injection concentrate is named on the ISMP acute care high-alert list. Oral tablets are not listed.
Sources: [1]
WarfarinVitamin K antagonists
ISMP entry: “anticoagulants (e.g., warfarin, low molecular weight heparin, unfractionated heparin)”
Routes: all forms this database covers
Warfarin is named on the ISMP acute care high-alert list under anticoagulants.
Sources: [1]
Listed only for other routes (6)
The ISMP list names these drugs or their category only for routes outside the forms this database covers.
AlbuterolShort-acting beta-2 agonists
ISMP entry: “adrenergic agonists, IV”
Inhaled albuterol is not on the ISMP acute care high-alert list. IV adrenergic agonists are.
Sources: [1]
ClopidogrelP2Y12 inhibitors (antiplatelets)
ISMP entry: “antithrombotic agents, including:”
Oral clopidogrel is not on the ISMP acute care list. Its antithrombotic category names anticoagulants, factor Xa and direct thrombin inhibitors, IV glycoprotein IIb/IIIa inhibitors, and thrombolytics.
Sources: [1]
DigoxinCardiac glycosides
ISMP entry: “inotropic medications, IV”
Oral digoxin is not on the ISMP acute care list. IV inotropic medications, including IV digoxin, are on it.
Sources: [1]
MetoprololBeta blockers
ISMP entry: “adrenergic antagonists, IV”
Oral metoprolol is not on the ISMP acute care list. IV adrenergic antagonists, including IV metoprolol, are on it.
Sources: [1]
NaloxoneOpioid antagonists
ISMP entry: “opioids”
Naloxone is not on the ISMP acute care high-alert list. The opioids it reverses are.
Sources: [1]
NitroglycerinNitrates
ISMP entry: “nitroprusside sodium for injection”
Sublingual nitroglycerin is not on the ISMP acute care list. The only nitrate-type vasodilator listed is nitroprusside sodium for injection.
Sources: [1]