High-Alert Medications in Community/Ambulatory Settings

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
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, oral
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
chloral hydrate liquid, for sedation of children
heparin, including unfractionated and low molecular weight heparin
methotrexate, non-oncologic use
midazolam liquid, for sedation of children

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