High Alert Medications

Department of Pharmacy Services

Professional Development and Training

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.

The following mnemonic will help in remembering

Special safeguards to reduce the which drugs are considered High Alert Medications
risk of errors may include strategies such as: and therefore would require double checking upon
dispensation, preparation and administration.
✓ standardizing the ordering, storage,
preparation, and administration “P I N C H Me”
Potassium salts, Concentrated
P
✓ improving access to information about these electrolytes and Parenteral Nutrition
drugs
I Insulin and Oral Hypoglycemic Agents

✓ limiting access to high alert medications Narcotics, Moderate Sedation Agents,

N Neuromuscular Blocking Agents,
✓ using auxiliary labels Anesthetic Agents
Chemotherapeutic Agents,
✓ employing clinical decision support and C Radiocontrast Agents,
Radiopharmaceuticals
automated alerts and
H Heparin and Antithrombotic Agents
✓ using redundancies such as automated or
independent double checks when necessary. Medications with Narrow Therapeutic
Me
Index

(Note: manual independent double checks are not

always the optimal error-reduction strategy and may
not be practical for all of the medications on the list.)

Feb. 18, 2022, Rev. 08

Disclaimer: Hardcopies of this document are considered uncontrolled. Please refer to Sharepoint for the latest version. It is your
responsibility to check the correct and latest version of document before use.
Page 1 of 3
 High Alert Medications
Department of Pharmacy Services
Professional Development and Training

Table 1: CLASSES/CATEGORIES OF MEDICATIONS

adrenergic agonists (IV) e.g. EPINEPHrine, phenylephrine, norepinephrine
adrenergic antagonists (IV) e.g. propranolol, metoprolol, labetalol
anesthetic agents (general, inhaled and IV) e.g. propofol, ketamine
antiarrhythmics (IV) e.g. lidocaine, amiodarone
antithrombotic agents including:
• anticoagulants e.g. warfarin, low-molecular weight heparin
• factor Xa inhibitors and direct oral anticoagulants e.g. fondaparinux, apixaban, ribaroxaban, edoxaban
• direct thrombin inhibitors e.g. argatroban, bivalirudin, dabigatran etexilate
• thrombolytics IV e.g. streptokinase, alteplase, actilyse, tenecteplase
• glycoprotein IIb/IIIa inhibitors e.g. eptifibatide
cardioplegic solutions
chemotherapeutic agents, parenteral and oral e.g. DOXOrubicin, capecitabine, methotrexate
dextrose, hypertonic (20% or greater) e.g. D50W vial
dialysis solutions (peritoneal and hemodialysis) e.g. CAPD, Duosol, Multibic
epidural or intrathecal medications e.g. bupivacaine, fentaNYL, methotrexate
hypoglycemics (oral) e.g. metFORMIN, SITagliptin, gliclazide
inotropic medications (IV) e.g. digoxin, milrinone
insulin (subcutaneous and IV) e.g. insulin glulisine, insulin glargine
liposomal forms of drugs and conventional counterparts e.g. liposomal and conventional amphotericin B
moderate sedation agents (IV) e.g. dexmedetomidine, midazolam, LORazepam
moderate and minimal sedation agents, oral for children e.g., chloral hydrate, midazolam, ketamine IV
narcotics/opioids (IV, transdermal, oral) e.g. oxycodone, morphine, fentaNYL
neuromuscular blocking agents e.g. succinylcholine, rocuronium, vecuronium
parenteral nutrition preparations e.g. Kabiven, Nutriflex, Combiflex
radiocontrast agents (IV) e.g. iopamidol, gadolinium, iohexol
radiopharmaceuticals e.g. dimercaptosuccinic acid, sodium pyrophosphate
sterile water for injection, inhalation, and irrigation e.g. sterile water glass bottle 1L (EM)
(excluding pour bottles) in containers of 100mL or more
sodium chloride for injection, hypertonic, greater than e.g. sodium chloride vial 2.5meq/mL (20mL)
0.9% concentration

Table 2: SPECIFIC MEDICATIONS

amiodarone (IV) methylergometrine (IV)
calcium gluconate (IV) NALoxone (IV)
carbetocin (IV) oxytocin (IV)
digoxin (IV, PO) potassium chloride (IV)
EPINEPHrine (IM, SC) potassium phosphates (IV)
magnesium sulfate (IV, IM) vasopressin (IV or intraosseous)
methotrexate (oral, non-oncologic use)

Reference/s:
1. Institute for Safe Medication Practices 2018 List of High Alert Medications in Acute Care Settings
2. TC-PM-017-67-00; Inclusion of Naloxone in the List of High Alert Medications
3. TC-PM-019-17-00: Updated List of High Alert Medications
4. TC-PM-020-14-00: Review of High Alert Medication (HAM) List
5. TC-PM-022-10-00: Additional Drugs in HAM list, Revisions in Do Not Use Abbreviation List and Addition in the Look-
Alike Drug List
Feb. 18, 2022, Rev. 08
Disclaimer: Hardcopies of this document are considered uncontrolled. Please refer to Sharepoint for the latest version. It is your
responsibility to check the correct and latest version of document before use.
Page 2 of 3
 High Alert Medications
Department of Pharmacy Services
Professional Development and Training

Prepared by:
Ian A. Ocray, RPh
Drug Information and Training Officer

Reviewed by:
Cristina P. Solomon, RPh
Quality and Training Officer

Rachel Merci B. Mundo, RPh

Unit Manager, Professional Development and Training

Approved by:
Hazel Faye R. Docuyanan, RPh, MS
Chief Pharmacy Officer and Department Manager, Pharmacy Services

Feb. 18, 2022, Rev. 08

Disclaimer: Hardcopies of this document are considered uncontrolled. Please refer to Sharepoint for the latest version. It is your
responsibility to check the correct and latest version of document before use.
Page 3 of 3