Provincial High-alert Medication List

Classes/Categories of Medications Specific Medications

adrenergic agonists: IV (e.g., epiNEPHrine, ePHEDrine, isoproterenol, Epoprostenol: IV
PHENYLephrine, norepinephrine, doBUTamine, dopamine, salbutamol)
magnesium sulfate injection
adrenergic antagonists: IV (e.g., propranolol, metoPROLOL, labetalol,
esmolol) methotrexate: oral for non-oncologic
use
anesthetic agents: general, inhaled and IV (e.g., propofol, ketamine,
sevoflurane, isoflurane, desflurane, etomidate) opium tincture

antiarrhythmics: IV (e.g., lidocaine, amiodarone, procainamide, oxytocin: IV

adenosine, bretylium, ibutilide) nitroprusside sodium for injection
antithrombotic agents: potassium chloride for injection:
anticoagulants (e.g., warfarin, acenocoumarol, tinzaparin, concentrate
enoxaparin, dalteparin, danaparoid, unfractionated heparin)
factor Xa inhibitors (e.g., fondaparinux, rivaroxaban) potassium phosphates injection
direct thrombin inhibitors (e.g., apixaban, argatroban, promethazine: IV
bivalirudin, dabigatran)
thrombolytics (e.g., alteplase, tenecteplase) vasopressin: IV or intraosseous
glycoprotein IIb/IIIa inhibitors (e.g.,eptifibitide, tirofiban,
abciximab)
cardioplegic solutions
chemotherapeutic agents: parenteral and oral
dextrose: 20% or greater (hypertonic)
dialysis solutions: peritoneal and hemodialysis
epidural or intrathecal medications
hypoglycemics: oral (e.g., acarbose, GLICLAzide, glyBURIDE, The following medications are also
metFORMIN, pioglitazone, repaglinide, SITagliptin, linagliptin, saxagliptin) associated with higher risk and must
comply with the segregated storage
inotropic medications: IV (e.g., digoxin, milrinone) and labelling requirements for high-
insulin: SC and IV alert medications. Refer to the
Management of High-alert
liposomal forms of drugs and conventional counterparts (e.g., Medications Policy, Procedure, and
amphotericin B, amphotericin B-lipid complex, amphotericin B-liposomal, Electrolytes Guideline for labelling
DOXOrubicin HCL, DOXOrubicin- pegylated liposomal, PACLitaxel, specifics:
PACLitaxel-nab) calcium chloride IV
moderate sedation agents: IV (e.g., dexmedetomidine, midazolam) calcium gluconate IV
potassium acetate IV
moderate sedation agents: oral, for children (e.g., chloral hydrate) potassium chloride small volume
bolus bags
narcotics/opioids: IV, transdermal, and oral
sodium phosphate IV
neuromuscular blocking agents (e.g., succinylcholine, rocuronium,
sodium acetate IV
pancuronium, atracurium, cisatracurium)
parenteral nutrition preparations
Institute for Safe Medication Practice. Retrieved from
radiocontrast agents: IV http://www.ismp.org/Tools/highalertmedications.pdf
on Sep, 17, 2014.
sterile water for injection, inhalation, and irrigation (excluding pour ISMP 2014. Permission is granted to reproduce
bottles) in containers of 100 mL or more material with proper attribution for internal use
within healthcare organizations. Other reproduction
sodium chloride for injection: greater than 0.9% (hypertonic) is prohibited without written permission from ISMP.

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