High-alert drugs are drugs that bear a heightened risk of causing significant patient harm when they are used in error. High-alert drugs carry a significant risk of causing serious injury or death to patients 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. For years, the Institute for Safe Medication Practices (ISMP) has published a list of high-alert medications for acute care settings. ISMP gives the following strategies to reduce the risk of errors and minimize harm. Standardizing the ordering, storage, preparation, and administration of these medications Improving access to information about these drugs Limiting access to high-alert medications Using auxiliary labels and automated alerts Employing redundancies High Alert Drugs The following medicines should ‘ring alarm bells’ as having important interactions: Warfarin Statins Macrolide Antibiotics Calcium Channel Blockers Azole antifungals SSRIs – fluoxetine Amiodarone Digoxin Rifampicin, Isoniazid Antiepileptic medicines – particularly carbamazepine, phenytoin; less so valproate Important Drug Interactions of High Alert Drugs Warfarin Monitor INR and patient closely when adding metronidazole, ciprofloxacin, cotrimoxazole, clarithromycin, doxycycline, fluconazole, azathioprine, rifampicin, isoniazid, carbamazepine, phenytoin, sulfasalazine, amiodarone Adjust dose of warfarin, at the outset, when adding these drugs Switch to LMWH or UFH Atorvastatin Do not use with verapamil, clarithromycin, itraconazole, fluconazole, ciclosporine Monitor CPK levels Switch to rosuvastatin (with warfarin, atorvastatin may be better) when adding any of these drugs Clarithromycin Do not use with atorvastatin, digoxin, warfarin, dabigatran, rivaroxaban, apixaban, colchicine, phenytoin, carbamazepine and drugs that prolong QT interval May use azithromycin or another antibiotic in patients taking any of these drugs Itraconazole, Fluconazole Do not use with atorvastatin, dabigatran, rivaroxaban, apixaban, digoxin Use carefully with warfarin, carbamazepine, phenytoin, rifampicin Digoxin Do not use with clarithromycin, itraconazole, ciclosporine, verapamil, diltiazem Use carefully with diuretics, amiodarone, rifampicin, phenytoin, carbamazepine Rifampicin, Isoniazid Use carefully with hepatotoxic drugs Use carefully with phenytoin, carbamazepine, warfarin, digoxin, calcium channel blockers, oral contraceptives, corticosteroids, sulfonylureas, macrolide antibiotics, azole antifungals Carbamazepine, Phenytoin Do not use with clarithromycin, oral contraceptive pills Use carefully with warfarin, itraconazole, isoniazid, rifampicin Amiodarone Use carefully with digoxin, warfarin, carbamazepine, phenytoin, and drugs that prolong QT interval Sildenafil Do not use with nitrates Allopurinol Do not use with azathioprine For Further Information Please Subscribe