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News Release

ISMP Updates High-Alert Medication List

Changes Include Addition of Tranexamic Acid Injection

The Institute for Safe Medication Practices (ISMP) has published a 2024 version of its high-alert medication list, which includes input from safety experts and a national survey. The main addition to the list is the inclusion of tranexamic acid injection, an antifibrinolytic that is used in a variety of hemorrhagic conditions to control bleeding, including postpartum hemorrhage.

ISMP published its first compilation of six “high-alert” medications in 1989, and those drugs are still on ISMP’s list today. High-alert medications are defined as those 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 involving them may be more devastating to patients.

“Respondents to ISMP’s 2023 survey indicated a higher level of recognition that some medications such as potassium phosphate for injection and oxytocin are considered to be high alert,” says Shannon Bertagnoli, PharmD, ISMP Medication Safety Specialist, Publications. “We are pleased to see that increasing level of awareness of high-alert status, since knowledge of risk and implementing safeguards can help prevent potentially fatal errors.”

Survey respondents shared that errors involving tranexamic acid for injection are frequently related to storage issues and mix-ups with look-alike medication vials, most often anesthetics that are also commonly stored in surgical and procedural locations. When accidentally administered via a neuraxial route, tranexamic acid injection is a potent neurotoxin with a mortality rate of about 50%, and almost always harmful to the patient.

ISMP has repeatedly warned about errors with tranexamic acid, including publishing a feature article in the ISMP Medication Safety Alert! Acute Care newsletter and issuing a National Alert Network (NAN) warning.

For a copy of the 2024 List of High-Alert Medications in Acute Care Settings, click here.


Renee Brehio, Medication Safety Analyst and Editor,

About the Institute for Safe Medication Practices

The Institute for Safe Medication Practices (ISMP) is the nation’s first 501c (3) nonprofit organization devoted entirely to preventing medication errors. ISMP is known and respected for its medication safety information. For more than 30 years, it also has served as a vital force for progress. ISMP’s advocacy work alone has resulted in numerous necessary changes in clinical practice, public policy, and drug labeling and packaging. Among its many initiatives, ISMP runs the only national voluntary practitioner medication error reporting program, publishes newsletters with real-time error information read and trusted throughout the global healthcare community, and offers a wide range of unique educational programs, tools, and guidelines. In 2020, ISMP formally affiliated with ECRI to create one of the largest healthcare quality and safety entities in the world, and ECRI and the ISMP PSO is a federally certified patient safety organization by the U.S. Department of Health and Human Services. As an independent watchdog organization, ISMP receives no advertising revenue and depends entirely on charitable donations, educational grants, newsletter subscriptions, and volunteer efforts to pursue its life-saving work. 


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