High-Risk Medicines (HRMs) can be defined as “medicines that are most likely to cause significant harm to the patient, even when used as intended”. Recognised Best Practice in relation to HRMs comes from the National Patient Safety Agency (NPSA): High Risk Drugs List, however, this mainly concerns traditional face-to-face prescribing practice. When HRMs are prescribed online, risks could potentially be enhanced if there is a lack of technology to facilitate adequate pharmacovigilance and patient monitoring.

Key medicines which frequently feature in scientific articles on high-risk medicines include:

• NSAIDs
• DMARDs: Methotrexate and azathioprine
• Chemotherapeutic agents
• Anti-infective such as amphotericin or aminoglycosides
• Medicines with a narrow therapeutic index such as heparin¹ or lithium².
• Medicines that can affect the unborn child such as valproate, statins and ACE inhibitors
• Medicines that are not taken orally
• Common medicines associated with suicide: antidepressants
• Black triangle medicines – any new medicine newly approved (usually a period of five years following first authorisation)

If you would like more information on this topic please have a look at our article on the Online Prescribing Formulary.