European Journal of Clinical Pharmacology

, Volume 70, Issue 6, pp 637–645 | Cite as

Identifying high-risk medication: a systematic literature review

  • Eva A. Saedder
  • Birgitte Brock
  • Lars Peter Nielsen
  • Dorthe K. Bonnerup
  • Marianne Lisby
Review Article



A medication error (ME) is an error that causes damage or poses a threat of harm to a patient. Several studies have shown that only a minority of MEs actually causes harm, and this might explain why medication reviews at hospital admission reduce the number of MEs without showing an effect on length of hospital stay, readmissions, or death. The purpose of this study was to define drugs that actually cause serious MEs. We conducted a literature search of medication reviews and other preventive efforts.


A systematic search in PubMed, Embase, Cochrane Reviews, Psycinfo, and SweMed+ was performed. Danish databases containing published patient complaints, patient compensation, and reported medication errors were also searched. Articles and case reports were included if they contained information of an ME causing a serious adverse reaction (AR) in a patient. Information concerning AR seriousness, causality, and preventability was required for inclusion.


This systematic literature review revealed that 47 % of all serious MEs were caused by seven drugs or drug classes: methotrexate, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDS), digoxin, opioids, acetylic salicylic acid, and beta-blockers; 30 drugs or drug classes caused 82 % of all serious MEs. The top ten drugs involved in fatal events accounted for 73 % of all drugs identified.


Increasing focus on seven drugs/drug classes can potentially reduce hospitalizations, extended hospitalizations, disability, life-threatening conditions, and death by almost 50 %.


Adverse reactions Medication errors Medication review High-risk drugs 


Conflict of interest and funding


Supplementary material

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ESM 1 (DOCX 16 kb)
228_2014_1668_MOESM2_ESM.docx (23 kb)
ESM 2 (DOCX 23 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Eva A. Saedder
    • 1
  • Birgitte Brock
    • 2
  • Lars Peter Nielsen
    • 1
  • Dorthe K. Bonnerup
    • 3
  • Marianne Lisby
    • 4
  1. 1.Department of Clinical PharmacologyAarhus University HospitalAarhus CDenmark
  2. 2.Department of Biochemistry and Department of BiomedicineAarhus University HospitalAarhusDenmark
  3. 3.Hospital PharmacyAarhus University HospitalAarhusDenmark
  4. 4.Research Centre of Emergency MedicineAarhus University HospitalAarhusDenmark

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