NPSA Rapid Response Report RRR018 -Preventing fatalities from medication loading doses. A risk assessment tool to support local implementation

Varinder Rai, Regional Medicines Information Manager, London Medicines Information ServicePublished

The NPSA rapid response report on preventing fatalities from medication loading doses directs organisations to identify and risk assess use of loading doses with the aim of producing a list of critical medicines (to include at least warfarin, amiodarone, digoxin, and phenytoin) that informs subsequent actions.

This updated document provides a comprehensive list of medications for which a loading dose is given in routine clinical practice. This list seeks to reduce duplication of effort in enabling organisations to identify high-risk loading dose situations that occur locally and to allow them to consider the risks that may be present and strategies for appropriate risk reduction.

This list is based on the content of BNF 78 (September 2019 to March 2020) and BNF for Children (September 2018 to 2019). The medicines are presented in both alphabetical and legacy BNF Chapter order and indications are described as loading doses may be required for some licensed indications but not others.