OBJECTIVE To develop high-alert medication list that complies with Chinese medication practice. METHODS The study was organized by the Group of Medication Safety Experts, Hospital Pharmacy Committee, Chinese Pharmaceutical Association. Selection criteria for high-alert drugs were developed with Delphi consensus among 18 medication safety experts, then two rounds of survey followed. The first round contained open-ended questions, by which the respondents were asked to nominate high-alert medications in addition to ISMP list according to the selection criteria. The new nominations were classified and screened by the experts group to get a preliminary list. The second round was grading scale survey. The healthcare workers who responded to the first round survey were asked to grade on their familiarity to and the risk degree of each medication in the preliminary list. With familiarity as the weight, the weighted risk averages and standard deviations of each medicine were calculated to decide if the medication was included in the high alert medication list or not. RESULTS Selection criteria of high alert medications were developed, which contains 6 items and were used in the first round survey. Totally 782 healthcare workers in 23 hospitals responded to the survey. Through two rounds of survey, 24 classes and 14 specific medications were included in the final list. Compared with ISMP list, the newly added were two more classes, including reproductive toxic drugs and intravenous theophylline, 4 more specific medications, including topical potassium permanganate, 5 mg·mL^-1 atrophine injection, lyophilizing thrombin powder and arsenic trioxide for injection. CONCLUSION A high-alert medication list is developed with two more classed and four more drugs newly adding to the ISMP list, which complies better with Chinese healthcare practice.