Introduction: The utilization of HAMs is crucial in emergency and intensive care departments, as they can cause a significant amount of damage to the patient and health care members if we could not follow the standard treatment guidelines. Drug utilization evaluation/review involves a comprehensive review of the patient’s prescription and medication data before, during, and after dispensing to ensure appropriate medication decision making and positive patient outcomes. Objective: This study was taken up given finding the utilization patterns and rectifying the issues with the usage of high alert medications (HAMs) and improving their utilization. Methodology: A cross-sectional study was conducted for 6 months at a south Indian tertiary care hospital. Treatment guidelines were prepared to compare the actual drug use. Data were collected both retrospectively and prospectively by patients and care taker’s interview, medication chart review, and discussion with prescribers and applied WHO DUE indicators to evaluate utilization patterns. Results: Of 362 cases, 57.73 % were males/ and the majority geriatrics. Among all HAMs Insulin is frequently prescribed (34.5 %) and the costly drug is Enoxaparin. Generic names were used in writing prescriptions and parenteral formulations were mostly used. Around 9 ADRs were identified and managed, and a total of 133 moderate to severe Drug-Drug Interactions were found, of them, only 2 were actual. Conclusion: With this study, we conclude that the use of HAMs was found to be appropriate as per the guidelines as we observed very few DRPs with the study drugs. Keywords: HAM, DRP’s, DUE, ICU, DDD