Abstract: OBJECTIVE To evaluate the effect of targeted management of key monitoring drugs in municipal public medical institutions, and provide empirical evidence for control strategy optimization and rational drug use. METHODS Key monitoring drugs were picked according to the national and provincial key monitoring drug lists. The implementation effect of targeted management of key monitoring drug was evaluated by comparing the drug income, drug proportion in total drug income, defined daily dose between October 2018-September 2020 in public medical institutions. The data after targeted management were analyzed by pareto chart analysis. RESULTS According to the catalogue and clinical application, 18 kinds of key monitoring drugs were included. Compared with before and after control, the purchase amount decreased from 99.418 6 million yuan to 43.432 7 million yuan, DDDs decreased by 41.34%, and the proportion of total drug purchase amount decreased from 3.80% to 1.98%. Among them, the proportion of key monitoring drugs in secondary hospitals was significantly higher than that in tertiary hospitals and primary hospitals. Cardiovascular and cerebrovascular adjuvant drugs and traditional Chinese medicine injections decreased significantly in public medical institutions above second level. Oral preparations such as butylphthalide and citicoline decreased greatly in tertiary hospitals. CONCLUSION The targeted control of key monitored drugs has achieved remarkable results. Public medical institutions below the third level should further strengthen the control. The analysis of the use of key monitored drugs helps to optimize the control strategies and measures.