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Pharmacoeconomics and Outcomes

Risk of Suicide Attempts and Intentional Self-Harm on Alprazolam compared with Other Benzodiazepines and Buspirone

(1265) Risk of Suicide Attempts and Intentional Self-harm on Alprazolam Compared with Other Benzodiazepines and Buspirone

Saturday, March 23, 2024
12:30 PM – 2:30 PM East Coast USA Time

    Primary (first) Author(s)

  • JL

    Jill E. Lavigne, N/A

    Professor
    Wegmans School of Pharmacy, St John Fisher University
    Pittsford, New York, United States

    • Presenting Author(s)

  • JL

    Jill E. Lavigne, N/A

    Professor
    Wegmans School of Pharmacy, St John Fisher University
    Pittsford, New York, United States

    • Co-Author(s)

  • KH

    Kwan Hur

    University of Chicago Center for Health Statistics, United States

  • JM

    J John Mann

    Paul Janssen Professor of Translational Neuroscience
    Columbia University, United States

  • RG

    Robert Gibbons

    Blum-Reise Professor of Medicine, Director Center for Health Statistics
    University of Chicago, United States

Objectives: Suicide is a leading cause of death in the U.S., having risen over 30% from 2000- 2018. Identification of pharmacological agents associated with increased risk and safer alternatives may help reverse this trend. The objective of this study is to confirm a previous signal for increased risk of hospital or emergency room admissions for suicide attempt or intentional self-harm following prescription fills for the benzodiazepine, alprazolam, in comparison to other benzodiazepine and non-benzodiazepine anxiolytics.

Methods:

Design: A within-person cohort design to study the dynamic association between alprazolam and suicidal behavior over 2-years. Parallel analyses were conducted for diazepam, lorazepam and buspirone. Setting: A pharmacoepidemiologic database of U.S. private insurance medical claims (MarketScan) from 2010-2019. Participants: 2,620,554 patients who filled an alprazolam prescription between 2012 and 2019 who had no prior prescriptions of alprazolam in 2010-2011.

Results: Adjusting for age and sex, diagnoses and medications related to suicidal behavior, and history of suicidal events, the hazard ratio (HR) for alprazolam was HR=2.30, 95% CI = 2.14, 2.47. A duration-response analysis for the modal dose (0.5mg) revealed a 9% increase in suicidal events per additional month of alprazolam treatment (HR=1.09, 95% CI = 1.07, 1.11). Parallel analyses with long-acting (diazepam) and short-acting (lorazepam), found similar associations, whereas the non-benzodiazepine anxiolytic, buspirone, showed significantly less risk, and no increased risk in patients with a suicidal event history.

Conclusions: This large-scale pharmacoepidemiologic study confirmed the signal between alprazolam and suicide attempt. The increased risk extends to benzodiazepines in general, regardless of half-life and risk of withdrawal seizure. Non-benzodiazepine anxiolytics like buspirone may be a safer treatment than benzodiazepines, particularly in patients at increased risk for suicide.