Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study

Area of Science:

• Pharmacovigilance
• Clinical Psychiatry
• Epidemiology

Background:

• Zolpidem is a widely prescribed sedative-hypnotic medication.
• Understanding the potential risks associated with zolpidem use is crucial for patient safety.
• Previous research has suggested a possible link between hypnotics and adverse psychiatric events.

Purpose of the Study:

• To investigate the association between zolpidem exposure and the risk of suicide or suicide attempts.
• To assess the dose-response relationship between zolpidem use and suicide risk.
• To examine this association across various demographic and clinical subgroups.

Main Methods:

• A nationwide case-control study design was employed.
• Cases included 2,199 individuals who committed suicide or were hospitalized for suicide attempts (2002-2011).
• Controls were randomly selected, matched to cases by age, sex, urbanization, and occupation, with a 1:10 ratio. Adjusted odds ratios (ORs) were calculated, controlling for comorbidities and concomitant medications.

Main Results:

• Zolpidem exposure was significantly associated with an increased risk of suicide/suicide attempt (OR = 2.08; 95% CI, 1.83-2.36).
• A clear dose-response relationship was observed, with higher cumulative doses of zolpidem correlating with greater risk (e.g., OR = 2.81 for ≥180 mg).
• The association remained consistent across various subgroups, including different age groups, sexes, urbanization levels, occupations, and individuals with or without comorbid mental disorders or insomnia.

Conclusions:

• This study confirms a significant association between zolpidem use and the risk of suicide or suicide attempts.
• The observed risk is present in individuals with and without comorbid psychiatric conditions.
• Findings underscore the importance of careful consideration of zolpidem prescription, especially in vulnerable populations.