Utilization of prescription drugs with warnings of suicidal thoughts and behaviours in the USA and the US Department of Veterans Affairs, 2009jphs_93 157..163 Jill E. Lavigne a , Anthony Au b , Rong Jiang b , Yu Wang b , Chester P. Good c , Peter Glassman d and Frances Cunningham b a Pharmacy Practice and Administration, Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York, b VA MedSAFE, Pharmacy Benefits Management Group, US Department of Veterans Health Affairs, Hines, Illinois, c VA Pgh Healthcare System, Pittsburgh, Pennsylvania and d VA Greater Los Angeles Healthcare System (GLA), Los Angeles, California, USA Abstract Objectives To develop a list of prescription medications labelled with warnings for adverse effects of suicidal ideation or behaviour and to describe utilization in the USA and in the Department of VeteransAffairs (VA) in 2009. Methods A systematic search of US Food and Drug Administration and other references using ‘suicide’, ‘suicidal’ and ‘suicidality’ was used to identify prescription drugs labelled for risk of suicidal ideation or behaviour. Prescription medications sold in the USA by sales volume are reported alongside VA utilization as determined from national electronic phar- macy records. Key findings One hundred and twenty-five prescription drugs were labelled for potential adverse effects of suicidal ideation or behaviour. Forty-five of these drugs were among the top 200 prescription medications sold in the USA in 2009 with a total sales volume of 540.8 million prescriptions. Rank-ordered utilization was similar in the VA. VAtotal fill volume was 5.99 million prescriptions. Conclusions The majority of prescriptions with adverse effect warnings of suicidal ide- ation or behaviour were generic. Relatively high volumes of drugs with warnings for suicidal ideation or behaviour are filled in the USA and in the VA. Keywords adverse effect; prescription drug; suicidal behaviour; suicidal ideation; utilization; veteran Introduction The US Food and Drug Administration (FDA) requires pharmaceutical manufacturers of a variety of prescription medications to place boxed and other warnings of suicidal ideation or behaviours on drug labels. Warnings appear on the labels of medications used for a wide range of indications such as anxiety, mood and depressive disorders, asthma, smoking cessation, diabetic neuropathy and menopausal hot flashes. [1] Yet a list of medications with warnings of potential suicidal ideation and behaviour is not readily available from the FDA. Little is known about the total utilization of the group of prescription drugs with warnings for suicidal behaviour or ideation, although studies have examined utilization trends within specific drug classes, such as anti-depressants. [1–5] Furthermore, biological mechanisms by which these drugs affect suicidal thoughts or behaviours are not well understood. [1] In the USA suicide is a more common cause of death than hypertension, homicide or HIV. [6] More than 34 000 people kill themselves each year, and more than 376 000 people are treated in US emergency rooms for self-inflicted injuries. [7] About 80% of all suicides occur in men. [6] The US suicide rate has remained unchanged since 2000 at 10.9 per 100 000 people. [6] These rates would be higher if we we included the full continuum of thoughts and behaviours associated with suicide: (1) thoughts about ending one’s life (suicidal ideation), (2) plans to die by suicide, (3) non-fatal suicidal behaviour (suicide attempt) and (4) ending one’s life (suicide). [8] US military suicide rates have increased over the same period, with some of the highest rates in the US Marine Corps (24 per 100 000 in 2009). [9] Veterans also face a bs_bs_banner Research Paper JPHSR 2012, 3: 157–163 © 2012 The Authors JPHSR © 2012 Royal Pharmaceutical Society Received January 16, 2012 Accepted April 3, 2012 DOI 10.1111/j.1759-8893.2012.00093.x ISSN 1759-8885 Correspondence: Jill Lavigne, Pharmacy Practice and Administration, Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY 14618, USA. E-mail: jlavigne@sjfc.edu 157 Downloaded from https://academic.oup.com/jphsr/article/3/3/157/6016307 by guest on 09 August 2023