Presentation (CTI)

OBJECTIVES: This study aimed to investigate the association between zolpidem use and suicide risk in adolescents of South Korea. Despite its contraindication in individuals under 18 years, zolpidem is still commonly prescribed. We examined the risk of suicide and suicide attempts associated with zolpidem exposure using a nationwide claims database.
METHODS: A retrospective cohort study was conducted using the Korean National Health Insurance Service (NHIS) database from June 2005 to December 2023. Adolescents (<18 years) diagnosed with insomnia (F51.0, G47.0) and prescribed hypnotics were included. Approximately 58,732 patients were identified, of whom 21,540 received zolpidem and 37,192 received other hypnotics (other z-drugs, benzodiazepines, antidepressants). The primary outcome was the first incidence of suicide or suicide attempt (ICD-10 codes: X60-84, Y87). Inverse probability of treatment weighting (IPTW) was used to adjust for confounders, and Cox proportional hazards models were employed to estimate the adjusted hazard ratio (HR) comparing zolpidem users with other hypnotics users.
RESULTS: The incidence of suicide or suicide attempt was significantly higher in the zolpidem group (2.6%) compared to the other hypnotic group (1.4%) (p<0.001). After IPTW adjustment, zolpidem use was associated with an increased risk of suicide-related events (adjusted HR: 1.74; 95% CI: 1.40-2.15). Subgroup analyses showed that females and patients with comorbid psychiatric disorders had a notably higher risk.
CONCLUSIONS: Zolpidem use in adolescents was associated with a higher risk of suicide and suicide attempts compared to other hypnotics. These findings highlight the need for strengthened monitoring and regulatory measures for zolpidem prescription in adolescents.