OBJECTIVES: To compare the risk of suicide attempts/behaviors associated with different smoking cessation medications among schizophrenic patients. METHODS: A retrospective cohort study was conducted using General Electric (GE) medical records database (1995-2011). The first day of being prescribed smoking cessation medication was defined as the index date. Patients were followed up to one year from index date. Patients’ suicide behaviors or attempts were identified through ICD9 codes and E-codes. Comprehensive codes for suicide were extracted from literature, for example, poisoning by solid or liquid (E950); hanging, strangulation, or suffocation (E953); drowning (E954), or jumping from a high place (E957). Cox proportional hazards model was applied to examine the association between cessation medication (nicotine replacement therapy, Bupropion or Varenicline) and suicidal/self-injurious behaviors developed during one year follow-up period. Other potential confounders included were age, race, gender, region, BMI, payment type, specialty group, having previous suicide behaviors/attempts or depression/exposed to anti-depressants one year before index date, nicotine addiction level, comorbidity index, and severity of mental disorder.   RESULTS: Our cohort consisted of 3,925 patients with diagnosis of schizophrenia or schizoaffective disorder who initiated cessation medication. Among them, 104 (2.65%) had suicide attempts or behavior within one year after cessation exposure. The number of suicide increased dramatically after exposure within 3 months. However, statistically significant difference in the risk of suicide attempts/behaviors was not detected across cessation regimens in the Cox proportional hazard analysis. Only comorbidity index was found to be associated with suicide, which showed that higher Charlson comorbidity indices was associated with higher risks of suicide behaviors within one year (HR=1.15, 95% CI=1.04 – 1.27). CONCLUSIONS: There were no significant differences in suicide attempts/behaviors with different cessation medications. Healthcare providers should pay close attention to all the possible signs of suicide among this high risk population, especially those on pharmacological cessation intervention trying to quit smoking.