Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System

Abstract

Introduction Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. Methods We retrieved cases of ‘intentional overdose’ and ‘poisoning deliberate’ from the FAERS (January 2004–December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. Results We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g). Conclusion Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01269-x.

A Cross-Sectional Analysis of Intentionally Self-Inflicted Poisoning Among Hospitalized Patients.

“…This socioeconomic dimension suggests a potential link between economic hardship and intentional selfpoisoning. Addressing these underlying determinants requires a holistic approach that extends beyond the confines of healthcare to encompass broader social and economic considerations [11,12]. The observed ruralurban divide in our study aligns with a national survey conducted by WHO [13], revealing a higher prevalence of self-harm in rural areas.…”

An exploratory study evaluating the 20 medications most commonly associated with suicidal ideation and self-injurious behavior in the FAERS database

“…Amlodipine exhibits the highest ROR for completed suicide, and acetaminophen stands out with the highest reported frequency. A study based on the FAERS highlights acetaminophen, promethazine, amlodipine, quetiapine, and metformin as the most commonly used drugs in deliberate self-poisoning incidents 37 . Incidents of suicide attempts involving excessive doses of amlodipine and acetaminophen have been reported in various studies [38][39][40] .…”

Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System

“…Building on insights from prior studies on drugs 39 and events 31,40,41 co-occurrence, our network analysis aimed to unveil sub-syndromes. Using three established network estimations as distinct mathematical representations (PPMI, Ising, ϕ ) and excluding negative links (i.e., potential mutually exclusive events), we explored co-reporting patterns.…”

“…Building on insights from prior studies on drugs [44] and events [31,45,46] co-occurrence, our network analysis aimed to unveil, within the drug-induced impulsivity syndrome, sub-syndromes of cohesively clustered events. Together with the Ising estimation [32,47], already implemented in pharmacovigilance because of its ability to obtain a sparser and easily interpretable network (because of fewer links and more definite clusters) [31], we implemented two other more connected network estimations in order to identify broader co-reporting patterns (PPMI [34], Ising, ϕ [33]).…”

“…We downloaded FAERS quarterly data in ASCII format (January 1 st , 2004, to March 31 st , 2022) [25]. Adverse events were coded according to the Medical Dictionary for Regulatory Activities (MedDRA®, version 25.0) preferred terms (PTs) [38], while drugs were standardized according to their active ingredients [39]. The latest report version was retained, and rule-based deduplication was applied to reduce redundancy (cfr.…”