Prescribing considerations in a patient at risk of suicide

Drug overdoses are commonly taken during suicide attempts. Older and frail people are at higher risk of fatal toxicity in an overdose because of an increased likelihood of having multiple comorbidities, resulting in potential drug–drug and drug–disease interactions.

If a patient is at risk of suicide, limit access to drugs that can be harmful in overdose; for example:

• avoid prescribing drugs with a high risk of toxicity when taken in overdose (eg tricyclic antidepressants, venlafaxine, opioids, drugs with a narrow therapeutic index)
• if using a potentially harmful drug, prescribe a small quantity or use a staged-supply prescription in collaboration with the pharmacist (eg one week at a time)
• use a preparation supplied in a blister pack instead of a bottle, to increase the effort required to obtain a harmful dose
• supervise drug administration
• restrict physical access to the drug (eg locking in a cupboard/container).