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Suicide Attempts and the Nicotine Patch

Charles J. Engel, MD; A. Hilton Parmentier, MD
JAMA. 1993;270(3):323-324. doi:10.1001/jama.1993.03510030047028.
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To the Editor.  —Within recent months, four pharmaceutical manufacturers have brought nicotine replacement patches onto the US market for the treatment of nicotine dependence. The package inserts for these nicotine patches warn physicians that the risks of nicotine replacement therapy in patients with known cardiovascular or peripheral vascular disease should be weighed carefully against the benefits of smoking cessation. We write to report the case of a patient with known coronary artery disease who attempted suicide by means of nicotine overdose using nicotine patches.

Report of a Case.  —Our patient was a 44-year-old man who presented in October 1992 with a single episode of major depression and recurrent suicidal ideation. Diagnostic evaluation resulted in additional diagnoses of pathological gambling, alcohol dependence syndrome, and nicotine dependence. The patient had undergone coronary angioplasty in August 1992 for coronary artery disease. Two weeks prior to his October hospital admission, he attempted suicide by


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