Intimate partner homicide (IPH) is a critical public health and safety issue in the USA. In this study, we determine the prevalence and correlates of perpetrator suicide and additional homicides following intimate partner homicide (IPH) in a large, diverse state with high quality data. We extract IPHs from the North Carolina Violent Death Reporting System for 2004–2013 and identify suicides and other homicides that were part of the same incidents. We analyze the likelihood (in odds ration form) of perpetrator suicide and additional homicides using logistic regression analysis. Almost all IPH-suicide cases were by men with guns (86.6%). Almost one-half of IPHs committed by men with guns ended with suicide. Male-perpetrated IPH incidents averaged 1.58 deaths if a gun was used, and 1.14 deaths otherwise. It is well-known that gun access increases the chance that a violent domestic relationship will end in death. The current findings demonstrate that gun IPH is often coupled with additional killings. As suicidal batterers will not be deterred from IPH by threat of punishment, the results underline the importance of preemption by limiting batterers’ access to guns.