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In subjects with hepatic impairmentcitalopram clearance was decreased and plasma concentrations were increasedThe use of Celexa in hepatically impaired patients should be approached with caution and a lower maximum dosage is recommendedsee DOSAGE AND ADMINISTRATION
SSRIs and SNRIsincluding Celexamay increase the risk of bleeding eventsConcomitant use of aspirinnonsteroidal anti-inflammatory drugswarfarinand other anticoagulants may add to the riskCase reports and epidemiological studiescase-control and cohort designhave demonstrated an association between use of drugs that interfere with serotonin reuptake and the rxeurope. occurrence of gastrointestinal bleedingBleeding events related to SSRIs and SNRIs use have ranged from ecchymoseshematomasepistaxisand petechiae to life-threatening hemorrhages.
Patients should be advised that taking Celexa can cause mild pupillary dilationwhich in susceptible individualscan lead to an episode of angle closure glaucomaPre-existing glaucoma is almost always open-angle glaucoma because angle closure glaucomawhen diagnosedcan be treated definitively with iridectomyOpen-angle glaucoma is not a risk factor for angle closure glaucomaPatients may wish to be examined to determine whether they are susceptible to angle closureand have a prophylactic proceduree.giridectomyif they are susceptible.
Animal studies suggest that the abuse liability of Celexa is lowCelexa has not been systematically studied in humans for its potential for abusetoleranceor physical dependenceThe premarketing clinical experience with Celexa did not reveal any drug-seeking behaviorHoweverthese observations were zpak by mail. not systematic and it is not possible to predicton the basis of this limited experiencethe extent to which a CNS-active drug will be misuseddivertedand/or abused once marketedConsequentlyphysicians should carefully evaluate Celexa patients for history of drug abuse and follow such patients closelyobserving them for signs of misuse or abusee.gdevelopment of toleranceincrementations of dosedrug-seeking behavior
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