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If concomitant use of Celexa with other serotonergic drugs includingtriptanstricyclic antidepressantsfentanyllithiumtramadolbuspironeamphetaminestryptophan and StJohn’s Wort is clinically warrantedpatients should be made aware of a potential increased risk for serotonin syndrome particularly during treatment initiation and dose increases.

Symptoms associated with discontinuation of Celexa and other SSRIs and SNRIs have been reportedsee PRECAUTIONSPatients should be monitored for these symptoms when discontinuing treatmentA gradual reduction in the dose rather than abrupt cessation is recommended whenever possibleIf intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatmentthen resuming the previously prescribed dose may be consideredSubsequentlythe physician may continue decreasing the dose but at a more gradual rate.

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 occurrence of gastrointestinal bleedingBleeding events related to SSRIs and SNRIs use have ranged from ecchymoseshematomasepistaxisand petechiae to life-threatening hemorrhages.

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ssri discontinuation syndrome can become a reality for those who choose to abruptly cease their citalopram therapy.

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