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The prescriber should be aware that these figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those which prevailed in the clinical trialsSimilarlythe cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatmentsusesand investigatorsThe cited figureshoweverdo provide the prescribing physician with some basis for estimating the relative contribution of drug and non-drug factors to the adverse event incidence rate in the population studied.

At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with CelexaConverselyat least 14 days should be allowed after stopping Celexa before starting an MAOI intended to treat psychiatric disorderssee CONTRAINDICATIONS

Neonates exposed to Celexa and other SSRIs or serotonin and norepinephrine reuptake inhibitorsSNRIslate in the third trimesterhave developed complications requiring prolonged hospitalizationrespiratory supportand tube feedingSuch complications can arise immediately upon deliveryReported clinical findings have included respiratory distresscyanosisapneaseizurestemperature instabilityfeeding difficultyvomitinghypoglycemiahypotoniahypertoniahyperreflexiatremorjitterinessirritabilityand constant cryingThese features are consistent with either a direct toxic effect of SSRIs and SNRIs orpossiblya drug discontinuation syndromeIt should be noted thatin some casesthe clinical picture is consistent with serotonin syndromesee WARNINGSSerotonin Syndrome

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.

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