If you notice any of these symptoms in your newborn, tell the doctor promptly. The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. Sexual dysfunction: May cause or exacerbate sexual dysfunction. Overmars H, Scherpenisse PM, Post LC. Fluvoxamine maleate: metabolism in man. Eur J Drug Metab Pharmacokinet 1983; 83: 269-80. trandate
NSAIDs, like ibuprofen, naproxen, or aspirin. Tryptophan: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Caution is advised when using this drug in children because they are more sensitive to the effects. This drug can often cause excitement in young children instead of drowsiness. It may take up to several weeks before you get the full benefit of this drug. Pirfenidone: CYP1A2 Inhibitors Strong may increase the serum concentration of Pirfenidone. Management: See full monograph for specific recommendations. Canadian product labeling specifically lists the use of pirfenidone with fluvoxamine as contraindicated.
Fluvoxamine has caused increased prolactin levels and galactorrhea in nonpregnant, nonnursing patients. CIBA PHARMACEUTICAL PRODUCTS, INC. Distributed by: Sun Pharmaceutical Industries, Inc. Pharmacopsychiatry 1993; 26: 100-1. She partially breastfed her infant extent not stated for 3 months from birth. No adverse events were seen in the infant who developed normally. MDD and other psychiatric disorders.
Jeffries J, Bezchlibnyk-Butler K, Remington G. Amenorrhea and galactorrhea associated with fluvoxamine in a loxapine-treated patient. J Clin Psychopharmacol. Fluoride with ADE: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Take fluvoxamine extended-release capsules by mouth with or without food. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Fluvoxamine Maleate Tablets for a condition for which it was not prescribed. Do not give Fluvoxamine Maleate Tablets to other people, even if they have the same condition. It may harm them.
What tests do health-care professionals use to diagnose depression? Several weeks may pass before your symptoms improve. Do NOT take more than the recommended dose, change your dose, or use fluvoxamine extended-release capsules for longer than prescribed without checking with your doctor. Taking MAO inhibitors with this medication may cause a serious possibly fatal drug interaction. Avoid taking MAO inhibitors isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication. Do not start taking fluvoxamine during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping fluvoxamine before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions. Am J Psychiatry 1993 Oct; 15010: 1566. Based on the number of males or females, as appropriate. SSRIs and SNRIs see Use In Specific Populations, Geriatric Use. Clin Psychopharmacol 1991 Dec; 116: 391-2. Spigset O. Serotonin syndrome induced by fluvoxamine-lithium interaction. Pharmacopsychiatry 1993 Nov; 26: 263-4. In some cases, a patient already receiving Fluvoxamine Maleate Tablets therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Fluvoxamine Maleate Tablets should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for two weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first.
Urokinase: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. Where can one seek help for depression? Do not start, stop, or change the dosage of any medicines without your doctor's approval. Tell your doctor or pharmacist if you are taking other products such as alcohol, antihistamines such as cetirizine, diphenhydramine other drugs for sleep or anxiety such as alprazolam, zolpidem muscle relaxants such as carisoprodol, cyclobenzaprine and narcotic pain relievers such as codeine, hydrocodone. Fosphenytoin: FluvoxaMINE may increase the serum concentration of Fosphenytoin. Patients with Concomitant Illness. methimazole
Dofetilide: CYP3A4 Inhibitors Weak may increase the serum concentration of Dofetilide. Older adults may be more sensitive to the side effects of this drug, especially bleeding, or loss of coordination, QT prolongation. Older adults may also be more likely to develop a type of salt imbalance hyponatremia especially if they are taking "water pills" diuretics. Loss of coordination can increase the risk of falling. LUVOX CR Capsules, there was one nonfatal intentional overdose. Hyponatremia low sodium in the blood may occur with fluvoxamine. Check with your doctor right away if you have confusion, difficulty concentrating, headaches, memory problems, weakness, and unsteadiness. Thus patients receiving oral anticoagulants and Fluvoxamine Maleate Tablets should have their prothrombin time monitored and their anticoagulant dose adjusted accordingly. No dosage adjustment is required for Fluvoxamine Maleate Tablets. CYP1A2 Inhibitors Strong: May decrease the metabolism of CYP1A2 Substrates. Store fluvoxamine extended-release capsules at room temperature between 59 and 86 degrees F 15 and 30 degrees C in a tightly closed container. Avoid temperatures above 86 degrees F 30 degrees C. Store away from heat, moisture, and light. Do not store in the bathroom. Keep fluvoxamine extended-release capsules out of the reach of children and away from pets. In a single-dose study comparing the exposures after oral administration of a combination capsule of 15 mg Phentermine and 92 mg topiramate to the exposures after oral administration of a 15 mg Phentermine capsule or a 92 mg topiramate capsule, there is no significant topiramate exposure change in the presence of Phentermine. However in the presence of topiramate, Phentermine C max and AUC increase 13% and 42%, respectively. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take see section. Ocular effects: May cause mild pupillary dilation which in susceptible individuals can lead to an episode of narrow-angle glaucoma. Consider evaluating patients who have not had an iridectomy for narrow-angle glaucoma risk factors. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Absorption: The absolute bioavailability of Fluvoxamine maleate is 53%. Oral bioavailability is not significantly affected by food. During premarketing clinical trials conducted in North America and Europe, multiple doses of Fluvoxamine maleate were administered for a combined total of 2737 patient exposures in patients suffering OCD or Major Depressive Disorder. Untoward reactions associated with this exposure were recorded by clinical investigators using descriptive terminology of their own choosing. where to buy indian clavaseptin clavaseptin
Therefore, Fluvoxamine and thioridazine should not be coadministered. Using fluvoxamine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Fluvoxamine Maleate Tablets can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how Fluvoxamine Maleate Tablets affects you. Do not drink alcohol while using Fluvoxamine Maleate Tablets. New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe. Deferasirox: May increase the serum concentration of CYP1A2 Substrates. SSRI such as LUVOX CR Capsules. Marshall AM, Nommsen-Rivers LA, Hernandez LL et al. Serotonin transport and metabolism in the mammary gland modulates secretory activation and involution. J Clin Endocrinol Metab. To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used diazepam for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Vandel S, Bertschy G, Bauman P, et al. Fluvoxamine and fluoxetine: interaction studies with amitriptyline, clomipramine and neuroleptics in phenotyped patients. Pharmacol Res 1995; 316: 347-53. Perhexiline: CYP2D6 Substrates may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates. SNRI exposure late in the third trimester include respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypo- or hypertonia, hyper-reflexia, jitteriness, irritability, constant crying, and tremor. An examination of population subgroups from this trial did not reveal any clear evidence of a differential maintenance effect on the basis of age or gender. Consult full interaction monograph for specific recommendations. Keep Fluvoxamine MALEATE TABLETS bottle closed tightly. Several recent epidemiologic studies suggest a positive statistical association between SSRI use including Fluvoxamine Maleate Tablets in pregnancy and PPHN. Other studies do not show a significant statistical association. where to purchase bisoprolol uk
Take this medication by mouth with or without food as directed by your doctor. The effectiveness of Fluvoxamine Maleate Tablets for the treatment of obsessive compulsive disorder OCD was demonstrated in two 10-week multicenter, parallel group studies of adult outpatients. Fluvoxamine may be taken with or without food. Take fluvoxamine at bedtime, unless your doctor tells you otherwise. Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Am J Psychiatry 1996 Jun; 1536: 840-1. Serotonin syndrome is a possibly fatal syndrome that can be caused by fluvoxamine extended-release capsules. Your risk may be greater if you take fluvoxamine extended-release capsules with certain other medicines eg, MAOIs, "triptans". Symptoms may include agitation; confusion; hallucinations; coma; fever; fast or irregular heartbeat; tremor; excessive sweating; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms. cheap insulin medicamento insulin
On average, both lorazepam alone and lorazepam with Fluvoxamine produced substantial decrements in cognitive functioning; however, the coadministration of Fluvoxamine and lorazepam did not produce larger mean decrements compared to lorazepam alone. Trabert W, Hohagen F, Winkelmann G, et al. A seizure, and electroencephalographic signs of a lowered seizure threshold, associated with fluvoxamine treatment of obsessive-compulsive disorder. Pharmacopsychiatry 1995; 28: 95-7. Yoshida K, Smith B, Kumar RC. Fluvoxamine in breast-milk and infant development. Br J Clin Pharmacol. Included as part of the PRECAUTIONS section. Fluvoxamine maleate tablets may increase the amount of Lotronex in your body, which could increase its actions and side effects. Low levels of or in the may also increase your risk of QT prolongation. Concentrations of thioridazine and its two active metabolites, mesoridazine and sulforidazine, increased threefold following coadministration of Fluvoxamine. BusPIRone: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Management: The combination of a selective serotonin reuptake inhibitor and buspirone should be undertaken with great caution. Post hoc exploratory analyses for gender effects on outcomes did not suggest any differential responsiveness on the basis of gender. Further exploratory analyses revealed a prominent treatment effect in the 8-11 age group and essentially no effect in the 12-17 age group. Treatment should consist of those general measures employed in the management of overdosage with any antidepressant. Phentermine hydrochloride equivalent to 30 mg Phentermine base. Post-traumatic stress disorder PTSD off-label use: Oral: Immediate release: 75 mg twice daily Spivak, 2006. It is not known if Phentermine is excreted in human milk; however, other amphetamines are present in human milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. The dosage is based on your medical condition, response to treatment, age, and other you may be taking.
Cimetidine: May decrease the metabolism of Selective Serotonin Reuptake Inhibitors. CYP2D6 Inhibitors Moderate: May decrease the metabolism of CYP2D6 Substrates. Theophylline: The effect of steady-state Fluvoxamine 50 mg bid on the pharmacokinetics of a single dose of theophylline 375 mg as 442 mg aminophylline was evaluated in 12 healthy non-smoking, male volunteers. The clearance of theophylline was decreased approximately 3-fold. Therefore, if theophylline is coadministered with Fluvoxamine maleate, its dose should be reduced to one-third of the usual daily maintenance dose and plasma concentrations of theophylline should be monitored. No dosage adjustment is required for Fluvoxamine Maleate Tablets. Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are. Capsules unless directed to do so by your physician. Fritze J, Unsorg B, Lanczik M. Interaction between carbamazepine and fluvoxamine. Acta Psychiatr Scand 1991 Dec; 84: 583-4. Along with its benefits, this medication may rarely cause abnormal drug-seeking behavior addiction. This risk may be increased if you have abused alcohol or drugs in the past. Take this medication exactly as prescribed to lessen the risk of addiction. Two mothers breastfeeding while taking stable doses of fluvoxamine were studied with timed blood and milk samples over 24 hours. pono.info trileptal
Using fluvoxamine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Shulman RW. The serotonin syndrome: a tabular guide. Can J Clin Pharmacol 1995; 23: 139-44. N-desmethyldiazepam to a level that was too low to measure over the course of the 2 week long study. The information contained in the Truven Health Micromedex products as delivered by Drugs. Some products that may interact with this drug include: clozapine, fluvoxamine, sodium oxybate. DISPENSE IN TIGHT, LIGHT-RESISTANT CONTAINER. Prescriptions should be written for the smallest quantity consistent with good patient care. The patient's family or caregiver should be alerted to monitor patients for the emergence of suicidality and associated behaviors such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania; patients should be instructed to notify their healthcare provider if any of these symptoms or worsening depression or psychosis occur. MAOI in the last 2 weeks unless directed to do so by your physician. Is it possible to prevent depression? Some Fluvoxamine Maleate Tablets may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking Fluvoxamine Maleate Tablets. piroxicam mylan online
In vitro data suggest that Fluvoxamine is a relatively weak inhibitor of CYP2D6. Capsules should be slowly titrated during initiation of therapy. P2Y12 inhibitors, NSAIDs, SSRIs, etc. The doctor or pharmacist will give you the manufacturer's patient information sheet Medication Guide when you begin treatment with fluvoxamine. Read the information carefully and ask your doctor or pharmacist if you have any questions. Asenapine: FluvoxaMINE may increase the serum concentration of Asenapine. The efficacy of Fluvoxamine maleate for the treatment of obsessive compulsive disorder was demonstrated in a 10-week multicenter placebo controlled study with 120 outpatients ages 8-17. In addition, 99 of these outpatients continued open-label Fluvoxamine maleate treatment for up to another one to three years, equivalent to 94 patient years. Fluvoxamine maleate is a selective serotonin 5-HT reuptake inhibitor SSRI belonging to the chemical series, the 2-aminoethyl oxime ethers of aralkylketones. Sperber AD. Toxic interaction between fluvoxamine and sustained release theophylline in an 11-year-old boy. Drug Saf 1991; 66: 460-2. Luvox is FDA-approved for obsessive-compulsive disorder in adults and in children age 8 and above, as well as for social phobia in adults. Taking with or without food, on a full or empty stomach. Teriflunomide: May decrease the serum concentration of CYP1A2 Substrates. Check with your doctor first before taking any other medicines with fluvoxamine. Monoamine Oxidase Inhibitor MAOI. Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid. Only some people are at risk for these problems. money order cheapest carbamazepine mastercard
What about discontinuing antidepressants? MAO Inhibitors: May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details. Exceptions: Linezolid; Methylene Blue; Tedizolid. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk. Discontinuation of Fluvoxamine Maleate Tablets should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. Diazepam is used to treat anxiety, alcohol withdrawal, and seizures. It is also used to relieve muscle spasms and to provide sedation before medical procedures. This medication works by calming the brain and nerves. Diazepam belongs to a class of drugs known as benzodiazepines. Frequent: weight gain and weight loss. Anon. Fluvoxamine for obsessive-compulsive disorder. Med Lett Drugs Ther 1995 Feb 17; 37942: 13-4. Panobinostat: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid concurrent use of sensitive CYP2D6 substrates when possible, particularly those substrates with a narrow therapeutic index. LUVOX CR Capsules or placebo. Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. PNA. Of the 247 infants, 154 developed PNA. Infants who were exclusively given formula had about 3 times the risk of developing PNA as those who were exclusively or partially breastfed. Four of the infants were exposed to low doses of fluvoxamine in utero and none had PNA. This medication can slow down the removal of other medications from your body, which may affect how they work. Fluvoxamine maleate overdose include gastrointestinal complaints nausea, vomiting and diarrhea coma, hypokalemia, hypotension, respiratory difficulties, somnolence, and tachycardia. Other notable signs and symptoms seen with Fluvoxamine maleate overdose single or multiple drugs include bradycardia, ECG abnormalities such as heart arrest, QT interval prolongation, first degree atrioventricular block, bundle branch block, and junctional rhythm convulsions, dizziness, liver function disturbances, tremor, and increased reflexes. Take this medication by mouth with or without food as directed by your doctor, usually once daily at bedtime, or twice daily once in the morning and once at bedtime. If you are taking this medication twice daily and the doses are not equal, then the larger of the 2 doses should be taken at bedtime. CYP1A2 Inducers Strong: May increase the metabolism of CYP1A2 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider discontinuation if symptomatic hyponatremia occurs. hyzaar
cheap fluvoxamine canada free shipping, pharmacy fluvoxamine vs, buy fluvoxamine online pharmacy uk, what is the fluvoxamine without insurance, buy fluvoxamine itch stopping cream, shop fluvoxamine work, cheap fluvoxamine generic online, prescription fluvoxamine, buy fluvoxamine online shopping canada, can you purchase fluvoxamine over the counter, cheapest fluvoxamine purchase canada, buy fluvoxamine online reddit, buy generic fluvoxamine online usa, fluvoxamine online overnight delivery, fluvoxamine canada costco, money order fluvoxamine online, fluvoxamine shop dublin, money order fluvoxamine payment australia, price fluvoxamine uk, purchase fluvoxamine review, buy fluvoxamine in canada, canada generic fluvoxamine online, how much does fluvoxamine cost at walmart, cheap fluvoxamine gold coast, generic fluvoxamine discussion, buy fluvoxamine store, buy fluvoxamine dr fox, fluvoxamine alternative canada, cost of a fluvoxamine dose pack, order cheapest fluvoxamine visa canada, fluvoxamine at rite aid, fluvoxamine cost per pill, buy fluvoxamine online canada, can i buy fluvoxamine at costco, fluvoxamine canada side effects, over the counter fluvoxamine canada, buy fluvoxamine in london, order fluvoxamine canada, generic fluvoxamine trusted pharmacy, overnight fluvoxamine us pharmacy, fluvoxamine purchase now mastercard europe, fluvoxamine how to order online, fluvoxamine price nz, fluvoxamine online consultation, generic fluvoxamine vs brand, price of fluvoxamine ireland, generic fluvoxamine express shipping, buy fluvoxamine pills, generic fluvoxamine mail order pharmacy, secure tabs fluvoxamine, fluvoxamine south africa, fluvoxamine canada store, buy fluvoxamine online south africa, fluvoxamine 100 mg tablet, fluvoxamine price increase, where to buy fluvoxamine fast melts, pills fluvoxamine for sale without a pression, purchase cheapest fluvoxamine visa canada, buy fluvoxamine 5mg, buy fluvoxamine with echeck, fluvoxamine pharmacist only nz, fluvoxamine drop, buy fluvoxamine payment europe, generic fluvoxamine from us pharmacy, buy now cheap fluvoxamine otc, cost of fluvoxamine walgreens, canada fluvoxamine review, store fluvoxamine sales, buy brand fluvoxamine online canada, fluvoxamine omni, online fluvoxamine tablet, money order generic fluvoxamine payment, generic fluvoxamine pharmacy reviews, fluvoxamine brands uk, best price generic fluvoxamine, buy fluvoxamine 25mg tablets, boots pharmacy fluvoxamine, giant fluvoxamine, where to buy fluvoxamine forum, purchase fluvoxamine buy, generic fluvoxamine europe, drug fluvoxamine price, brand manager fluvoxamine, fluvoxamine company store, purchase cheapest fluvoxamine payment uk, purchase fluvoxamine payment usa, buy fluvoxamine san francisco, fluvoxamine purchase online store australia, fluvoxamine price in the philippines, cheaper version of fluvoxamine, shop fluvoxamine coupon, money order fluvoxamine online shopping, fluvoxamine vs generic brand, purchase generic fluvoxamine online usa, buy fluvoxamine over the counter, price fluvoxamine medicamento, fluvoxamine purchase uk, discount fluvoxamine yahoo, pharmacy fluvoxamine basket, cheap brand fluvoxamine 100mg, cheap fluvoxamine purchase mastercard otc, generic fluvoxamine best deal, fluvoxamine directly, mail order fluvoxamine online visa, where to purchase fluvoxamine uk, fluvoxamine mylan online, pharmacy fluvoxamine generic coupon, fluvoxamine price in market, money order cheapest fluvoxamine mastercard, cheap fluvoxamine medicamento, where to buy indian fluvoxamine
In patients with liver disease or dysfunction, Luvox should be slowly titrated in patients during the initiation of treatment. The dosage may need to be lowered in patients with liver or kidney disease. Do not initiate fluvoxamine in patients receiving linezolid or IV methylene blue; consider other interventions for psychiatric condition. Asunaprevir: May increase the serum concentration of CYP2D6 Substrates. tretinoin price in market
SSRI effectiveness with concurrent use. How should I store Fluvoxamine Maleate Tablets? Goodman WK, Price LH, Delgado PL, et al. Specificity of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 1990 Jun; 47: 577-85. Dasatinib: May enhance the anticoagulant effect of Agents with Antiplatelet Properties. No gender differences were observed in adolescents.
These reactions are listed in order of decreasing rates in the OCD trials. This drug passes into breast milk. Consult your doctor before breast-feeding. Week 12 compared to baseline on the Y-BOCS.
Take Fluvoxamine Maleate Tablets exactly as prescribed. Your healthcare provider may need to change the dose of Fluvoxamine Maleate Tablets until it is the right dose for you. Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors. Cannabis: May decrease the serum concentration of CYP1A2 Substrates. Cephalothin. Specifically, the risk for bleeding may be increased.