Optimise vol status & diuretic therapy before starting treatment to stabilise patient after decompensation event, particularly in patients w/ very high NT-proBNP levels. Temporary down-titration or discontinuation of treatment is recommended if patient experiences tolerability issues (symptomatic hypotension or systolic BP <90 mmHg). Do not initiate in patients w/ systolic BP <100 mmHg. Consider potential for symptomatic hypotension in patients w/ hypovolaemia, severe left ventricular outflow obstruction, resting hypotension, autonomic dysfunction, history of hypotension, or concomitant treatment w/ antihypertensives or organic nitrates. Not recommended w/ PDE5 inhibitors eg, sildenafil. Rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Minor influence on the ability to drive or use machines. Not recommended in patients w/ eGFR <15 mL/min/1.73 m
2 at treatment initiation or on dialysis; severe hepatic impairment. Do not use during pregnancy & in women of childbearing potential not using contraception. Lactation. Childn & adolescents <18 yr.
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