May cause symptomatic hypotension. Patients w/ systolic BP <100 mmHg or symptomatic hypotension at treatment initiation. Potential for symptomatic hypotension in patients w/ hypovolemia, severe left ventricular outflow obstruction, resting hypotension, autonomic dysfunction, history of hypotension, or concomitant treatment w/ antihypertensives or organic nitrates. Adjust dose of diuretics & treat other causes of hypotension (eg, hypovolemia) if symptomatic hypotension occurs; then reduce dose or interrupt treatment temporarily if symptomatic hypotension persists despite such measures. Not recommended w/ phosphodiesterase-5 (PDE-5) inhibitors eg, sildenafil in patients w/ heart failure due to potential increased risk for symptomatic hypotension. Not recommended in patients w/ eGFR <15 mL/min/1.73 m
2 at treatment initiation or on dialysis; severe hepatic impairment. Not recommended during pregnancy & in women of childbearing potential not using contraception. Lactation. Ped patients <18 yr.