Obtain medical history, physical exam & CV status prior to treatment initiation. Patients w/ left ventricular outflow obstruction (eg, aortic stenosis, hypertrophic obstructive cardiomyopathy), rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of BP. Risk of serious CV events including MI, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack. Coadministration w/ α-blocker may lead to symptomatic hypotension. Patients w/ anatomical penis deformation (eg, angulation, cavernosal fibrosis or Peyronie's disease); retinitis pigmentosa; bleeding disorders or active peptic ulceration; resting HTN (BP >170/110) or history of cardiac failure or CAD causing unstable angina; predisposing conditions to priapism (eg, sickle cell anaemia, multiple myeloma or leukaemia) or suffered life-threatening arrhythmia w/in the last 6 mth. Discontinue use if sudden visual or hearing loss occurs. Do not use in patients w/ history of NAOIN; increased risk of NAOIN recurrence. Provide immediate medical assistance in case of prolonged erections >4 hr & priapism; may result to penile tissue damage & permanent potency loss if not treated immediately. Potentiated antiaggregatory effect of Na nitroprusside. Not recommended to use in combination w/ other PDE5 inhibitors, pulmonary arterial HTN treatments or other treatments for erectile dysfunction. Possible dizziness & altered vision; may affect the ability to drive & use machines. Not indicated for women & childn <18 yr.
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