Acute myocardial infarction in past 90 days; history of non-arteritic anterior ischaemic optic neuropathy; hypotension avoid if systolic blood pressure below 90 mmHg. Mild to severe heart failure; patients in whom vasodilation or sexual activity are inadvisable; recent stroke; uncontrolled arrhythmias; uncontrolled hypertension; unstable angina. See also Prescribing in the elderly. Arrhythmias; chest pain; dizziness; dyspnoea; eye pain; fatigue; gastrooesophageal reflux disease; haemorrhage; hypertension; hypotension; nausea; oedema; palpitations; skin reactions; tinnitus; vision disorders; vomiting. Acute coronary syndrome; angioedema; cerebrovascular insufficiency; eye erythema; eye swelling; haematospermia; hyperhidrosis; memory loss; optic neuropathy discontinue if sudden visual impairment occurs ; priapism; retinal occlusion; seizure; Stevens-Johnson syndrome; sudden cardiac death; sudden hearing loss discontinue drug and seek medical advice ; syncope. Manufacturer advises consider initial dose reduction to 20 mg once daily in mild to moderate impairment.

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