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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.

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Its significance is that other drugs metabolized by the same enzymes are metabolized faster and therefore circulate in a lower concentration than expected for a given dose. This could mean that they become ineffective. Alternatively, a drug could be metabolized faster than expected into a toxic compound.

There are many proprietary preparations, which are more refined and therefore more acceptable to patients, but they are less effective. They are used as a creams, lotions, ointments and bath oils in concentrations from Coal tar preparations are less irritating to normal skin than dithranol, but can cause folliculitis. Keratolytics break down keratin and soften skin, which improves penetration of other treatments. Salicylic acid ointment is most frequently used either on its own or in combination with coal tar or dithranol. Phototherapy is the use of ultraviolet light, which produces improvement in most patients with psoriasis but should only be done under supervision of a dermatologist.

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