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There are no known benefits to withdrawal bleeds and no known risks to missing them. Another way in which Cialis works is by stopping PDE5 from destroying cGMP. The OG Little Blue Pill that made its name as the first prescription Erectile Dysfunction treatment. The effectiveness of sildenafil was evaluated in most studies using several assessment instruments. No significant interactions were shown when sildenafil was co administered withtolbutamide or warfarin , both of which are metabolised by CYP2C9.