Orlistat side effects reviews cialis is an effective, reversible, selective inhibitor of phosphodiesterase type 5 (PDE 5) specific to cyclic guanosine monophosphate (cGMP). When sexual stimulation causes local release of nitric oxide, inhibition of PDE 5 by Cialis leads to increase of cGMP levels in the cavernous body of penis. It results in the relaxation of arterial smooth muscles and blood flow to the tissues of the penis that causes erections. Cialis has no effect when sexual stimulation is absent. Cialis improves erection and let’s achieve a successful sexual intercourse. The drug acts for 36 hours. If sexual arousal is present the effect appears even after 16 minutes after the medication was taken. In case you notice any side effects not listed above, contact your doctor or pharmacist. You can not appoint tramadol in acute alcohol intoxication (poisoning); patients with hypersensitivity to narcotic analgesics; patients taking MAO inhibitors. A pregnant appointment should be made with extreme caution. Children under the age of 14 do not prescribe the drug.