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No it is not necessary to take a pill break unless you want to get pregnant. Lack of estrogen or its lesser quantity reduces blood flow towards the female genital region which depletes tissue health and performance of organs. Penbutolol increases effects of sildenafil by additive vasodilation. During 3 to 6 months of double blind treatment or longer term , open label studies, few patients withdrew from active treatment for any reason, including lack of effectiveness. Amobarbital will decrease the level or effect of sildenafil by affecting hepatic intestinal enzyme CYP3A4 metabolism.