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The effects of ulipristal on a developing baby are unknown. Cases of a sudden loss of hearing or decrease in hearing, sometimes accompanied by tinnitus and dizziness, with the use of PDE 5 inhibitors, including sildenafil. Sildenafil takes 30 120 minutes to work, and is advised to be taken one hour before sexual activity. Patients with cardiovascular disease who have not engaged in sexual intercourse for a number of years should have their cardiovascular status carefully assessed prior to initiating treatment with sildenafil.