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Exercise Intolerance and Shortness of Breath: By improving endothelial blood flow and oxygen delivery to skeletal and respiratory muscles, L-carnitine can help delay the onset of anaerobic metabolism, reducing the burning sensation and breathlessness experienced during mild exertion

The reason is that these PDE5 inhibitors depend upon a sufficient amount of cGMP being produced as the PDE5 inhibitors prevent the breakdown of cGMP allowing this molecule to exert its vasodilatory effect in penile vascular tissue

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This synthesis process occurs through a two-step reaction at the expense of two molecules of ATP (Fig