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Whereas a PDE5 inhibitor, such as Viagra, has a vascular mechanism of action, PT-141 appears instead to act on the central nervous system specifically on the hypothalamus, which plays a key role in regulating erectile function.6 Further distinguishing it from the Viagra type is that it may initiate erections without visual sexual stimulation.7 To date, one of the most compelling studies on PT-141s efficacy for ED is a randomized, double-blind, and placebo-controlled trial published in the Journal of Urology in 2008, which involved 342 married men with ED who were nonresponsive to sildenafil (generic for Viagra)

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This combination makes it more likely for NAPQI to build up in the liver in dangerous concentrations when combined with acetaminophen