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doi:10.1016/j.cmet.2017.04.013 (Animal) Everard A, Belzer C, Geurts L, et al

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sequential administration such as administration of an oral form of a PDE-5 inhibitor, followed by administration of an intranasal form of a melanocortin agonist, preferably wherein the administration of the intranasal form of a melanocortin agonist is a determined time interval subsequent to oral administration of a PDE-5 inhibitor, optimal therapeutic results may be obtained with minimal adverse side effects

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As more data accumulates, formal guidelines will likely become more permissive