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NICE recommends lifestyle modifications and PDE5 inhibitors such as sildenafil, tadalafil, vardenafil, and avanafil as first-line pharmacological treatments

Kee et al., 2023) and meta-analyses reinforces that genetic differences in drug-metabolizing enzymes directly influence plasma concentrations and clinical outcomes, with poor metabolizers tending toward higher exposure and potential toxicity, and ultrarapid metabolizers often demonstrating underexposure and poor therapeutic response