ED drugs prove effective, safe for men with diabetes. Part 2.

Taken an hour before sexual activity, PDE-5 inhibitors work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

"PDE-5 inhibitors have been considered the mainstay of treatment for erectile dysfunction in the general population for many years," said Vardi. "Diabetics are prone to this complication, and the etiology of their erectile dysfunction is multifactorial, thus making their treatment a special challenge for physicians and other health care professionals."

No deaths were reported in any of the included trials; the most common side effects for men in the treatment groups were headache, flushing and upper respiratory tract complaints and flu-like symptoms. The overall risk for developing any adverse reaction was 4.8 times higher in the PDE-5 group than in the control group.

As with any drug therapy, the Cochrane reviewers caution that men should use PDE-5 inhibitors only as directed by their physicians.

"These drugs can be taken on an 'as needed' basis, as their half-life spans from several hours to 48 hours at most," said Vardi. "Patients should also consult their physicians for drug-drug interactions and specific contraindications."

While this review supports the short-term safety of these medications for men with diabetes, experts say as yet there is no concrete evidence whether these medications are safe for the long term.

"I prescribe PDE-5 inhibitors every day to people with diabetes," said John Buse, M.D., director of the Diabetes Care Center at the University of North Carolina School of Medicine. "But whether they are safe [in the long term] is the essential quandary of all medical care. We make our best guesses based on imperfect information, hopes and fears. And then we monitor progress. I am impressed that patients with diabetes in my practice in 2006 are living much better lives and perhaps longer lives than they did 10 years ago."