Only trained doctors may prescribe Viagra

By Jules Bell

JAKARTA (JP): As Austin Powers the star of his self-titled box-office hit would say: Viagra keeps you swinging, baby! Medically, it would have to be said the super-stud spy is "right- on", and that is good news for an estimated six million Indonesian men suffering erectile dysfunction.

From Sept. 4 another 300 Indonesian doctors -- mostly from Jakarta -- will be permitted to prescribe Viagra after completing a one-day training session here in the capital titled: The Management of Erectile Dysfunction.

The famous anti-impotence medication has not been labeled a "wonder drug", without very impressive medical results worldwide. However, before popping the pills and enjoying their effect, there are some serious considerations. New in Indonesia, Viagra is still the subject of a six month government monitoring program, and has a restricted status.

For patients, this equates to ensuring a prescribing doctor has attended a Viagra training session. This is imperative according to a consensus of medical experts, Ministry of Health regulations and recommendations from the Indonesian Doctors Association.

Speaking last Thursday at a press conference held at the Faculty of Medicine, the University of Indonesia, Dr. Daniel Makes said the aim of the September session was to increase the doctors' knowledge and skill levels in treating erectile dysfunction and to increase the number of doctors permitted to prescribe Viagra.

"Viagra was released on Aug. 1," he said, "and most doctors have no authority yet to prescribe the drug."

The course is part of the Continuing Medical Training for Doctors Program or known by the acronym PKB - Pendidikan Kedokteran Berlanjutkan. PKB manages the training of Indonesian doctors regarding new developments in medicine. The program is also a joint effort involving the Foundation for the Advancement of Medicine in Indonesia, and the University of Indonesia.

After the completion of the training doctors must pass a test on the course material, after which they are certified to prescribe Viagra, prescriptions for which bear their PKB number.

"This is the same requirement for the prescription of Viagra as in the U.S. and Europe," said Dr. Rochani, another member of the event's organizing committee and University of Indonesia medical school staff member.

The doctors attending this latest session will join about 1,400 other doctors mostly from Jakarta, having attended the first one-day training course in July. Other training sessions have been conducted throughout Indonesia, and more sessions are scheduled for the future.

Due to Viagra's present monitoring status, prescription and administration of the drug is restricted to authorized doctors and licensed pharmacies. Doctors legally permitted to prescribe the drug are required to complete detailed reports on any side- effects or complications found.

Viagra has been available on the black market for some time. However, this should decrease as more doctors are trained, Dr. Rochani said at the conference.

"Before there was so much Viagra released onto the black market. Now the release of Viagra is more under control. Doctors prescribing the drug are only those with medical education."

The introduction of Viagra into Indonesia is part of a carefully controlled process. "Viagra is a safe and effective medicine," said Dr. Rochani, "but there have been some complications with it in the U.S." A study there last August found that random use of Viagra was allegedly linked to the deaths of 69 Americans in five months. "We want to be careful here in Indonesia to ensure that there are as few problems as possible," he added.

Viagra - which works by increasing the blood flow to the penis, necessary for establishing and maintaining an erection - is most dangerous for patients when taken in conjunction with heart and circulation system medication containing nitrates. "Nitrate heart disease medication is potentiated by Viagra," explained Dr. Rochani.

Nitrates are vasodilators and therefore an active component of drugs used for treating high blood pressure and heart disease; they relax blood vessel walls thereby increasing the diameter of blood vessels and lowering blood pressure. Viagra however, increases the effect of nitrates, leading to disruption of a patient's blood pressure and a potentially life threatening scenario.

Patients taking heart medication can simultaneously take Viagra Dr. Rochani said, but this must be under careful supervision.

Speaking generally about Viagra and associated risks, Dr. Makes explained that "if used with good monitoring, then there are usually no side effects."

Viagra has been the subject of careful studies over the past two years in Jakarta and Surabaya. The results were consistent with those worldwide said Dr. Rochani, finding that Viagra is effective in approximately 70 percent of cases and shows very few side effects.

The training session is clearly necessary in the opinion of the chairman of the Indonesian Erectile Dysfunction Advisory Committee, urologist Dr. Akmal Taher.

"In Indonesia there are a lot of doctors who did not study erectile function during their undergraduate study," he said, "that is why these sessions were suggested by the Indonesian Medical Association which produces the content of the program."

Speaking to The Jakarta Post, Dr. Taher stressed how important it is that doctors are trained correctly.

"We don't want patients to come to doctors and ask for Viagra, and have the doctors just prescribe it. That is the worst possible scenario," he said.

Another important aim of the training is to ensure that doctors do not prescribe Viagra in curable impotence cases. "It is important to seek the cause," he said. "In some 15 to 20 percent of patients a curable cause can be found. These kind of patients do not need drugs," stressed Dr. Taher.

Pharmacies are also bound to the regulations and therefore responsible for ensuring a doctor has attended a Viagra training session before administering the drug to patients. Prescriptions for Viagra must bear the treating doctor's PKB number.

Melawai chemist in the Blok M area is one of Jakarta's pharmacies licensed to dispense the drug. "If you don't have a prescription with a PKB number, then we cannot give you any (Viagra)," said a staff member at the pharmacy.