Only trained doctors may prescribe Viagra

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.