Substance Abuse

Everything You Need To Know About Meldonium

Mildronate meldonium chemical structure

Information about the drug meldonium may be few and far between in the past, but everything changed after the failed drug test of Maria Sharapova which shocked the tennis world in 2016. The five-time Grand Slam Champion tested positive for the substance in a drug test conducted during the 2016 Australian Open.

Apparently, Sharapova has been taking the said drug in 2006 as she it was prescribed by her doctor due to irregular heart rate, deficiency in magnesium, and blood glucose level monitoring stemming from a family history of diabetes. According to Sharapova, she was unaware that meldonium was among the list of banned substances by the World Anti-Doping Agency (WADA) until she was given a letter regarding her failed drug test from the International Tennis Federation (ITF). Sharapova was suspended from playing tennis for the next two years by the ITF.

In April 2016, her suspension has been decreased because her use of meldonium was not an intention to enhance her performance but rather was taken to help treat her medical condition.

What is Meldonium?

It is a substance that has been developed in 1970 by Ivars Kalvins which was manufactured by Grindeks of Latvia. It is mainly distributed as an anti-ischemic drug. Meldonium is widely used in both Latvia and Russia and has no FDA approval for consumption in the United States.

WADA’s list of banned substances released in January 2016 included meldonium. It does not belong to any of the scheduled drugs, and therefore its use as an athletic performance enhancer is yet to be determined. Prior to the inclusion of meldonium to the list, several athletes have already been using it.

Scientific Director of the Banned Control Substances Group Don Catlin has strongly announced that meldonium has zero percent evidence of being a performance enhancer drug. There is a continuing debate regarding its real effects on an individual.

WADA has included meldonium among other banned substances because it increases the blood flow of the individual, which subsequently provides more endurance. The drug falls under the category “metabolic modulator”.

Uses of Meldonium

Being an anti-ischemic drug, meldonium is used for the treatment of coronary artery diseases since this condition constricts the blood vessels thereby allowing little blood flow to the different organs of the body, most especially the heart. The main action of an anti-ischemic drug is to help dilate the arteries to help increase blood flow and at the same time increase the flow of oxygen throughout the body.

Meldonium has also been found to be effective in the treatment of seizures as well as having an anti-hypnotic effect. It may also be helpful in decreasing the withdrawal symptoms being experienced by an individual with chronic alcohol dependence.

Side Effects from Meldonium Use

The use of meldonium to treat ischemic heart conditions has been proven to be an advantage. However, just like most drugs, there may be unfavorable symptoms that are likely to happen such as:

  • Changes in blood pressure
  • Irregular heartbeat
  • Allergic reactions
  • Irregular skin conditions
  • Indigestion

Prevalence Among Athletes

meldonium tennis drug testing

According to the laboratory findings at the Baku 2015 European Games, a large number of athletes were using meldonium. Among the athletes that competed, 13 competition winners were taking meldonium at the time of the competition and were competing in 15 to 20 events.

Most of the athletes taking the substance did not inform the anti-doping authorities about their use. There were only 32 athletes out of 662 athletes who declared their use of the said substance.

Meldonium has been classified the same way as insulin because of its ability to modify how hormones alter the enzymatic reactions in the body, which can block the production of estrogen.

The allowable amount of meldonium should be less than 1 mcg/ml for tests done before March 1, 2016. Research have shown that traces of meldonium may be evident in blood samples for a long period of time. As a result, stopping the use of the substance a few days to a week before a competition would still yield a positive result.

WADA further states that the intention to cheat is not required to find an athlete to be in violation of the WADA Code. This means that whether intentional or not, for as long as athletes were tested positive for this banned substance, they will all be liable. The athlete’s participation with competitions may be affected, resulting to a standard ban of four years.

Other Athletes Suspended For Meldonium Use

Sharapova’s positive drug test result for meldonium may have been sensationalized because of her excellence in the sport. However, there were several other athletes that have been found positive with meldonium.

Alexander Povetkin

The Russian professional boxer with a two-time World Boxing Association Heavyweight Championship title was found positive with meldonium in May 2016. It was only a week prior to a match set with WBA Heavyweight Champion Deontay Wilder. Because of this discovery, the match has been postponed indefinitely by the WBC.

In August, WBC cleared Povetkin from the case saying that it was impossible to prove that Povetkin ingested meldonium after it was included among the list of banned substance released in January 1, 2016. According to Povetkin, he has stopped using meldonium. He was advised to take a second drug test after 12 months at his own expense.

In related news, Povetkin tested positive for enobosarm in his B sample taken in December 2016 forhis bout with Bermane Stiverne.

Abeba Aregawi

Abeba Aregawa is an Ethiopian-Swedish athlete who was found positive with meldonium, leading to his suspension on February 2016. According to her, she took the medication after the release of the list, thinking that it was a vitamin supplement.

Endershaw Negesse

This Tokyo Marathon Winner is among several athletes from Ethiopia who tested positive for meldonium. WADA suspects that a doctor may be involved in the transportation of the drug to Ethiopia.

Eduard Vorganov

The Russian professional road bicycle rider was suspended in February 2016 together with other athletes from Team Katusha. However, in August 2016, an amnesty were given to athletes found positive with meldonium as there was not enough evidence to prove that they were still taking the substance a few months after the release of the latest list of banned substances. It was announced that Vorganov has joined the Minsk Cycling Team in 2017.

Olga Abramova

This Ukranian athlete is banned for 1 year after testing positive for meldonium two weeks after the release of the list of banned substances. She was not given amnesty like the rest of the athletes who were found to be positive with meldonium because the level of meldonium found in her system was 7 times more than the permissible level.

More Information About WADA

WADA is an international independent agency funded by sports agencies and governments around the world that help in education, scientific research, development of anti-doping capacities and monitoring policies implemented related to sports in all countries.

The agency was established in 1999 to address the alarming number of athletes getting involved with drugs with the intention of misleading the public regarding with their strength and capabilities. Among the list of banned substances and techniques include the following:

  • Androgens
  • Blood doping
  • Peptide hormones
  • Diuretics
  • Stimulants
  • Narcotics
  • Cannabinoids

Blood doping is the injection of red blood cells or artificial oxygen containers. This technique is done by extracting the individual’s own blood prior to a competition to allow the body to replenish fresh red blood cells thereafter injecting back the stored blood before the competition.

Helpful Links and Resources

http://www.usada.org/substances/prohibited-list/athlete-guide-2017-prohibited-list/

https://www.wada-ama.org/en/prohibited-list

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