Meldonium is a drug banned by WADA in 2016 that is used to treat heart conditions but may improve endurance. It works by altering carnitine metabolism and forcing the body to burn glucose instead of fat. While evidence of performance enhancement is limited, many athletes tested positive for meldonium in 2015-2016, including tennis star Maria Sharapova. Meldonium sales in Latvia are over 56 million euros annually, though it is not approved for use in the United States.

1. Meldonium: The Latest
Performance Enhancing
Drug
By Floyd Arthur

2. The World Anti-Doping
Agency has a new drug in
its sights -- meldonium.
Also known

3. as Mildron?ts, Quaterine,
MET-88, THP and
trimethylhydrazinium
propionate,

4. meldonium is
manufactured by the
Latvian pharmaceutical
company Grindeks and
sold

5. under the brand name
Midronate.

6. It is widely used in
Eastern Europe and
Central Asia for the
treatment of angina,
heart

7. attacks and ischemic
stroke, but is not
approved for use in the
United States.

8. Meldonium was banned
by the WADA in 2016. But
after dozens of elite
athletes tested

9. positive for the drug
earlier this year, the anti-
doping agency
determined that any

10. athlete who failed a drug
test for meldonium prior
to March 2016 may still
compete.

11. What is Meldonium?

12. Meldonium is a fatty-acid
oxidation inhibitor that
alters the metabolic
pathway for

13. carnitine. Developed by
chemist Ivar Kalvins,
chair of the scientific
board of the Latvian

14. Institute of Organic
Synthesis, the drug was
first used to improve
sexual performance

15. and sperm motility in
boars.

16. Meldonium’s first known
use in humans occurred
between 1979 and 1989,
when it was given to

17. Soviet troops in
Afghanistan to improve
their endurance in the
country’s mountainous
terrain.

18. According to the a study
published in Drug Testing
and Analysis in December
2015, meldonium

19. “demonstrates an
increase in endurance
performance of athletes,
improved rehabilitation
after

20. exercise, protection
against stress and
enhanced activations of
central nervous system
functions."

21. The WADA classifies it as
a metabolic modulator,
similar to insulin.

22. Meldonium Use in
Athletes

23. Meldonium first came to
the attention of
antidoping officials in
2015, when the

24. Partnership for Clean
Competition funded a
study to test for
meldonium in athletes

25. worldwide. The group,
which includes
representatives from the
U.S. Anti-doping Agency,

26. the U.S. Olympic
Committee and various
professional sports
leagues, looked at 8,300

27. anonymous urine
samples from athletes in
different sports. It found
meldonium in 182

28. samples, a rate of 2.2
percent. According to
Larry Bowers, chair of the
PCC Scientific

29. Board, that is more than
twice the rate for any
other banned substance
on the WADA list.

30. Then, meldonium hit the
headlines when tennis
star Maria Sharapova
tested positive for

31. the banned drug at the
Australian open in
January 2016. Since then,
dozens of athletes,

32. including Olympic gold-
medalist Semion
Elistratov and world
champion speedskater

33. Pavel Kulizhnikov, both of
Russia, have tested
positive for the drug.

34. According to a study
published in the British
Journal of Sports
Medicine in March 2016,

35. a total of 490 athletes
tested positive for
meldonium at the Baku
2015 European Games.

36. Doe Meldonium Work?

37. There is little evidence
that meldonium actually
enhances athletic
performance.

38. According to Mark Stuart,
a pharmacist in London
who is on the medical and

39. antidoping commission
of the European Olympic
Committees, “The
evidence around

40. whether it is a
performance-enhancing
drug is quite thin.”

41. In fact, there is almost no
available scientific
evidence on the effects of
meldonium on

42. performance at all, other
than the fact that it
appears to inhibit the
synthesis of

43. carnitine, which the body
uses to burn fat. This
might force the body to
burn glucose,

44. which produces more
energy under conditions
of low oxygenation than
fat, said Dr.

45. William R. Hiatt, a
cardiologist and
professor at the
University of Colorado
School of

46. Medicine, in an interview
with the N.Y. Times.

47. This hypothesis is borne
out by a Grindeks’ funded
randomized controlled
trial which

48. demonstrated marginal
but significant
improvement in exercise
tolerance in patients with
stable

49. angina who were given
meldonium for a period of
12 months. It may also be
why athletes believe

50. the drug will improve
their performance when
they are exercising at
peak capacity.

51. Meldonium is Latvia’s
leading medical export,
with sales of over 56
million euros ($64

52. million) in 2013. It cannot
be obtained legally in the
United States except with
approval

53. from the FDA. It is not
known how Sharapova,
who has lived in Florida
since she was 7

54. years old, obtained the
drug.

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