Why Was Maria Sharapova Banned from Taking Meldonium?
Maria Sharapova, five-time tennis Grand Slam champion and the world’s highest paid female athlete, was recently banned from taking meldonium, a drug newly named on the banned substances list this year by The World Anti-Doping Agency. According to reports, she stepped “glumly” to the press conference podium, reasoned she simply hadn’t read the new list and had been taking the drug since 2006 for various symptoms such as frequent bouts of the flu. The plausibility of her story notwithstanding, what is meldonium why was it banned only in January of 2016?
Meldonium is a drug developed in Latvia for heart patients to increase blood flow but has not yet been approved for sale in the United States. Indeed, many people, including those in the healthcare industry, didn’t even know what the substance was
The World Anti-Doping Agency classified meldonium as a metabolic modulator (a “modulator” is a change in the kinetics of an enzyme or metabolic pathway) and moved the drug from its watch list to its list of banned substances in January 20163.
The chemical name for Meldonium is trimethyl hydrazinium propionate. It works by inhibiting the availability of L-carnitine to the body, which is found naturally in milk and meats, and can also be synthesized. L-carnitine helps move long-chain fatty acids into the mitochondria for oxidation and energy production in the muscles. In the U.S. carnitine is prescribed as the drug Carnitor and is not on the list of banned substances.
Meldonium and Performance?
Meldonium as modulator inhibits this flow of long-chain fatty acids, decreasing L-carnitine levels in the tissue and plasma. This inhibition essentially reduces the production of fatty acid, shifting it to glucose metabolism. Aerobic glucose metabolism consumes less oxygen and appears to increase glucose uptake. This, some believe aids in the performance of athletes.
However, the clinical efficacy of meldonium has yet to be internationally studied and as yet has not been given sufficient evidence of its efficacy; all the studies except one are published in Russian. Abstracts of randomized controlled trials report its efficacy in reducing angine, arrhythmias, and anxiety among others, as well as reducing such conditions as heart failure and diabetic peripheral neuropathy (a type of nerve damage that can occur if you have diabetes), yet do not note its effects on athletic performance. Adverse effects were only mentioned in one study, which states there wasn’t any.
Adverse Effects of Meldonium?
No long-term studies on the safety and efficacy of meldonium have been published. No studies on the effect of meldonium on athletic performance in humans have been published. Most articles about meldonium cited on PubMed are by Latvian authors and therefore studied by only a small group of medical professionals internationally.
Reason For Banning
So though meldonium does not yet show evidence of adverse effects, there is also limited evidence showing the benefits to athletes as well. It has not been studied widely, more research needs to be done the effect the drug has on the body, and reliable research on its use for athletic performance is not available. It’s for these reasons the World Anti-Doping Agency have declared it a banned substance.
- Clarey, Christopher and Mike Tierney. ‘Maria Sharapova Admits Taking Meldonium, Drug Newly Banned by Tennis’. Tennis (The New York Times), March 8, 2016. http://www.nytimes.com/2016/03/08/sports/tennis/maria-sharapova-failed-drug-test.html?_r=0
- Office of Dietary Supplements. Dietary supplement fact sheet: Carnitine. February 11, 2016.http://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/ Accessed March 10, 2016.
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- Prohibited List. World Anti-Doping Agency. https://www.wada-ama.org/en/what-we-do/prohibited-list Accessed March 9, 2016
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- Staff, Mayo Clinic. ‘Diabetic Neuropathy Definition’. Mayoclinic February 24, 2015,. Accessed April 3, 2016. http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/definition/con-20033336