Mildronate (Meldonium)
Meldonium is a drug used to treat angina, myocardial infarction, and chronic heart failure. It’s manufactured in Latvia under the commercial name Mildronate and is one of the country’s largest exports, with turnover reaching close to 75 million dollars in 2013. It is not yet approved by the FDA for use in the U.S.
Meldonium was added to the WADA list of banned substances on January 1, 2016 because of “evidence of its use by athletes with the intention of enhancing performance.” As a result, none of the athletes banned for this substance will have performances prior to that date removed from their records, and Aregawi will keep her 2013 world title.
Clinical testing of the drug was first reported in 2005, with the conclusion that a combination of meldonium and lisinopril may improve the quality of life, exercise capacity and mechanisms of peripheral circulation in patients with chronic heart failure.
Additional research, which tested the efficacy and safety of the drug in combination with standard exercise tolerance therapy, concluded that meldonium improved the endurance and workload capacity of stable angina patients.
Some studies in patients with Parkinson’s or Alzheimer’s disease have also shown that meldonium affects the central nervous system by protecting against neurotoxicity, which benefits the mental capacity for learning and understanding.
Why Do Athletes Use Meldonium?
The World Anti-Doping Agency added meldonium to their list of prohibited substances. Since its ban in January 2016, numerous athletes have tested positive for the substance. The list is growing rapidly, including a large number of Russian athletes, which may be due to its wider use and availability in that part of the world.
Biathletes, cyclists, ice dancers and judo wrestlers have become the latest athletes to test positive for meldonium. The most well-known athlete to admit using the drug was tennis player Maria Sharapova, who is the highest-paid female athlete in the world.
But why would these world-class athletes, who are presumably in excellent health, take a medication designed for those with heart problems?
As indicated by the symptoms it was developed to treat, meldonium basically increases and improves blood flow. By reducing oxygen consumption within cellular structures, it significantly boosts an athlete’s endurance and tolerance for increased physical workloads. It also reduces the time needed for recovery from exertion, which is particularly important for achieving top performance.
What are the Risks of Meldonium?
Contrary to the almost glowing statements about meldonium’s potential benefits, there is considerable uncertainty surrounding the actual performance improvements for athletes.
Mark Stuart, a London pharmacist who is on the medical and anti-doping commission of the European Olympic Committees stated, “The evidence around whether it is a performance-enhancing drug is quite thin.” In fact, some evidence shows that when used by a healthy individual it might actually hinder performance by causing the slower release of energy through the breakdown of fat.
So could the drug pose a health concern to someone who does not have condition for which the drug is approved? As with nearly all drugs or medications, there are potential side effects for meldonium. These may include:
- Irregular heartbeat
- Changes in blood pressure
- Irregular skin conditions
- Allergic reaction
- Indigestion
Some experts argue there is no scientifically proven danger for using meldonium as a performance enhancer. Even so, the ban has imposed ethical and legal grounds for prohibiting athletes from using the substance.
As with all medications, unwarranted and unsupervised use is ill-advised. Using meldonium without a legitimate medical need may pose risks to your health, even if they are undocumented or haven’t been studied officially.