Facts about Meldonium and performance enhancement

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Late last week tennis superstar and the world’s richest female athlete Maria Sharapova was suspended from tennis after she admitted to failing a drug test at the Australian Open in January.  Here to talk about the controversy is our pharmacist,

Meldonium is manufactured in Latvia for patients with chest pain but is not FDA approved. When you are vigorously exercising and your muscles start to run low on oxygen, you end up using anaerobic metabolism to turn your fatty acids into energy making less energy and creating lactic acid.  This makes you feel lethargic and gives you muscle aches when you are done.  Meldonium makes the heart and muscles use glucose instead of fatty acids and it takes less oxygen to convert glucose into energy so you are less likely to get fatigued and recover faster.  This is the same idea as Lance Armstrong who reportedly used erythropoietin to make more red blood cells so he could deliver more oxygen to the muscles.

The rules banning meldonium just went into effect January 1st. Before the drug was banned, the world anti-doping agency tested over 8000 urine samples just to see what athletes were taking, 2.2% of samples contained meldonium and more alarming, 17% of samples from Russian athletes contained meldonium.  Since the ban, 12 athletes have tested positive including 10 from former Soviet countries, mostly Russia.  Meldonium is not FDA approved so doctors in the United States should not be able to write for them.  Since Maria Sharapova reportedly lives most in the United States most of the time it is unclear why she would be given a Latvian drug for a potential heart ailment instead of one of the proven therapies we have available here and her heart ailment was supposedly due to a short term complication of the flu which makes it hard to support use 10 years later.  We are likely to see several other athletes test positive over the next few months before the consequences of testing positive suppresses it.

Meldonium isn’t FDA approved or very well studied so the risks are not well known.  However, by forcing muscles to use glucose instead of fatty acids for energy could lead to hypoglycemia which could be fatal because the brain only uses glucose for energy.

Dr. Michael White, UConn School of Pharmacy