On March 7, when Russian tennis superstar Maria Sharapova admitted to taking meldonium that caused her to fail a drug test, the media became abuzz about the drug.
Meldonium, also known as mildronate, is produced in Latvia and marketed in mostly Eastern Europe and Russia as a drug to treat heart problems such as angina, heart attacks, heart failures and even strokes.
A quick search on the US National Library of Medicine reveals that there were also several studies on the possible beneficial effects of meldonium on Parkinson’s disease and type 2 diabetes, but these studies were conducted on animals, so we have yet to have any conclusive answers on its benefits on human beings.
Meldonium has not been approved by the US Food and Drug Administration (FDA), even though the manufacturer alleged that this is because getting an FDA approval is a costly process. It has been approved for sale in Russia and Eastern Europe, however, hence its use by people in those regions.
Not OK for athletes?
The World Anti-Doping Agency (WADA) is the organisation that maintains the list of drugs and medications prohibited to athletes. According to WADA’s addendum, which contains recent changes to its list, meldonium was added “because of evidence of its use by athletes with the intention of enhancing performance”.
What does this mean?
Well, to get to the answer, we have to be a bit more technical and look at how the drug works on cells.
Meldonium improves circulation by changing the way these cells break down various substances (protein, fat, carbohydrates, etc) into energy.
Normally, this process, called metabolism, occurs in structures in the cell called mitochondria. Meldonium blocks long-chain fatty acids from entering mitochondria, so these structures metabolise carbohydrates instead.
Carbohydrate metabolism consumes less oxygen than fat metabolism, so in cases where oxygen supply in the blood is reduced – such as when there is poor circulation due to atherosclerosis – cells can still stay alive and function.
For athletes, taking meldonium also means that they need less oxygen to reach optimal performance. Under normal circumstances, an athlete’s performance reaches a limit when his or her cells use up more oxygen than the lungs can deliver. But with meldonium reducing the amount of oxygen needed by the athlete’s cells, he or she can now push farther, perform longer and play harder – giving the athlete an unfair edge over other competitors. Hence, the WADA ban.
ABC Australia. Available at www.abc.net.au
Drugs.com. Available at www.drugs.com
US National Library of Medicine. Available at www.ncbi.nlm.nih.gov