Molluscum in sport: a banned drug still tempts athletes

Since the beginning of 2016, the World Anti-Doping Agency (WADA) has added meldonium (mildronate) to the list of prohibited doping substances. Although this decision was made almost a decade ago, data shows that some athletes still resist the temptation to fight for victories and medals with the help of this drug.

"Meldonium was added to the list of banned doping substances ten years ago. Despite this, there are still cases where traces of its use are found in the bodies of athletes. And these are not isolated cases," says Rūta Banytė, head of the Lithuanian Anti-Doping Agency.

WADA recently announced that meldonium was the most commonly tested doping agent in 2023, under the classification of hormones and metabolic modulators. In total, meldonium was detected 77 times in doping tests worldwide in 2023, 7 more than in 2022.

In Lithuania, 7 athletes are currently serving a disqualification for taking meldonium.

Why is meldonium prohibited and dangerous?

"In the past, meldonium was very common in sports medicine. We call it the old man's vitamin and it's a product that came from cardiology to sports. In very simple terms, it helps to carry oxygen more efficiently to the heart cells," explains sports medicine doctor Paul Petraitis.

According to him, sports physicians used to prescribe meldonium to athletes when they experienced even minimal cardiac problems due to heavy exercise.

"It has to be said that the product has often solved these problems. However, in the end, it was shown that it could provide an advantage. This is why meldonium was added to the list of banned products," adds Mr Petraitis.

Traces of meldonium remain in the body for a relatively long time. "It can be detected even 6-9 months after consumption. It is therefore really surprising to me that some athletes have still not given up on this product," he says. The sports physician also stresses that there are no alternatives to meldonium that have the same effects and are not banned in sport.

"Perhaps this increases the temptation to take risks," says Petraitis.

Petraitis also says that in medicine, in cardiology, meldonium is prescribed for patients with severe heart disease. "It must be understood that these are disorders where no sport, especially professional sport, is possible."

Medical uses and health risks

Dr Rokas Šerpytis, a cardiologist at Vilnius University Hospital Santaros Klinikos, explains that mildronate, as a metabolic drug, is intended for the treatment of certain diseases of the cardiovascular system, especially in the case of ischaemia, which is a lack of oxygen to the tissues. Examples of such diseases, he says, include chronic ischaemic heart disease and chronic heart failure. The product can also be used in post-myocardial infarction conditions where optimal medical therapy is not sufficient.

"Mildronate, simply put, affects metabolism, improves oxygen uptake and cellular energy balance, and promotes the use of glucose rather than fatty acids for energy production," says Dr Rokas Šerpytis.

"However, it is important to stress that in medicine, this product is prescribed for a maximum period of 2 months. If it is used for a longer period of time, certain disorders and residual effects may occur, for example, long-term use may affect the metabolism of fatty acids," warns Dr Šerpytis.

He also points out that the efficacy of meldonium is not always based on high-level clinical trials, which is why its prescription in modern evidence-based medicine is limited and should be based on an individual assessment of the patient's condition.

"It works by altering cellular energy metabolism, inhibiting fatty acid oxidation and stimulating glucose utilisation. While this is useful in the case of oxygen deprivation, long-term alteration of this mechanism without a clear medical necessity may have undesirable consequences," the cardiologist notes.

High-profile doping scandals involving meldonium

Since its inclusion on the list of banned substances, meldonium has been at the epicentre of many high-profile doping scandals. Perhaps the most famous case, which has attracted a huge amount of global media attention, involved Russian tennis player Maria Sharapova, who admitted to using the drug in 2016. Although she claimed to have taken it medically for heart problems, she was disqualified by the International Tennis Federation.

Traces of meldonium were also detected in the blood of Russian Olympic medallists Ekaterina Bobrova (ice skating), Yuliya Yefimova (swimming) and Pavel Kulizhnikov (speed skating) during doping tests.

Mikhail Mudrik, a Chelsea FC player, is currently suspended for taking meldonium.

These cases highlighted the prevalence of meldonium in Eastern European sports.

"All these cases, in a way, support the assumption that the highest use of meldonium was among Russian athletes, as well as athletes from other Eastern European countries," says Petraitis.