What is trimetazidine and why was it banned at the Olympics?

key takeaways

  • An Olympic figure skater has tested positive for the illicit drug trimetazidine.
  • Trimetazidine is a medicine used to prevent or treat chest pain and other heart-related conditions.
  • The drug has been banned by the World Anti-Doping Agency since 2014.

At the 2022 Beijing Olympics, 15-year-old Russian figure skating gold medalist Kamila Valieva tested positive for a banned drug called trimetazidine.

According to the International Testing Agency (ITA), she failed a drug test on December 25, 2021, while a urine sample was collected by Russian authorities. However, it was only confirmed this week.

The case will be heard by the Court of Arbitration for Sport (CAS) and needs to be decided before Valieva’s next women’s singles short program match on Tuesday 15 February 2022. It is not known whether Valieva has any heart problems.

What is trimetazidine and what is it used for?

Trimetazidine is a medicine used to prevent or treat attacks of angina — a type of chest pain caused by reduced blood flow to the heart — and other heart-related conditions. It works by increasing blood flow to the heart and limiting rapid increases in blood pressure.

There are several ways to treat angina pectoris naturally

“This drug can make the heart more efficient, reduce the oxygen consumption of the heart, and [cause] Less stress on the heart,” Michael Joyner, MD, a human performance specialist and Mayo Clinic anesthesiologist, told VigorTip. “This may be beneficial for patients with heart failure or blocked coronary artery disease. ”

According to the European Medicines Agency, the drug is also used to treat symptoms such as vertigo (spinning sensation and dizziness), tinnitus (ringing in the ears), and vision loss or visual disturbances. According to current recommendations, the drug should not be prescribed for patients with vertigo or tinnitus. It should only be used as a symptomatic treatment or as an additional treatment for patients with angina (chest pain).

Is trimetazidine legal to use?

Medicines containing trimetazidine have been on the market since the 1970s and are now available in Bulgaria, Cyprus, Denmark, France, Germany, Italy, Portugal, Spain and many other countries. While the drug has been used for years in Asian and European countries as a treatment for heart disease, it has not been approved for clinical use by the U.S. Food and Drug Administration (FDA), Johnson-Arbor said.

Why is trimetazidine banned in sports?

Since 2014, trimetazidine has been included in the World Anti-Doping Agency (WADA) list of prohibited substances in the “Hormones and Metabolic Modulators” category. It is illegal because of evidence that athletes use it in and out of competition to improve performance.

Kelly Johnson-Arbor, MD, a medical toxicologist and co-medical director of the National Capital Poison Center, told VigorTip that the drug is considered a performance-enhancing drug because of its possible beneficial effects on exercise capacity and energy.

“While it does not have the muscle-building or stimulant-like effects of many recognized performance-enhancing or stimulant drugs, trimetazidine can improve physical efficiency and endurance in athletes,” she said.

The drug could also affect metabolism in ways that improve skeletal muscle or heart function, Joyner added. This improvement in endurance is critical to athletic performance.

Typically, when used as a performance-enhancing drug, trimetazidine begins to work within hours of swallowing a single dose, with clinical effects lasting several days. It may be detected in the athlete’s urine in the days after the athlete’s last use of the drug.

But it may actually have little effect on young and healthy adults or athletes.

“It’s unlikely to improve the performance of young athletes, such as [Valieva],” Joiner said. “The hearts of people like this are working at peak efficiency, their muscles are burning all the glucose you need, and there simply isn’t a lot of performance-enhancing benefits. ”

Some doctors even thought the drug might harm her. Although trimetazidine can optimize the metabolic function of the heart under stress, there are risks associated with taking the drug.

Side effects of trimetazidine include gastrointestinal discomfort, tremors and weakness, according to Johnson-Arbor. Serious adverse symptoms can also occur with long-term use of this drug, including symptoms of Parkinson’s disease (a disorder that causes muscle stiffness, involuntary muscle movements, and difficulty walking). Less serious side effects include headache, rash, nausea, dizziness, and vomiting.

“Although trimetazidine’s effects have not been specifically studied in children, the drug’s side effects are likely to be similar in children and adults,” Johnson-Arbor said.

Johnson-Arbor added that trimetazidine was detected in urine samples from athletes who exercised as varied as swimming, soccer, weightlifting and cycling.

The substance has also been used by other Russian athletes, including Nadezhda Sergeyeva, who was disqualified from the 2018 PyeongChang Winter Olympics two days before her sled race because she tested positive for the drug . The most high-profile and high-profile case involving trimetazidine was Chinese swimmer Sun Yang, who tested positive for the drug in 2014.