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Updated 08 March 2016

Why did Sharapova take Meldonium?

Former world number one tennis player Maria Sharapova failed a drug test at the Australian Open due to a substance, called Meldonium or Mildronate, she has been taking for 10 years for health issues.

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Maria Sharapova failed the drug test for Meldonium on January 26, 2016 while playing at the Australian Open.

According to Drugs.com, Meldonium, which is also known as Mildronate, is manufactured by pharmaceutical company Grindeks in Latvia and used in the treatment of certain heart conditions such as angina, heart attacks, heart failure and for ischaemia, which is a lack of blood flow to parts of the body. Grindeks, told the Associated Press that four to six weeks was a common course. “Depending on the patient’s health condition, treatment course of meldonium preparations may vary from four to six weeks. Treatment course can be repeated twice or thrice a year,” the company said in an emailed statement.


“Only physicians can follow and evaluate patient’s health condition and state whether the patient should use meldonium for a longer period of time.”

Read: Your guide to legal sports supplements

The medication works by dilating blood vessels and increasing blood flow, which in turn improves exercise capacity, physical and mental endurance, and also brain function.

The US National Library of Medicine says that Meldonium improves the users’ mood and allows them to become more active.

Meldonium was on the World Anti-Doping Agency’s (Wada) list of drugs being monitored until September 2015, and on 1 January 2016 it was added to the list of banned substances.

During a press conference Maria Sharapova said she'd been prescribed Meldonium by her family doctor and had been taking it since 2006.

She had been prescribed it for her irregular EKGs, or electrocardiogram readings. An EKG is a test that records each heartbeat onto a piece of paper.

Image: Mildronate or Meldonium. Source: http://www.grindeks.lv/

Mildronate

Read: Your guide to illegal sports supplements

She said, "I was getting sick a lot. I was getting the flu every couple of months. I had irregular EKG results.

"I had a deficiency in magnesium and a family history of diabetes, and there were signs of diabetes. That is one of the medications, along with others, that I received."

Read: How and EKG may predict heart disease risk 

The medication was also prescribed to address a magnesium deficiency (that can cause muscle cramps in athletes), and Sharapova's family history of diabetes.

Sharapova claims she was unaware Meldonium had been added to the WADA list of banned substances until she received a letter from the International Tennis Federation informing her of a failed drug test during the 2016 Australian Open.

Meldonium is classed as an S4 substance under the Wada code, which addresses hormone and metabolic modulators. 

Metabolic modulators are a newer class of drugs that benefit patients by modulating cardiac metabolism without altering the fluid dynamics of blood flow.

They increase glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen.

It was invented in the mid-1970s at the Institute of Organic Synthesis of the Latvian SSR Academy of Sciences by Ivars Kalvins.

Sources:

Metabolic modulation: a new therapeutic target in treatment of heart failure, American Journal of Therapeutics, 2011 November.

Drugs.com, http://www.drugs.com/international/meldonium.html

Grindex.lv http://www.grindeks.lv/en/products/prescription-medicine/grindeks-brand-products/mildronate

Mildronate improves the exercise tolerance in patients with stable angina: results of a long term clinical trial, Vilnis Dzerve et al, Seminars in Cardiovascular Medicine, 2010

After Maria Sharapova tested positive for the banned substance meldonium, the drug's Latvian manufacturer says the usual maximum length for a course of the drug is six weeks, rather than the 10 years that the Russian tennis star says she has used it for,James Ellingworth, AP, 8 March 2016

Read more:

WADA calls for wider efforts to tackle sports doping 

The iPhone app that fights doping in sport

Drugs and doping in rugby

 
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