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

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

According to International testing agency (ITA), she failed a drug test during a urine sample collection by Russian authorities on December 25, 2021. However, confirmation only came out this week.

The case will be heard by the Court of Arbitration for Sport (CAS), with a decision needed before Valieva’s next event in the women’s singles short program on Tuesday, February 15, 2022. It is not yet clear whether Valieva has any issues cardiac.

What is trimetazidine and what is it used for?

Trimetazidine is a drug used to prevent or treat angina attacks, which are a type of chest pain caused by reduced blood flow to the heart, and other heart conditions. It works by increasing blood flow to the heart and limiting rapid spikes in blood pressure.

“The 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 expert and Mayo Clinic anesthesiologist, told Verywell. “This could be beneficial in patients who suffer from heart failure or who have coronary blockages.”

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

Why is trimetazidine banned in sport?

Trimetazidine is listed by the World Anti-Doping Agency (WADA) listing of substances banned since 2014 in the “hormonal and metabolic modulator” category. It is illegal for athletes to use both in and out of competition due to evidence of performance enhancement.

Kelly Johnson-Arbour, MDmedical toxicologist and co-medical director of the National Capital Poison Center, told Verywell that the drug is considered a performance-enhancing drug because it may have beneficial effects on exercise capacity and energy.

“Although it lacks the muscle-building or stimulant-like effects of many commonly recognized performance-enhancing or performance-enhancing drugs, trimetazidine can improve physical efficiency and endurance in athletes,” she said.

The drug could also affect metabolism in ways that could improve skeletal muscle or heart performance, Joyner added. This type of endurance enhancement is crucial for athletic performance.

Typically, when used as a performance-enhancing drug, trimetazidine begins to work within hours of ingesting a single dose, and clinical effects can last for days. It can be detected in the urine of athletes for several days after their last use of the drug.

But it might not actually have much of an effect on young, healthy adults or athletes.

“It is unlikely to improve the performance of young athletes like [Valieva]”Said Joyner. “The heart of a person like this is working at its maximum efficiency and his muscles can burn all the glucose you need, it is really unlikely that he has many benefits to improve the performance.”

Some doctors even suggest the drugs might harm him. Although trimetazidine may optimize the metabolic function of the heart under stress, taking this drug also carries risks.

Side effects of trimetazidine include gastrointestinal distress, tremors and weakness, according to Johnson-Arbor. There could also be serious adverse symptoms after long-term use of the drug, including symptoms of Parkinsonism (a disorder that causes muscle stiffness), involuntary muscle movements and difficulty walking. Less serious side effects include headache, rash, nausea, dizziness, and vomiting.

“Although the effects of trimetazidine have not been specifically studied in children, it is likely that the side effects of the drug will be similar in children and adults,” Johnson-Arbor said.

Johnson-Arbor added that trimetazidine has been detected in urine samples from athletes participating in a variety of sports, including swimming, soccer, weightlifting and cycling.

Other Russian athletes have also used the substance, including Nadezhda Sergeeva, who was disqualified at the 2018 Pyeongchang Winter Olympics two days before her bobsleigh race after testing positive for drugs. The most notable and high-profile case involving trimetazidine is that of Chinese swimmer Sun Yang, who tested positive for the drug in 2014.