Since tennis star Maria Sharapova’s news conference yesterday, in which she admitted to using the prohibited substance meldonium, much attention has been focused on the drug. Sharapova admitted to taking the substance for the past 10 years, though it was only added to the World Anti-Doping Agency’s prohibited list this January.

The drug is used to prevent ischemia, with a mechanism of action based on decreasing L-carnitine concentration, regulating energy metabolism and enhancing the preconditioning-like adaptive responses.  It has also been evaluated in patients with congestive heart failure (CHF) and type 2 diabetes. Though Sharapova claims to have taken the drug for health reasons, different models have shown the the drug may also have athletic benefits. In a series of studies (mostly animal) it has been shown to increase endurance, quicken rehabilitation, protect against stress, and enhance central nervous system functions (CNS). The evidence surrounding its potential performance-enhancing properties is why the drug was newly added to the list of prohibitive substances.

Developed in Latvia, meldonium is widely available without prescription in many eastern European countries, though it is not licensed in the U.S. or most western European countries. Last year revealed the results of a research project which found 2.2% of 8,300 urine samples collected from athletes contained mildronate (another name for meldonium). Sharapova is the first athlete to fall foul of the meldonium ban, but she likely won’t be the last.

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