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What Is Meldonium?


Star tennis player Maria Sharapova is facing backlash - and losing endorsement deals - after revealing that she failed a drug test at this year's Australian Open. In a press conference, Sharapova admitted to taking the drug Meldonium, and said she has been taking it for more than a decade for medical issues.

"Meldonium is used in some countries to treat cardiac ischemia - or reduced blood flow to the heart," says John Ryan, MD, a cardiologist with University of Utah Health. "It increases metabolism in the heart muscles so they can better manage blood, oxygen and energy."

The drug was added to the list of banned substances in January of this year by the World Anti-Doping Agency. The reasoning behind the ban is that while Meldonium can be used to help the metabolism in heart muscles, it has a similar effect on other muscles as well. "This means athletes can potentially do more with less," says Ryan. "Perhaps muscles are less likely to be fatigued, and recovery times are likely to be shorter."

Meldonium is only approved for use in a handful of countries - most of them in Eastern Europe. Here in the United States, a combination of ACE inhibitors and beta blockers are used to treat cardiac ischemia. Aspirin and statins also are recommended to help these patients avoid heart attacks. "These drugs have shown they improve clinical outcomes in patients with cardiac ischemia," says Ryan. "Meldonium does not have the same proven outcomes, and likely had side effects that raised questions for the FDA."

The manufacturer of Meldonium says the drug "improves the physical capacity and mental function" of healthy people. It also claims that it does not alter the performance of athletes. So, could Sharapova have been taking the drug for legitimate health reasons?

"Similar medications are used and indicated only in people who have significant heart failure or coronary artery disease," says Ryan. "It would be difficult to perform at an elite athletic level with either of these conditions."