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Story behind meldonium–from pharmacology to performance enhancement: a narrative review
  1. Wolfgang Schobersberger1,
  2. Tobias Dünnwald1,
  3. Günther Gmeiner2,
  4. Cornelia Blank1
  1. 1Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT, Hall in Tirol and Tirol Kliniken GmbH Innsbruck, Austria
  2. 2Doping Control Laboratory, Seibersdorf Labor GmbH, Seibersdorf, Austria
  1. Correspondence to Professor Wolfgang Schobersberger, Department for Psychology and Medical Sciences, Institute for Sports Medicine, Alpine Medicine & Health Tourism, UMIT, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol 6060, Austria; wolfgang.schobersberger{at}


Recent reports from the World Anti-Doping Agency (WADA) indicate an alarming prevalence in the use of meldonium among elite athletes. Therefore, in January 2016, meldonium was added to WADA's prohibited list after being monitored since 2015. Meldonium has been shown to have beneficial effects in cardiovascular, neurological and metabolic diseases due to its anti-ischaemic and cardioprotective properties, which are ascribed mainly to its inhibition of ß-oxidation and its activation of glycolysis. Despite its widespread use, there are only a few clinical studies or clinical trials available. Meldonium is registered in most Baltic countries and is easily accessible through the internet with no serious adverse effects reported by the manufacturer so far. Among athletes, meldonium is used with the purpose of increasing recovery rate or exercise performance. The benefit of taking meldonium in view of performance enhancement in athletes is quite speculative and is discussed without sound scientific evidence. This narrative review provides a detailed overview of the drug meldonium, focusing on the main topics pharmacology and biochemical actions, clinical applications, pharmacokinetics, methods of detection and potential for performance enhancement in athletes.

  • Performance
  • Drug use
  • Doping
  • Pharmacology

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  • Contributors WS, TD and CB systematically searched the literature for studies related to Meldonium. WS and TD separately judged the inclusion criteria of the studies. GG was responsible for the pharmacology and detection section. All authors contributed to the writing and finalisation of the paper and the revisions.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.