What is Meldonium? The drug behind Maria Sharapova’s positive test

Maria Sharapova announced she has tested positive for Meldonium. Explaining the background, benefits and other cases relating to the drug.

In March, tennis star Maria Sharapova announced that she was informed of a positive test at the Australian Open for Meldonium, which is considered a banned substance by the World Anti-Doping Agency.

The supplement was added to the WADA list on Jan. 1, 2016 after one year of being watched closely on the anti-doping governing body's monitoring program. The drug is also banned by the International Tennis Federation's Anti-Doping Program as a result.

In the aftermath of Sharapova’s ITF suspension, take a closer look at Meldonium. 

Background

Meldonium is an anti-ischemic drug used clinically to treat myocardial infarction and chronic heart failure. Meldonium was first developed and marketed by the Latvia-based pharmaceutical company Grindeks and was one of the country's largest exports. It garnered €65 million in sales for 2013. 

The drug can be taken by capsules or injections.

It is not approved by the United States' Food and Drug Administration. WADA classifies the drug as a S4 substance which focuses on hormone and metabolic modulators.

Benefits

Among the positive benefits of Meldonium in endurance sports are decreased levels of lactate and urea in blood, glycogen increase during extended exercise, increased rate of recovery and increased heart function. The drug was recommended to treat patients with ischemic disorders of the cerebral circulation.

While Ivars Kalvins, the inventor of Mildronate (another name for the drug), may not call it a performance enhancing drug, clinical trials on humans have proven to show effects. Much like EPO, which was invented with illnesses in mind, athletes soon discovered the benefits for sport.

Some athletes from the USSR have been rumored to use it for years for heart support. Sharapova said she had been prescribed the supplement for about 10 years to treat medical issues, including abnormal EKG readings, a magnesium deficiency and more.

• Sharapova's attorney John Haggerty details failed drug test

A suspension for the five-time Grand Slam champion has not been determined but Sharapova will be provisionally suspended beginning on March 12, according to the ITF. There is still a chance that she could return in time to compete at the 2016 Olympics in Rio de Janeiro.

There are also groups that believe Meldonium does not provide performance enhancement.

“There’s really no evidence that there’s any performance enhancement from meldonium. Zero,” said Don Catlin, the director of Banned Substances Control Group told USA Today.

Results from the European Games in Baku, Azerbaijan have yielded 66 positive tests for Meldonium in 762 doping samples.

Investigations are also taking place in claims by athletes that have tested positive that say they stopped taking the substance after it was banned yet it has remained in their system for weeks and months after the fact.

Meldonium in other sports

A recent study found that more than 180 cases of Mildronate use were spread across numerous different sport disciplines.

Swedish distance runner Abeba Aregawi, the 2013 world champion at 1,500-meters, also tested positive for Meldonium last week. She has accepted a provisional suspension and requested the testing of a B-sample. Several Ethiopian athletes that have also tested positive for Meldonium are expected to be announced soon.

Other athletes who have reportedly tested positive for Meldonium include six wrestlers from Georgia, Russian cyclist Eduard Vorganov and Ukrainian biathlete Olga Abramova.

Just before Sharapova's announcement, Russian ice dancer Ekaterina Bobrova revealed that she had also tested positive for Meldonium at the 2016 European Figure Skating Championships.

The next highest profile cases after Sharapova include Yuliya Efimova, the four-time breaststroke world champion from Russia, and Nikolai Kuksenkov, Russia's top male gymnast.

In early April, Vitaly Prokhorov, head coach of Russia's U18 Junior National Team, told Russia's R-Sport news agency that the team was informed to replace its line-up and coaching staff as more than 15 players reportedly tested positive for Meldonium. New players needed to be selected just one day before the team was preparing to depart for the world championships.

More than 120 athletes have tested positive for Meldonium since it was banned.

Sharapova’s ban

The ITF announced on June 8 that Sharapova would receive a two-year ban from tennis due to her consumption of Meldonium. The ban will be backdated to January, which means it is set to end on January 25, 2018.

• Breaking down Sharapova’s two-year ban, ITF’s ruling and appeal process​

Sharapova stated in a post on her Facebook page that she will appeal the decision.

“While the tribunal concluded correctly that I did not intentionally violate the anti-doping rules, I cannot accept an unfairly harsh two-year suspension,” Sharapova wrote. “The tribunal, whose members were selected by the ITF, agreed that I did not do anything intentionally wrong, yet they seek to keep me from playing tennis for two years. I will immediately appeal the suspension portion of this ruling to CAS, the Court of Arbitration for Sport.”