What is Trimetazidine?

Russian figure skating star, 15 year old Kamila Valieva tested positive for trimetazidine, which is a banned substance per WADA. This announcement comes during the Beijing Olympics, where Valieva is a favorite for gold in the women’s singles skating competition.

Vaileva competed in the team figure skating event, where the Russian Olympic Committee (ROC) secured the gold medal on February 7. The positive test, which was collected prior to the Olympics, is now putting the ROC’s team gold medal in jeopardy. There is a hearing scheduled for Sunday at 8:30 p.m. Beijing time (7:30 a.m. on Monday ET) to determine if Valieva is eligible to compete individually on Tuesday. The results of the CAS hearing are expected for Monday around 2:00 PM local time.

The timing is at question here – It took until February 8 for a laboratory in Sweden to report that it had detected a banned substance, and the Russian Anti-Doping Agency, the overseeing testing agency in this case, lifted a provisional ban a day later.

In December 2019, Russia was banned from participating in the Olympics for four years due to hosting a state sponsored doping agency. Athletes from Russia can compete under the Russian Olympic Committee (ROC).

Trimetazidine is the same substance that Chinese swimmer Sun Yang tested positive for in 2014, resulting in him serving a three month ban from competition. When Yang tested positive, trimetazidine had only been on the banned substance list for four months.  

Yang claimed that he was medically prescribed trimetazidine to treat heart palpitations. At that time, the drug was classified as a stimulant, but the World Anti Doping Agency (WADA) did not pursue the case after investigation. 

More recently, Yang was issued an eight-year suspension in February 2020 for tampering with doping control procedures where he destroyed vials containing his sample. After successfully appealing the sentence, his ban was reduced to four years, making it possible for Yang to make a comeback at the Paris Olympics in 2024. 

This is also the same substance that American swimmer Madisyn Cox tested positive for. She was initially given a two year ban, though that was ultimately reduced to 6 months when she proved that the positive test was via a contaminated supplement.

So, what exactly is trimetazidine?

It’s a drug used to treat angina and other heart conditions by increasing blood flow to the heart and limiting blood pressure swings. Trimetazidine is not approved for use in the United States. 

As stated earlier, trimetazidine has been banned by WADA since 2014, and it’s classified as a “hormone and metabolic modulator,” which is illegal for athletes to use both in and out of competition because it likely increases cardiac output to the athlete’s benefit. 

Banned metabolic modulators have been used by cyclists, weightlifters, boxers, wrestlers, skiers and other athletes from dozens of countries including Russia, Poland, Columbia, Belgium and Germany, CNN reports. 

After becoming the first woman to land a quadruple jump at the Olympics, Valieva was a favorite for the gold in the individual skating event. 

The issue is also more complicated due to Valieva’s age since she is considered a “protected person” under WADA doping code, since she is not yet 16 years old at the time of the violation. This means that the committee will also consider if Valieva herself was at fault, due to her minor status. If found guilty, Valieva could face a maximum two-year ban instead of four. 

Does Trimetazadine Provide Any Benefit?

There were at one time believed to be benefits of trimetazadine taken on its own that could help athletes, but there is a growing body of opinion that it doesn’t really provide any benefit.

Multiple doctors have chimed in that they don’t think it works even for its intended purpose.

Dr. Benjamin Levine, a renowned sports cardiologist at UT Southwestern Medical School, says he doesn’t think it provides any benefit.

“The chance that trimetazidine would improve her performance, in my opinion, is zero,” Dr. Levine told TechAI.com. “The only chance would be for it to hurt her.”

“Why things get banned is – anything that has a remote possibility of influencing performance gets banned,’ said Dr. Michael Joyner of the Mayo Clinic in a Todayarticle.

Joyner says that even if an athlete were doping, he doesn’t believe that this is a drug they would use – he says it’s too easy to test for, and that there are other substances that are harder to test for and more effective.

These comments are specifically for Valieva and the needs of the body in a 4 minute figure skating routine. There is some evidence that the drug might provide some effects for endurance athletes, though there is still not a ton of research to support that one way or the other.

These controversies and borderline drugs continue to raise the big questions about doping and where the lines are drawn between legal, illegal, and therapeutic use exemptions as technological advancements make doping more nuanced, and also makes testing more sensitive, detecting more-and-more unintentional contaminations.

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Dave Ladd
2 years ago

The culture of doping should be of more concern than the tears of one athlete. You can’t get to the ones responsible if you don’t stop her from competing. Some doctors can be politically persuaded to break the rules, for the honor of their country, others for money, or coercion. Whatever the motivation, if it doesn’t work (bring home the medals), and embarrasses the state (Russia), they’ll be a little less motivated to try it again.

Riccardo
2 years ago

Obviously it’s a banned substance and she’s tested positive, the obvious precedent is a 2 year or 6 month suspension if you can prove it was a contaminant. Similar standards should apply.

However, WADA is way too focused on testing for this type of nonsense with questionable performance benefits when it’s actually relatively easy to get away with taking real steroids (i.e. exogenous hormones).

The most effective general steroid and one of the most difficult to test for is testosterone and yet no one is ever caught for using it…seems odd no?

Last edited 2 years ago by Riccardo
Qqq
2 years ago

After the CAS ruling it’s a substance legal for use by minors.

Admin
Reply to  Qqq
2 years ago

That is not even close to what the CAS ruling said.

The CAS ruling only related to a provisional suspension that would block her from continuing to compete at these Games. They explicitly said their ruling was not on the merits of the case, and not relating to the results of the team event. That all still needs to be adjudicated. They simply ruled that she could continue to compete.

Her medals and results could still later be stripped by the other processes in place for anti-doping procedures.

Rafael
2 years ago

I can assure you doping is the least problematic stuff about Russia Skating Federation.. the mental and physical abuse they do to athletes, many are discarded after 1OG due to crhonic knee and back pain, most are taught to not eat and be as thin as possible, they do not have strenght to hold the acrobatics as they get older and the body changes.. and they are not the only one doing it to girls..

It is not so much different than a lot of abuse that are done to Gymnasts..

Bobo Gigi
2 years ago

It’s a banned substance so there should be no debate.
Russia loses its gold medal in the team competition and Kamila Valieva is suspended.
The simple fact that she may be allowed to compete in the singles competition drives me crazy!
I don’t care about her age and if it’s an adult who gave her the substance. Yes it’s very likely. But who cares?
She took a banned substance so she must be suspended and Russia must be disqualified.

cynthia curran
Reply to  Bobo Gigi
2 years ago

Well, let’s say her two quad landing did seem strange. Yeah, women can do quads but usually not as good as men. Nathan Chen the Salt Lake kid deserved his medal on the men’s.

Spectatorn
2 years ago

While I understand the argument that she is minor and the concern of whether she is at fault – assuming she was given the drug without knowing, I can’t agree to let her get away with the positive test.

Whoever give her the prescription or drug deserves and should be ban from any sports simply by providing banned substance to a minor.

But if minor (athletes) are allowed to be off the hook after positive test, that would be unfair for other athletes competed against them. Also, it give the signal to use banned substance until 16, which is bad for the young athletes and also go against the ideal of anti-doping.

At the end of the day,… Read more »

Last edited 2 years ago by Spectatorn
Steve Nolan
2 years ago

and that there are other substances that are harder to test for and more effective.

But athletes wouldn’t use those. No sir.

All my faves are clean.

Last edited 2 years ago by Steve Nolan
Snarky
2 years ago

A banned substance that the Russians think doesn’t matter. Meldonium trimetazinine. It doesn’t matter. They have no morals. Corruption is the national mantra.

HJones
Reply to  Snarky
2 years ago

American swimmers were using Meldonium too, btw, before it was put on the banned list.

cynthia curran
Reply to  HJones
2 years ago

You can have a heart condition when you are young but its more likely to show up in middle to old age. There was no argument that she had a heart condition.

Stan Jones
Reply to  Snarky
2 years ago

Have you ever been there? Do you even know anyone from there? Or do you judge by the cnn propaganda?