“Mildronate is not a doping or even a vitamin. Meldonium: how does this drug work and what is it for? Use in medicine and sports Which drug was banned for athletes this year?

No one dared to argue.

“Colleagues, special attention! Mildronate is on the list! “WADA has banned mildronate, don’t screw it up!” “What instead of mildronate, please advise!” These are typical calls in Russian specialized forums and social networks last week– in those where athletes, both amateurs and professionals, communicate with each other. What's happened? And something terrible happened - the World Anti-Doping Agency published a list of prohibited drugs for 2016. And one of the items there is mildronate (meldonium) - a drug that, since Soviet times, was considered mandatory for use in the preparation of athletes at a level slightly above the physical education level. Now WADA believes that with its help it is possible to improve results, and practicing doctors, although ironically, call mildronate a “harmless vitamin”, but at the same time state: Russia has not learned to protect its interests and scientific developments. There is no possibility, and there is no particular desire.

“We’ll have to rewrite the textbooks”

I’ll immediately explain the title, which hints at a sequel. A year and a half ago, I wrote a text entitled “How Russian know-how was betrayed” about how WADA unexpectedly quickly equated the popular method of training Russian athletes -

It is clear that the Russians are accepting something, but no one understands what exactly or why. And since the Russians mean doping, they can’t do it any other way.

inhalation of xenon and argon - to the use of prohibited drugs. Revelations by German journalists about “secret Russian doping” came out the very next day after our sensational victory at the Olympics in Sochi, and three months later, xenon and argon, without much evidence, were equated in their effects to EPO and banned. At the same time, inert gases were used in Russian sports, without much concealment, for at least two decades - but after the information noise raised by the world media, the Russian side did not even make an attempt to enter into some kind of scientific discussion with WADA (as they say, even dissuading individual enthusiasts from such attempts). Now we will have to rewrite all domestic sports textbooks on pharmacology.

"The problem is that scientific world in Russia, with the exception of several laboratories of the Academy of Sciences, it lives in its Russian-language journals,” Sergei Ilyukov, a sports doctor at the Center for the Study of Sports Medicine from the Finnish city of Kuopio, explained to the Championship. – Research on Russian developments is not presented in the English-language peer-reviewed literature; they are simply not known. Hence these far-fetched incidents from last year, like with inert gases or another drug - preductal (trimetazidine)"

“Mildronate is produced in Latvia, but is used only in post-Soviet countries,” continues Ilyukov. “They haven’t even heard of him in Western sports.” It is clear that the Russians are accepting something, but no one understands what exactly or why. And since the Russians mean doping, they can’t do it any other way. The Cold War mentality, the generation that grew up with it, is now exactly at the level where decisions are made. I am sure that if studies about Russian developments were present in Western journals, there would be no ban. It turns out that Russian sports science, due to its closed nature, is becoming a victim of prejudice.”

From “I don’t feel anything” to “it seems to fit”

The irony here is that, unlike inert gases, mildronate is at best a placebo, at worst - vitamins (or vice versa, it depends on what is better and what is worse). And WADA classified it as an extremely serious category S4 - hormones and metabolic modulators.

Late Soviet myths are doing their job. There is no statistically reliable data on the effectiveness of mildronate in highly qualified athletes.

This means that using it could potentially result in a ban of up to four years. Considering the prevalence of this drug in Russia, ridiculous cases will probably soon appear when a promising career is interrupted due to vitamins. “Yes, an extremely strange decision. Mildronate is similar to vitamins. There is no harm, only psychologically it seems that the body is “strengthened”, nothing more,” comments Ilyukov.

The doctor of the Russian national football team, Eduard Bezuglov, has a similar opinion. “I haven’t used it in my practice, because I think that it doesn’t make much sense. Its theoretically possible effect quietly achieved normal sleep And good nutrition. It is attractive to many due to its low cost and availability. Well, late Soviet myths do their job. There is no statistically reliable data on its effectiveness among highly qualified athletes,” he said in an interview with the Championship.

“Personally, when I was training, the coach told me to drink mildronate and riboxin, which all athletes now call a “vitamin,” says Master of Sports in swimming, medalist of the Russian Championship Galina Shipovalova, who is now involved in triathlon at the amateur level and even won two “halves” of Ironman. – In the 90s, it was almost the only drug that a mere mortal athlete could buy and not go broke. We used it in the heaviest microcycles. I felt the effect. It really became easier to bear the loads, and my endurance increased.”

“It was used very often, especially in cyclic sports, but also periodically in game sports. It’s difficult to assess its effectiveness: it rarely went in isolation. From personal experience of communicating with athletes, I can say that no one considered it a panacea, and reviews range from “I don’t feel anything” to “it seems to work,” agrees Bezuglov.

Interestingly, mildronate was indirectly mentioned during the doping scandal with Shakhtar Donetsk goalkeeper Alexander Rybka almost four years ago. The first deputy of the FFU sports and medical committee, Vyacheslav Popov, recommended it as a legal means for weight loss.

And we will be silent

In general, God bless him, with this drug with an incomprehensible effect. There is no point in particularly defending it. On the one side. On the other hand, there is still no one to defend it. In the WADA structure on at the moment There are two Russians present - and both of them have no leverage in making decisions related to current scientific research. This is a member of the board of founders, Deputy Minister of Sports Pavel Kolobkov and a member of the commission for finance and administration, adviser to the Minister of Sports Natalya Zhelanova. There are no representatives of ours in the research committee on health and medicine, nor in expert groups - neither on prohibited drugs, nor on laboratories. The head of the Russian Anti-Doping Laboratory, Grigory Rodchenkov, tried to join the research committee several times, but without success.

Therefore, for now all that remains is to read the texts where the UK and US anti-doping agencies enter into scientific discussions and lobby WADA for what they consider correct and necessary. The 2016 list, despite their efforts, did not include hormones for treatment thyroid gland, because of which both structures publicly expressed their disappointment. In their opinion, the use of thyroid hormones directly affects the improvement of results. Whether this is true or not, it will become clear very soon - the British and Americans intend to continue the fight.

Yesterday they came to us for xenon, today for mildronate, and tomorrow WADA will come for a truly valuable scientific development, which they suddenly want to consider doping. Simply by the fact that, as Ilyukov noted above, if they are Russian, that means doping. And we will remain silent again.

The drug of discord. Why Mildronate was recognized as a doping and who is it prescribed to?

The drug is literally for everything - so you can call it “Mildronat”, which has not left newspaper pages and television interviews for several days after Maria Sharapova’s loud statement.

Just two months ago it was a common medicine that everyone used - and ordinary people, and athletes. However, on January 1, 2016, everything changed - he was added to the anti-doping list. And a series of scandals immediately broke out - it turned out that this was one of the most frequently used drugs among Russian athletes. As a result, literally the whole world learned about the “inconspicuous” and inexpensive medicine. AiF.ru figured out why Mildronate is so scary and why it was equated with heavy doping agents.

Basics of pharmacology

At its core, Mildronate is a medicine that improves metabolism. The active ingredient of the drug - meldonium - is structural analogue a substance found in every cell of the human body.

This drug was created in the 70s of the 20th century in one of the institutes of the USSR. Therefore, it is mostly prescribed and accepted in Eastern Europe and Russia.

Mildronate delivers oxygen to cells in accordance with their need for it. It is also responsible for cleansing cells of toxic metabolic products and protecting them from damage. Due to its regular use, the body can withstand heavy loads and is able to quickly restore energy reserves. This allows it to be used for treatment and prevention various problems cardiovascular system, blood supply to the brain. Also, this drug is often prescribed for increased physical and mental activity.

It is especially good for ischemia, because is able to slow down necrotic zones and accelerate the recovery period.

In case of heart failure, the drug increases myocardial contractility and increases the body's resistance to physical activity. And in the event of ischemic cerebrovascular accidents, it improves blood circulation in the damaged area and promotes the redistribution of blood in favor of the affected area.

When is it prescribed?

Finding Mildronate in the medicine cabinet of a simple Russian family is not a problem. After all, it is prescribed quite often. Thus, it is widely used in complex therapy diseases such as:

Chronic heart failure
Coronary heart disease (heart attack, angina, etc.)
Cardiomyopathy
Chronic and acute cerebrovascular accidents

Decreased performance
The period after surgery of any kind (the drug helps reduce the rehabilitation period)
Physical overexertion
Hemophthalmos and other problems with the retina (visual impairment of various natures)
Chronic bronchitis or bronchial asthma (the drug acts as an immunomodulator)

Injections, tablets, drops

There are quite a few types of release forms and Mildronate. It is also available in tablets, injectable solutions, and can be used as drops, for example, to treat eye diseases. Exact dosage The doctor calculates it based on the severity of the situation, as well as the duration of the course. This drug can be taken by people over 18 years of age. Other contraindications include kidney disease, pregnancy, lactation and organic problems nervous system.

Among the adverse reactions that such a drug can cause are allergies, tachycardia, nervous excitement, changes in blood pressure.

The effect of Mildronate in sports

From the point of view of athletes, such a drug is valuable because it helps accumulate unoxidized fatty acids in the body’s cells, helps regulate oxygen supply to cells, activates glycolysis, improves muscle nutrition, thereby increasing the effectiveness of training and reducing fatigue. In addition, it is able to provide additional protection for the heart muscle during overload. And it was these facts that became the basis for the inclusion of Mildronate in the list of prohibited drugs.

Sport

15.03.16 WADA explained why meldonium was banned

Meldonium (mildronate), banned since the beginning of the year, is used to increase productivity. That's why this drug was included in the list of prohibited athletes, explained the press service of the World Anti-Doping Agency (WADA).

The agency strongly denies the presence of a political component in the ban on meldonium, the WADA press service emphasized. “WADA categorically denies that the inclusion of meldonium in the list of prohibited drugs is politically motivated,” R-Sport quotes the agency’s report.

Meldonium (mildronate) was added to the list of prohibited substances by the World Anti-Doping Agency on January 1, 2016. The substance belongs to class S4 of the World Anti-Doping Agency prohibited list (hormones and metabolic modulators). WADA added mildronate to the list of prohibited drugs after a request from the United States Anti-Doping Agency (USADA), which received information from a confidential source about the use of athletes from Eastern Europe this substance to improve your physical abilities. According to WADA, since the beginning of the year this substance has been detected in the blood of more than 60 athletes. To date, the names of 12 athletes convicted of using meldonium have been officially announced. Among them are eight Russians: biathlete Eduard Latypov, cyclist Eduard Vorganov, figure skater Ekaterina Bobrova, tennis player Maria Sharapova, speed skater Pavel Kulizhnikov, short track skaters Semyon Elistratov and Ekaterina Konstantinova, volleyball player Alexander Markin. Also positive result meldonium was tested by the 2013 world champion in the 1500 meter race, Swede Abeba Aregawi, Georgian freestyle wrestler David Modzmanashvili, and Ukrainian biathletes Olga Abramova and Artem Tishchenko.

Mildronate is used in sports to increase the body's endurance to high physical activity during training and to high neuropsychic stress during competitions. In the CIS countries, the drug is used to prevent heart disease.

The creator of the drug, Ivars Kalvins, said that about 2 million people, including athletes, annually use meldonium as a drug, but it is not a doping drug. Kalvins also called the ban on meldonium a violation of human rights.

Moscow, Zoya Berezina

Moscow. Other news 03.15.16

Articles

"SE" talked about the drug Mildronate ( trade name meldonium) in March 2016, when it caused a stir in world sports and led to the suspension Russian stars- tennis player Maria Sharapova, figure skater Ekaterina Bobrova, short track skater Semyon Elistratov and speed skater Pavel Kulizhnikov.

Also on the “black” list of those caught in mildronate at that time were runners Abeba Aregawi from Sweden and Ethiopian Endebe Negesse, Ukrainian biathletes Olga Abramova and Artem Tishchenko, and Russian cyclist Eduard Vorganov. The World Anti-Doping Agency (WADA) classified meldonium as doping only on January 1, 2016. Over the past two months, almost a dozen athletes have been caught on it, with status ranging from strong middle peasants to world sports stars. Not a bad harvest, considering that the positive effect of using meldonium, in principle, has not been proven by modern science.

ANNUAL TURNOVER OF MILDRONATE –

70 MILLION EUROS

Mildronate was developed in 1975 in Riga by Professor Ivars Kalvins. This specialist, who now heads the department of medicinal chemistry at the Latvian Institute organic synthesis, recently gave a detailed interview to French journalist Pierre-Jean Vazel, where he stated that he considers the ban on mildronate to be absurd.

Meldonium protects the athlete's health, but we do not have any scientific evidence that this drug improves training performance, said Dr. Kalvins. – On the contrary, meldonium reduces the rate of carnitine production and slows down the production of energy from fatty acids in the human body. The protective effect is achieved due to the fact that during overload, meldonium protects cells from ischemic damage. So you can prohibit meat, because it contains carnitine, which generally increases the rate of oxidation of fatty acids and stimulates energy production.

According to the inventor, meldonium is indicated for use in order to protect the heart muscle, both for athletes and simply for people experiencing stress and constant workload. The drug prevents heart attacks (myocardial infarctions) and muscle damage in case of overtraining. Professor Kalvins did not provide any data that meldonium can be used in the prevention of diabetes (as Maria Sharapova stated at her press conference).

Until January 1, 2016, when meldonium was included in the WADA prohibited list, it was one of the most common recovery drugs in Russian sports. Almost all representatives of cyclic disciplines used it - partly because it was so simple to accept, partly they really saw the effect.

Suffice it to say that Mildronate’s annual turnover was 70 million euros, which is 0.7 percent of Latvia’s entire budget. The cost of one package in a Russian pharmacy is around 300 rubles. The drug is widespread only in the post-Soviet space - in Western Europe have never heard of it, and it is not registered in the USA. Positive cases of meldonium in the Ethiopian runner and Swede Aregawi were most likely caused by the fact that a doctor from the former USSR worked with the teams there. Who and when advised Mildronate to Sharapova is an interesting question, considering that it was not easy to even get such a drug for an athlete permanently living in the USA.

WHY WAS MILDRONATE BANNED?

According to a 2015 study from a Cologne laboratory, meldonium was found in 2.2 percent of urine samples from all professional athletes. Of 8,320 randomly selected samples, meldonium was found in 182. In his latest film, German journalist Hajo Seppelt cited statistics that in 2015, meldonium was found in 724 out of 4,316 doping tests taken from Russian athletes. This is 17 percent of positive samples - a huge indicator.

In its new prohibited list, WADA classified meldonium as a hormone and metabolic modulator. This is a very serious class, the use of substances from which can result in up to four years of disqualification. All substances in this class are prohibited for use both in-competition and out-of-competition.

How meldonium, a drug that is prescribed in Russia even for pregnant women, got here is an interesting question. Most likely, it is associated with the general distrust in the Western world towards domestic sports science and the inability of our scientists to defend their position with reason.

Personally, I do not consider mildronate to be a drug that should be banned,” Sergei Ilyukov, an anti-doping expert and doctor of the Finnish Olympic team, previously told SE. – But my opinion differs from the point of view of my German colleagues who insisted on a ban at WADA. I am surprised that Russian colleagues do not defend their point of view on such issues at the WADA level. This is unfortunate because mildronate is mainly used in the former USSR.

Is it likely that all the athletes involved used mildronate even when it was approved, and tested positive in January? According to Ilyukov, such an explanation cannot be completely ruled out.

The withdrawal period for Mildronate varies from person to person,” Ilyukov explained. – But potentially, I do not exclude the possibility that an athlete could take mildronate in the fall and give a positive test at the beginning of the year. It should be borne in mind that the equipment of modern anti-doping laboratories is extremely sensitive. For example, if you take an Olympic standard pool of 50x25 meters and throw a sugar cube into it, with which you drink tea, then the sugar test will give a positive result and even show the concentration.

WHAT THE MINISTRY OF SPORTS SAID THEN

In accordance with Russian and international anti-doping legislation, I cannot now comment on these cases,” Natalya Zhelanova, adviser to the Minister of Sports on anti-doping issues, told SE. – As an official, I have no right to discuss any details, including personal information, pending the completion of an investigation and a decision by the appropriate anti-doping organization.

One 2015 study showed that 724 of 4,316 Russian athletes (17%) had meldonium in their system https://t.co/bdzYSn57As pic.twitter.com/oM7soHfQA1

“After the ban on mildronate, a substitute will appear from Europe or the USA”

Five-time Grand Slam winner Maria Sharapova admitted that a banned drug, mildronate (or meldonium), was found in her body. In addition to Sharapova, Olympic champions Ekaterina Bobrova (figure skating), Semyon Elistratov (short track), world champion Pavel Kulizhnikov (speed skating) and Alexander Markin (volleyball) tested positive for this drug in 2016.

The head of the department told Izvestia about the properties of the banned drug. sports medicine, Director of the Russian Research Institute of Sports Medicine state university Physical Education, Sports, Youth and Tourism (RGUFKSMIT), Doctor of Medical Sciences, Professor Andrey Smolensky.

At cardiological congresses there were a number of reports on the use of mildronate (meldonium) for the treatment of patients with coronary heart disease. The drug has no serious contraindications in terms of harm to health. It is a cardioprotector. The drug was used for overstrain of the cardiovascular system in athletes. It was synthesized in the USSR, gained access to the medical market, clinical practice. There is definitely no need to say that this is a secret agent,” Andrei Smolensky noted.

Does Mildronate create a competitive advantage over rivals?

No it's not anabolic steroid. It does not affect performance, but protects the athlete’s heart from unsafe ischemia or lack of oxygen. Meldonium helps against the harmful effects of working at the limit of one's capabilities. However, if a drug is considered prohibited by WADA, its use should be avoided. The rules are the same for everyone, and they must be followed.

I am sure that after mildronate is banned, a substitute from Europe or the USA will appear on the market. Because athletes need cardiovascular protection. Given the enormous physical exertion, every second elite athlete experiences cardiovascular strain. This can lead to very serious consequences.

Then why was mildronate banned?

It's hard to say. In patients with coronary artery disease, in combination with other drugs, it improved the functioning of the cardiovascular system and even exercise tolerance. These data were published 5 years ago by academician Lyubov Albinskaya. This does not apply to athletes.

Sharapova explained her 10-year use of mildronate due to health problems. In 2006, the tennis player discovered the first signs of diabetes, to which she has a family predisposition. There were also problems with magnesium deficiency, ECG results were unstable. Do you believe this explanation?

I believe her words. She says absolutely the right things. This is an outstanding athlete who closely monitors her pharmacology. In my opinion, the ban on mildronate from January 1, 2016 is a draconian measure. Last year everything was rosy, athletes around the world calmly accepted it, and then the door closed. WADA representatives should have closed it not with a bang, but gradually, having discussed all the conditions.

Western media claim that mildronate was used only by athletes from the CIS countries.

This is not true. In Europe and around the world, there are drugs for cardioprotection containing meldonium. IN food additives, in sports nutrition. It is impossible for Michael Phelps to swim 16 times in one Olympics with outstanding results and win eight gold medals without any consequences. This means that a recovery program exists, but it is a secret. Nobody is in a hurry to reveal it.

Will it be possible to obtain therapeutic approval for Mildronate in the future?

This is quite possible. Bronchostimulants are also prohibited, but salbutamol is used by many athletes in summer and winter sports. For example, in cross-country skiing there are a lot of athletes with bronchial asthma who have received therapeutic approval for the use of salbutamol. At the current stage of the Ski World Cup, about 55% of athletes have such permission. The wording is approximately as follows: “athletes need this drug according to their clinical indicators, like patients. Otherwise, they are in a dangerous state when heavy loads" Or another example. Insulin is prohibited. However, athletes with diabetes mellitus use insulin and take part in professional competitions. History may repeat itself with mildronate. However, the entire world community must agree with this.

Do you see a way out of this situation? How can we reduce the number of positive doping tests in Russia?

It is necessary to increase the self-education of the athletes themselves in this matter and, of course, to train a sufficient number of sports doctors. About 4 million people are involved in professional sports in our country. There is a severe shortage of sports doctors, to put it mildly. They just aren't cooked. We propose to create a new format. We have a special training program for specialists in this area. We are ready to present it and tell you all the necessary details for its implementation.

“If I were Sharapova’s sports doctor, I would undoubtedly recommend that she take mildronate,” said the inventor of the drug.

Scientist Ivars Kalvins, who is the creator of the drug Mildronate, is outraged that his brainchild has been blacklisted by the World Anti-Doping Agency (WADA) since January 1 of this year. The professor explained to Elena Kirillova why this drug is not doping and is vital for athletes.

Over the past few days, the phones of Ivars Kalvins, who heads the Latvian Institute of Organic Synthesis, have been red-hot - journalists from all over the world are turning to the scientist for comments.

One can understand them: following the famous tennis player Maria Sharapova, disqualification may threaten a whole chain of athletes. And not only Russian ones. However, most likely, the most serious blow will be felt by athletes from Russia and the CIS countries, where mildronate was especially popular.

The pride of Latvian pharmaceuticals

Is it true that initially this drug, which is called the pride of Latvian pharmaceuticals, was invented not for athletes, but for military personnel who were sent to serve in Afghanistan?

To combine business with pleasure, in our developments we turned to a resource that was in abundance at that time - fuel for air defense missiles. Fuel, as it turns out, has an expiration date, and disposal is a very problematic undertaking. We had to come up with something.

Because I was looking for a molecule that could help the human body during depletion of reserves due to long-term stress, then it occurred to me to use rocket fuel.

“Of course, there is no rocket fuel in the drug itself,” the professor laughs, “but, let’s just say, I invented a structure that was synthesized from this substance.

As the author of the drug, Kalvins hopes that mildronate has become the pride of Latvian pharmaceuticals. According to the scientist, the medicine has been on the market for 32 years, but during this period it never occurred to anyone to include it in the list of prohibited substances or call it doping.

“But now everyone in the world has learned that there is such a Latvia and there is mildronate,” the scientist states with an ironic grin.

One Latvian expert has already stated that meldonium is active substance in mildronate - was included in the list of prohibited substances, since when excessive consumption is harmful to health.

If you abuse salt, you will also have big trouble with health. Sorry, but if you violate the dosage of any medicine, it will have a harmful effect. Even if it's not a cure. Plain water It can also be harmful if you drink too much of it. This is not a reason to include a substance on the prohibited list.

I felt outraged and offended when I learned that mildronate was on this list. We live in a world evidence-based medicine, and not in the era of unsubstantiated allegations. If you say it's doping or something like that, then you have to prove it! And not just like that, but as a result of a double-blind, randomized, placebo-controlled clinical trial.

Some argue that mildronate is something like a vitamin or even a placebo. So why did the harmless “vitamin” end up on the blacklist? How to explain this contradiction?

Placebo or not - I suggest asking those who use the drug. Such statements are baseless. It was in cardiology that mildronate underwent double-blind, randomized, placebo-controlled clinical trials, which showed that the drug has a good effect on angina and more.

When overloads cross a certain threshold, irreversible cell damage begins and then we see sudden deaths completely young and strong people from extensive heart attack or stroke - right on the hockey field or at the marathon. Mildronate prevents this. Prevents damage to the heart muscle or brain from such stress.

The drug does not cause any increased performance or endurance, unless you consider that good health generally helps a person to be productive. Therefore, I argue that the ban on mildronate is, in fact, a crime against human rights. Athletes have the right to be healthy and protect their bodies.

How do you think this scandal could directly affect the popularity of the drug itself? For example, one of my marathon runner friends told me that after mildronate was banned, the first thing he did was run to the pharmacy and buy it. He says that if they prohibit it, then it definitely works!

And he did the right thing! Because it really does work, but not like doping (doping, by definition, is harmful to the body in the long term), but in a completely different way. Mildronate should be prescribed to any athlete who experiences such overloads that can harm the body! Our drug protects, not harms. If I were Sharapova’s sports doctor, I would tell her not to let a single day pass without Mildronate.

“The information reached me is that before mildronate was banned, athletes were monitored to see exactly who had and how much of the drug was in their body. And it was stated that athletes from Russia had the highest concentration. Obviously, it occurred to some people some kind of political decision. I can only assume, of course, that this could be the reason,” says Kalvins.

The professor does not exclude competition among medical drugs - there are a lot of people who want to occupy the Mildronate niche. But at the moment the drug is unique in its kind and it is difficult to find a similar replacement for it. However, the Latvian Institute of Organic Synthesis can boast of a new product.

“We have developed a new molecule that is much more effective than mildronate. About 40 times! This is a new generation of drugs. But, most likely, it will be banned even faster than mildronate!” - the professor laughs.

He hopes that clinical trials of the drug will be conducted this year.

“It will work “on the needle,” as they say. The fact is that, unlike Mildronate, which is taken in a course, this medication works almost instantly. If you administer it in the first two hours after the onset of a heart attack, you can save 40 percent of the myocardium. This drug will be a bomb! But the very biochemical principle of operation of this drug is similar to mildronate,” explains Kalvins.

Who will be responsible for the deaths?

According to Ivars Kalvins, mildronate can be purchased in pharmacies without a prescription if we're talking about about small dosages. For a person of average build, four capsules per day (250 mg) are enough. But for more serious dosages you need a doctor's prescription.

Historically, the drug became widespread precisely in the territory of the former USSR, although it was also used by Western athletes. Does this doping scandal have political overtones?

Now, most likely, I’m talking about the importance of politics in sports. She decides a lot. What resources were expended? Or what profits are made from an athlete winning Olympic gold? You understand what this means. The image of the state again. There are many factors. Of course, that’s why everyone is interested in athletes from their countries winning competitions.

It turns out that mildronate has simply become a bargaining chip in these political games?

Of course it's a shame. Tell me: who will now be responsible for the deaths that will appear among the young people who entered the competition field? No anti-doping committee will take responsibility. They banned the drug, and now people will die. They don’t accept any complaints - they included the drug on the list and that’s it.

The list of prohibited drugs includes, for example, diuretics. But what kind of doping is this - a diuretic substance? However, there is at least some reason there. Diuretics taken before the competition will help you lose a kilogram of water. If you need to jump high, then the meaning is clear. Or there are asthma medications. They are also prohibited, but with a caveat. I won't tell you the names, but I know that some Nordic ski racers always win competitions, and it turns out that they are lifelong asthmatics.

The inventor of mildronate assures that it is not doping and does not improve the results in any way. Why the medicine was blacklisted is anyone's guess.

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Hello friends. I have already written in some of my articles about what meldonium is. But I think it would be worthwhile to better understand that meldonium is a doping, how it works and whether it is true. In this article you can also hear the version of the creator of meldonium himself about why this drug was banned and recognized as doping.

As you and I already know, doping is a technique various drugs, influencing the human body in one way or another (for example, boosters or steroids) in order to increase performance in competitions (mainly in them).

And recently, the World Anti-Doping Agency has recognized meldonium as a prohibited drug. Let's figure out why and how this remedy affects the body.

How does meldonium work?

The creator of the drug, Ivars Kalvins, says that meldonium optimizes the functioning of cells, allowing them to produce more energy while consuming less oxygen. In short, the heart...

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Greetings to everyone who is now reading these lines. Have you ever thought about what doping is? And in general, what meaning do you put into this word? So, today we will talk about what meldonium is and why it is doping. I will try to explain it as simply as possible, so as not to “strain” you with abstruse speeches.

As you probably know, there is a World Anti-Doping Agency called WADA (in English). Every year the list of prohibited substances used in competitions increases.

Relatively recently, it also included meldonium, a drug with certain properties, which I will talk about a little below. By the way, it was found in the possession of Maria Sharapova, a well-known person. That's it, dear athletes.

But first, you still need to understand what doping is in order to understand why meldonium was included in the list of prohibited substances.

What does doping mean?

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The topic of new doping revelations in Russian sports is being actively discussed all over the world. How did it happen that the recently banned meldonium was found in the samples of tennis player Maria Sharapova, speed skater Pavel Kulizhnikov and our other athletes? And why was this drug even blacklisted, even if doctors say: it may be vital.

The creator of meldonium, Riga chemist Ivars Kalvins, never thought that his medicine would become so famous throughout the world in one day. For the third day in a row, Russian and foreign media have been calculating how many millions of dollars tennis player Maria Sharapova, who took this fifty-cent drug, could lose. Maria admitted that traces of the active substance mildronate were found in her doping test, and since January 1 it has been banned for all athletes in the world.

“Mildronate was first registered in 1984, and since then it has been on the market. And it never occurred to anyone to call it unacceptable for use...

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Over the past couple of days, meldonium has become one of the most famous drugs in Russia. Since January 1, 2016, it has officially been on the list of substances that are prohibited for use by the World Anti-Doping Agency. This drug is widely used in Eastern European countries and was first developed by the Latvian professor Ivars Kalvins, who, after a loud scandal, hastened to declare that meldonium does not help improve results, but only preserves the health of athletes.

THE GERMANS ADVISED TO BAN MELDONIUM

For many years, mildronate (another name for meldonium) was not included in the list of prohibited drugs. On the official website of the Russian Anti-Doping Agency, in the “Questions and Answers” section, questions have been asked since approximately 2011 about whether this drug is prohibited. And up until September 30, 2015, the official answer was always “no.” But then everyone began to be warned that from January 1, 2016, meldonium would be officially banned. And him...

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The drug meldonium in sports is one of the most discussed topics in the world and domestic media. This drug, once on the list of substances allowed for athletes, is officially recognized as doping by the World Anti-Doping Agency (WADA). Meanwhile, the majority of domestic scientists and specialists in sports nutrition do not agree with the decision of this organization and consider meldonium a harmless medicine that is not related to physical activity stimulants.

Let's try to figure out what meldonium is, how this drug works, what the benefits and harms of meldonium are, why athletes take it, and why meldonium was recognized as doping. Let's also consider the history of the creation of the drug and find out what its areas of application are.

Meldonium - general information, history of creation

The drug is a metabolic agent known medically as mildronate. The effect of meldonium on the body is stimulating and protective: the substance normalizes the functioning of cells,...

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What exactly is meldonium (trademark “Mildronat”), which has caused so much noise, the use of which can lead to the disqualification of a number of leading Russian athletes, the head of the Latvian Institute of Organic Synthesis, academician Ivars Kalvins, told in an interview with Rosbalt.

Mildronate was developed by you in the 70s, and the time of its creation coincided with the operation in Afghanistan, and only then the drug became a medicine “for the heart” and gained wide popularity, including among athletes, throughout the post-Soviet space. How and for what purposes was it actually originally developed?

Work on the drug lasted about five years. I came up with the molecule in the late 70s, and the first registration officially took place in 1984. The creation of the drug was based on the desire to somehow influence the consequences of negative stress, which provokes various diseases. We were looking for the cause, trying to identify a substance whose resources in the body dry up when...

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"SE" talks about the drug mildronate (trade name meldonium), which in recent months has caused a stir in world sports and led to the suspension of Russian stars - tennis player Maria Sharapova, figure skater Ekaterina Bobrova, short track speed skater Semyon Elistratov and speed skater Pavel Kulizhnikov.

"Mildronat" can be bought at any pharmacy. Photo: twitter.com

Also on the “black” list of those caught using mildronate are runners Abeba Aregawi from Sweden and Ethiopian Endebe Negesse, Ukrainian biathletes Olga Abramova and Artem Tishchenko, Russian cyclist Eduard Vorganov... The World Anti-Doping Agency (WADA) equated meldonium with doping only from January 1, 2016 year. Over the past two months, almost a dozen athletes have been caught on it, with status ranging from strong middle peasants to world sports stars. Not a bad harvest, considering that the positive effect of using meldonium, in principle, has not been proven by modern science.

ANNUAL TURNOVER OF MILDRONATE –
70 MILLION...

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Meldonium: what is it and why is it doping?

Russian athletes used a drug that was only recently included in the list of prohibited drugs. Is it really that dangerous, and does it have any approved analogues?

Meldonium wars. In the wake of the scandal surrounding the drug mildronate, in which Russian athletes were caught en masse, official Moscow asked questions: why meldonium was banned, but its analogues were not; Is this not a conspiracy? and why is WADA silent?

How was the decision to ban made? The USA Today writes that back in 2014, the American Anti-Doping Agency contacted WADA with a request to test meldonium. Allegedly, the agency learned that many athletes from Eastern Europe are taking the drug. WADA checked more than 8 thousand tests of athletes, and meldonium was found in 182 samples, which amounted to 2.2%. And in October last year, the drug Mildronate was banned. Sports Minister Vitaly Mutko believes that there is a policy of double standards. If...

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Vladislav Voronin talked with the creator of the drug, which the best tennis player in Russia took for 10 years.

The drug, which was found in Maria Sharapova’s doping test, can easily be bought in a regular Russian pharmacy. A package with 40 capsules costs about 270 rubles.

The fact is that mildronate was not developed in a secret laboratory for the military or athletes. It was created in 1975 by Professor Ivars Kalvins, now he heads the Department of Medicinal Chemistry at the Latvian Institute of Organic Synthesis (Riga).

First, the Ministry of Defense ordered Mildronate, then the Ministry of Health approved the drug for use. medical use. By 2013, Latvia was selling it for 70 million euros per year, which is about 0.7% of total exports.

In sports, mildronate (or meldonium) is most often used in Russia. Last year, when the drug was not yet banned, it was found in 17% of doping samples of Russian athletes. Among athletes from other countries, the percentage is almost 8 times lower -...

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Meldonium (mildronate): medical use and doping scandal

“Meldonium makes a person more resilient”, “mildronate is prescribed for heart problems”, “meldonium cannot be taken even as prescribed by a doctor - athletes are prohibited” - such statements recently can not only be read on forums and in comments to the news, but also heard on the bus, cafes and parks. It is not surprising - the doping scandal, the basis for which was this same mildronate, covered almost everyone.

What is actually known about mildronate? What does the creator of meldonium insist on?

Contents: What is meldonium: indications for use Opinion of the creator of meldonium Scientists' opinion about meldonium Doping scandal - chronology of events

What is meldonium (mildronate): indications for use

Meldonium (Mildronate) belongs to the group of metabolic agents that are capable of normalizing energetic metabolic processes in cells that have experienced...

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Meldonium: how does this drug work and what is it for? Application in medicine and sports

A number of high-profile sports scandals forced ordinary people to pay attention to meldonium; few people know how this drug works, but experts international organizations agreed that the substance is capable of artificially increasing the performance of athletes. This is precisely the reason for including meldonium in the list of doping drugs prohibited for use by athletes.

History of the creation of meldonium

By and large, meldonium is pure chemistry:

The substance was synthesized in the second half of the century. The birthplace of the drug is the USSR, and specifically the Republic of Latvia. Initial research generally concerned the issues of rocket fuel disposal. After some time, it was discovered that the resulting substance has a positive effect on the growth of animals and plants. It was only in the mid-80s that meldonium began...

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Russian sport is shaking and feverish again. A new wave of doping scandal hit him. Four top Russian athletes were caught using meldonium, which has been included in the list of prohibited drugs since the beginning of 2016. The victims of the new war were Olympic champions Ekaterina Bobrova and Semyon Elistratov, world champion and record holder Pavel Kulizhnikov, as well as the world's most famous Russian athlete Maria Sharapova. All revelations came to light literally within 24 hours. First, Bobrova spoke about the positive test, and then Sharapova admitted it. And somehow all this happened at the right time - just before the consideration of the issue of the participation of Russian athletes in the Olympics and at the same time with a new, still unproven, but well-promoted film about doping on the ARD TV channel.

And I really want to ask the question of the famous TV presenter. Coincidence? Don't think.

Studying the history of meldonium, it seems that the leaders of Russian sports at the same time...

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Meldonium is a metabolic drug that improves metabolism, reduces the load on the heart, improves the condition of blood vessels and, due to this, the condition of the body as a whole. It is not a stimulant,” Mehman Mamedov, professor, head of the laboratory for assessment and correction of cardiovascular risk at the State Research Center, explained to RR. preventive medicine Ministry of Health of Russia.

Meldonium was included in the WADA list only this year, although it was created back in the 70s of the last century. The homeland of meldonium is Latvia, which was then still part of the USSR. Almost immediately, the drug became almost mandatory for all professional athletes of the Soviet (and later the post-Soviet space). Therefore, its ban puts post-Soviet and Western athletes in unequal conditions in the pharmacological war for sporting achievements. And the point is not that meldonium provides advantages in results, but that it is guaranteed not to be found in the samples of athletes who do not...

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Pharmacists are wondering how meldonium, which is essentially a protective drug - helping prevent muscle tears and heart failure - ended up on the banned list.

In the late 70s, in the Latvian laboratory of the Institute of Organic Synthesis of the USSR, scientists could not get enough of it: after a dozen reactions, they finally received a substance that actively helps to normalize the metabolism of cells that had previously suffered hypoxia and ischemia. The medicine for heart disease quickly began to spread throughout Eastern Europe. Today in dozens of countries it is on the list of vitally important products. The scientists who created meldonium are confident that the drug has never been a doping drug.

However, this did not stop the World Anti-Doping Agency from adding the drug to the list of prohibited drugs. Despite the fact that people very often use meldonium specifically for the prevention of cardiovascular diseases under heavy loads. The price is low, available in almost every pharmacy. And they are often released without...

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The doping scandal that occurred in Russian sports, perhaps for the first time, allows us to look at the problem of “pharmacological support for sports” from a new perspective. Usually biochemical mechanism the effects of a prohibited drug are not carefully considered in the media and, as a result, no one tries to understand the benefits and harmful consequences drug. This time the problem was considered a little deeper, so there was an opportunity to help everyone understand the mechanisms of action of Meldonium and its “sports-applied” use.

Let's remember what happened. Since January 1, 2016, meldonium has been included in the list of prohibited drugs. At the beginning of the year, several Russian athletes were tested and by the beginning of March, doping tests of several leading athletes turned out to be positive. Special attention The media was attracted by Maria Sharapova's press conference, at which she admitted that she has been regularly taking meldonium for 10 years to prevent heart problems and prevent signs...

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Perhaps there is no other medical drug today that would cause the same excitement as meldonium. It is sold in pharmacies under the trade name Mildronate.

The world learned about this drug after Russian athletes were accused of doping. The latter was meldonium.

Invented in 1979 by the Institute of Organic Synthesis at the Academy of Sciences of the Latvian SSR to medical use Mildronate was approved in the country only in 1984. Before this, as various medical sources, it was used in agriculture to accelerate the growth of livestock and poultry. The inventor of meldonium, Professor Ivars Kalvins, and his colleagues conducted a series of clinical trials drug and came to the conclusion that it is the best way to maintain the heart muscle in those who are in pre-infarction state or have already had a heart attack. Meldonium improves the energy supply to heart cells, thereby significantly increasing the endurance of the heart muscle, which is very weak in heart attack survivors. Along the way, it turned out that the drug blocks the release of harmful enzymes in the body, improves the flow of various processes beneficial to the body, for example, peripheral circulation in people with chronic heart failure.

Such properties of the drug could not fail to be noticed by those who worked on creating miraculous remedies that increase endurance and intelligence. Therefore, further tests were carried out on athletes and military personnel. Mildronate immediately took root in sports. Doctors prescribed it to athletes to maintain the heart muscle under unimaginable overloads. The drug began to be used almost uncontrollably and constantly.

The doping scandal for pharmaceutical companies producing Mildronate has become... finest hour. They could not have imagined such a demand for the drug in their wildest dreams. Overnight, everyone wanted not only to support their heart (which was often not required at all), but to have increased performance and incredible endurance.

Doctor of Medical Sciences, Professor Sergei Tereshchenko is categorically against the use of mildronate without good reason. In his opinion, today there are no full-scale clinical trials confirming the effect of meldonium that is talked about so much. In any case, the professor believes, a healthy person, not an athlete, should artificially interfere with normal work heart, violating the rhythm established by nature is strictly contraindicated. Constant overload can weaken any organ, including the heart muscle.

Doctor of Medical Sciences, Professor Alexey Gorbunov and his students scientifically proved the negative effect of meldonium on the body healthy person. The fact is that mildronate reduces the synthesis of carnitine (it is in our body that is responsible for burning fat). IN normal conditions The heart muscle, or rather its cells, produces energy from fatty acids and glucose in a ratio of seven to three. Reducing carnitine changes this proportion. Heart cells begin to produce energy mainly from glucose. Cell metabolism is rebuilt, and heart cells are supplied with energy first. In the language of science, this means that the body switches from the lipolytic pathway of tissue metabolism to the glycolytic one, which for a healthy person is less in an efficient way obtaining energy. In general, the body's energy metabolism is disrupted.

The main disadvantage of this disorder is the decrease in carnitine, which acts on heart cells as an antioxidant and protects mitochondria from dysfunction. When the latter occurs, ATP synthesis slows down or completely stops, which can lead to cell death.

French professor Jean-Pter de Mondenard, based on the protocols of the Institute of Biochemistry in Cologne, conducted his own study of the effect of meldonium on human body. He concluded that the use of mildronate leads to a huge increase in the circulation of oxygen in the blood. For patients, this is relief, help for the heart muscle, and for healthy people, it is an instant acceleration of metabolism, an increase in oxygen absorption (up to 67 percent!), which, in fact, is doping.

– What is salvation for the sick, for the healthy, as a rule, has reverse effect, says the professor.

In addition, mildronate has an addictive effect. This is not a condition when the body, not receiving drugs, begins to “break down”. But a change from one tissue metabolism to another leads to drowsiness, apathy, and loss of strength. It is no coincidence that even patients are prescribed a strictly limited time for consuming this drug.

Meldonium (mildronate), banned since the beginning of the year, is used to increase productivity. Therefore, this drug was included in the list of prohibited substances for athletes, explained the press service of the World Anti-Doping Agency (WADA).

Meldonium (mildronate) was included in the list of prohibited substances by the World Anti-Doping Agency on January 1, 2016. The substance belongs to class S4 of the World Anti-Doping Agency prohibited list (hormones and metabolic modulators). WADA added mildronate to the list of prohibited drugs after a request from the United States Anti-Doping Agency (USADA), which received information from a confidential source about the use of this substance by athletes from Eastern Europe to improve their physical abilities. According to WADA, since the beginning of the year this substance has been detected in the blood of more than 60 athletes. To date, the names of 12 athletes convicted of using meldonium have been officially announced. Among them are eight Russians: biathlete Eduard Latypov, cyclist Eduard Vorganov, figure skater Ekaterina Bobrova, tennis player Maria Sharapova, speed skater Pavel Kulizhnikov, short track racers Semyon Elistratov and Ekaterina Konstantinova, volleyball player Alexander Markin. Samples from the 2013 world champion in the 1500 meter run, Swede, also tested positive for meldonium. Ababa Aregawi, Georgian freestyle wrestler David Modzmanashvili, Ukrainian biathletes Olga Abramova and Artem Tishchenko.

Mildronate is used in sports to increase the body's endurance to high physical stress during training and to high neuropsychic stress during competition. In the CIS countries, the drug is used to prevent heart disease.

Creator of the drug Ivars Kalvins said that about 2 million people, including athletes, annually use meldonium as a drug, although it is not doping. Kalvins also called the ban on meldonium a violation of human rights.

Moscow, Zoya Berezina

Moscow. Other news 03.15.16

Meldonium is a medication that regulates metabolic processes at the level of energy functions of cells. The key effect of meldonium on the body is to increase the survival of tissue cells in many disorders of the heart and brain against the background of ischemia (blood supply disorder) and hypoxia (oxygen starvation).

The substance was developed in 1975 by Soviet professor Ivar Kalvins (currently head of the department of medicinal chemistry at the Riga Latvian Institute). Since 2012, in Russia the pharmacological product has been included in the list of vital drugs.

During therapy, the drug substance:

supports heart and brain cells with unsatisfactory blood supply and deficiency of incoming oxygen, preventing their death;
prevents the development of ischemia (decreased blood supply) of the heart muscle and brain,
in case of an existing blood supply disorder, activates blood circulation in the area with affected cells;
reduces the frequency of attacks in patients with angina pectoris;
increases susceptibility to intense physical and intellectual activity during sports activities, preparation for exams;
prevents exhaustion of the nervous system;
increases immune resistance;
activates blood circulation in the vessels of the retina of the visual organs.

Application in sports

Meldonium is in no way a doping drug, and when sports activities It is used only as a means of protecting myocardial cells against the background of high-intensity work. With a rapid heartbeat during sports activities, oxygen starvation develops, which can lead to ischemia of the heart muscle. And the pharmaceutical product acts preventively, helping to restore strength between workouts and increase the organ’s resistance to overload.

During competitions this pharmacological agent will not increase the speed, muscle strength and endurance of the athlete himself, but will only reduce the risk of heart attack and stroke. That is, the therapeutic effect of the drug will manifest itself in better tolerance of training and a calmer reaction of the heart and brain to the intense rhythm of activity.

For diabetes

Today, the effect of meldonium on the processes occurring in the body during diabetes is being actively studied. Medical tests have shown that the substance inhibits the growth of glucose levels without increasing the level of insulin or lactic acid in the blood, and prevents loss of sensitivity.

The combination of meldonium and metformin, firstly, enhances the therapeutic effect of both drugs, and secondly, removes such side effect, as acidosis (increased acidity in the body) that occurs with long-term use of metformin, thirdly, contributes to a more pronounced weight loss effect in patients prone to weight gain.

Indications for use

In conditions of physical, emotional stress with cardiovascular and cerebral pathologies, intensive physical stress in athletes, Meldonium is able to redistribute blood flow to areas experiencing the greatest oxygen deficiency, reduce the concentration of toxins during metabolic processes, protecting the structure of cells that quickly compensate for energy losses from destruction. An assessment of the pharmacological activity of the drug showed it beneficial influence in the treatment of cardiac ischemia, disorders of the blood supply to cerebral tissues and their consequences. In people with these pathologies and myocardial insufficiency, the medicine is used to improve metabolic and energy processes in the cells of the heart muscle.

Due to its therapeutic properties, Meldonium is widely used together with other medications in the treatment of many pathological conditions:

1. Angina pectoris, heart attack, pre-infarction and post-infarction condition, dishormonal cardiomyopathy (impaired cardiac muscle function due to hormonal deficiency), chronic ischemia myocardium, congestive heart failure.

The action of the pharmaceutical product consists of the following effects:

the heart muscle tolerates stress more easily due to an increase in the strength of myocardial contractions and the volume of cardiac output;
the organ’s resistance to aggressive external factors increases;
at acute heart attack the medicine inhibits cell death, reducing foci of necrosis (death of tissue) due to increased blood circulation in the affected area;
the frequency of angina attacks decreases;
spread slows down pathological processes in the tissues of the heart, the transition of the disease to a severe form is delayed;
is declining recovery period after acute conditions.

2. Cerebrovascular (cerebrovascular) insufficiency, ischemic stroke.

The drug reduces the severity of such vascular syndromes as:

weakness, increased fatigue;
attacks of headache, fainting;
decreased mental performance;
neurological and emotional disorders, including panic attacks, depressive states;
movement disorders (unsteadiness of gait) and epileptic seizures;
memory impairment, attacks of dizziness (often with nausea);
hearing loss, tinnitus;
“blurred” vision, the appearance of spots, threads and “floaters” before the eyes;
vascular dementia ( intellectual disorders) against the background of vascular ischemia.

3. Discirculatory encephalopathy - damage to brain tissue as a result of slowly increasing circulatory disorders.

4. Myocardial dystrophy (myocardial dysfunction not associated with inflammatory and degenerative processes), including the teenage form.

5. Peripheral vascular diseases, thrombophlebitis, thrombosis.

6. Bronchial asthma.

7. High fatigue, physical, nervous and mental overload.

8. Neurological disorders due to exhaustion of the nervous system.

9. Reduced performance, general exhaustion of the body.

10. The period after serious illnesses and operations to speed up recovery.

11. Abstinence syndrome (“withdrawal syndrome”) in alcoholism and drug withdrawal. Meldonium helps relieve acute neurological disorders, improves intracellular metabolism, increases overall tone, and reduces the risks of pathological events such as heart attack and stroke.

12. Vascular disorders in the retina of the eye, including damage due to diabetes, hypertension, dystrophic pathologies, hemophthalmos (blood entering the vitreous with rupture of blood vessels), vein thrombosis, hemorrhages in the vitreous body, retina.

It should be clearly understood that the medication is most effective in preventing exacerbation of the above conditions, and in the treatment of diseases that are in acute stage, it is used only as an aid.

Release forms

There are two medicinal forms of Meldonium - capsules and injection solution for injection into a muscle, vein or steam - retrobulbar (into the tissue around the eye).

1 ml of solution contains 100 mg of meldonium, so a 5 ml ampoule contains 500 mg of the medicinal substance. One package contains 5 or 10 ampoules.

One capsule may contain 250 or 500 mg of the active ingredient. Each blister contains 10 capsules. One package usually contains blisters with total number capsules 30 or 60 pieces.

Pharmacological action

Meldonium is a structural analogue of the enzyme gamma-butyrobetaine, which is present in cells.

Thanks to this enzyme, the concentration of carnitine in the body decreases and the process of transporting fatty acids into myocardial cells slows down.

This delay is especially important during oxygen deficiency. With the normal supply of fats to the heart tissue and a lack of oxygen, fatty acids are not completely oxidized. At the same time toxic by-products metabolism accumulate, poison the heart tissue and block the delivery of ATP acid molecules to the cells - the main supplier of energy for all important processes.

By blocking fat metabolism, meldonium activates carbohydrate metabolism, during which more intensive formation of ATP molecules occurs and there is a lower need for oxygen, which allows cells to survive under oxygen starvation. At the same time, gamma-butyrobetaine has a relaxing and dilating effect on the blood vessels of the heart, brain and peripheral veins and arteries.

Meldonium: instructions for use

Features of application:

The drug has a tonic effect on nervous system, therefore, due to the slight stimulating effect, it is best to use the medicine before 15 hours. When prescribing a three-time dose, it is optimal to take the last dose, if possible, before 17:00, so as not to disturb night sleep.
Capsules are swallowed whole before or after meals with an average volume of water.
Doses, frequency and duration of use are determined only by the doctor, taking into account the specific disease and in accordance with the instructions for use of the medicine.
The average dose most often prescribed for chronic processes: Meldonium tablets are taken 2 capsules 250 mg 2 - 4 times a day, 500 mg 1 - 2 times. At injection solution - 1 - 2 ampoules once (0.5 - 1 gram) or 1 ampoule - twice a day
The standard duration of therapy is up to 14–20 days with the possibility of repeating the course at a similar interval.

Standard doses for certain types of pathologies

Angina pectoris in a stable form, chronic myocardial dysfunction: in capsules - 250 mg three times a day (the first 4 days), then for 30 - 60 days the medicine is taken in the same dose, but only twice a week.

In case of a heart attack, unstable angina The mode of application differs in that in the first 3–4 days, 1–2 ampoules are injected once a day (intramuscular or intravenous).

Acute cerebrovascular accident: 1 intravenous injection (1 ampoule) is given once a day for 10 days, then capsules are taken for 20–30 days (500–1000 mg per day).

In case of a chronic process, an intramuscular injection (500 mg) is given once a day or 250 mg tablets are taken three times a day (3 - 4 weeks).

Withdrawal syndrome: in capsules - 4 times 500 mg, in severe cases, intravenous injections of 500 mg are required twice a day (up to 10 days). The condition of the kidneys and liver requires special attention.

Vascular and dystrophic pathologies of the eye: exclusively in injections of 0.5 ml of solution for 10 days.

Side effects and contraindications

The drug is prohibited:

if the patient is under 16 years of age, if a woman is breastfeeding a baby breast milk or is expecting the birth of a child (due to lack of research);
with increased intracranial pressure;
when there is a violation of the outflow of blood through the veins;
when diagnosing intracranial neoplasms;
if the patient has increased intolerance to meldonium.

For chronic kidney and liver pathologies, the drug is prescribed with caution and with regular monitoring of urine and blood tests.

Adverse reactions, when dosages are observed, do not appear often, but the main ones include:

overexcitement, drop or increase in blood pressure,
increased heart rate;
weakness, headache, dizziness;
discomfort in the stomach, belching, diarrhea, gas formation.

Very rare allergic reactions in the form of rashes, skin itching, bronchospasm or Quincke's edema. In the blood against the background of allergies, eosinophilia can be detected - an increase in eosinophils.

Analogs

Full synonyms of Meldonium, that is, drugs with the same active substance and the same therapeutic effect: Mildronate, Angiocardil, Vasomag, Idrinol, Cardionat, Midolat, Mildrocard (in Belarus), Melfor, Medatern, Mildrakor (in Ukraine).

Analogues of Meldonium are medications with a similar or partial therapeutic effect, but with other active ingredients: Metamax, Riboxin, Vasonat, Cephasel, Angiosil, Mexicor.

Why meldonium is banned - doping scandal

Meldonium was added to Class S4 of the WADA Prohibited List as a hormone and metabolic modulator in January 2016. According to WADA, this drug, similar to insulin, modulates metabolic processes and improves the performance of athletes in competitions. Therefore, it was forbidden to take it before and during competitions.

The creator of the drug, biochemist Ivars Kalvins, and other experts believe that in fact, research has not proven that meldonium is capable of increasing the strength, speed or endurance of an athlete during competitions. It only protects the heart and brain of the athlete during overload and accelerates the restoration of cellular structures.

This means that there are no real medical grounds for including meldonium in the list of doping products; its ban is illegal and will only lead to increased mortality and disability among athletes.

Drug combinations

Can be used in parallel with medications against arrhythmia and angina pectoris, blood thinning medications, antiplatelet agents, diuretics, and bronchodilators. Caution when combined with drugs that lower blood pressure, cardiac glycosides, nitroglycerin, Nifedipine, alpha-blockers, drugs that dilate blood vessels of the heart and brain.