Meldonium isn’t a drug you’ll find on your local pharmacy shelf. It’s not a common painkiller or vitamin. But if you’ve followed sports news over the last decade, you’ve probably heard of it-especially after high-profile athletes like Maria Sharapova tested positive for it in 2016. Meldonium, sold under the brand name Mildronate, was originally developed in Latvia in the 1970s to treat heart conditions. Today, it’s best known for being banned by the World Anti-Doping Agency (WADA), but its story is more complex than just a doping scandal.
What Meldonium Actually Does in the Body
Meldonium works by blocking the enzyme gamma-butyrobetaine hydroxylase. This sounds technical, but here’s what it means in simple terms: it changes how your body produces energy under stress. Normally, your muscles use carnitine to transport fatty acids into mitochondria-the energy factories inside your cells. When oxygen is low, like during intense exercise or heart strain, the body shifts to burning more fat, which requires more oxygen. That’s a problem when you’re already struggling for air.
Meldonium steps in and slows down that fat-burning process. Instead, your body switches to burning glucose, which needs less oxygen to produce energy. This helps protect cells from damage during oxygen shortages. That’s why doctors originally prescribed it for patients with ischemia, angina, or after heart attacks. It doesn’t make you stronger. It helps your body survive harder physical demands without breaking down.
Why Athletes Started Using It
By the early 2010s, athletes in Eastern Europe-especially in countries like Russia, Latvia, and Ukraine-began using Meldonium outside of medical use. They weren’t taking it for heart problems. They were taking it to recover faster, train longer, and feel less fatigued. Studies showed it improved endurance in healthy people under physical stress. One 2013 study in the Journal of the International Society of Sports Nutrition found that healthy volunteers who took Meldonium for four weeks improved their time to exhaustion during treadmill tests by nearly 10%.
It wasn’t just endurance athletes. Footballers, cyclists, and even weightlifters reported better recovery between sessions. Coaches in Soviet-era sports programs had long used metabolic modulators, and Meldonium fit right in. It wasn’t on any banned list. It wasn’t even widely known outside medical circles. Until it was.
The WADA Ban: Why and When
On January 1, 2016, WADA officially added Meldonium to its list of prohibited substances. The decision wasn’t made lightly. WADA reviewed over 300 scientific papers and analyzed thousands of athlete samples. They found evidence that Meldonium was being used to enhance performance-not just treat illness. Athletes were taking it to push harder, recover faster, and delay muscle damage. In some cases, they were using doses far higher than those prescribed for heart patients.
The agency also noted that Meldonium’s effects were most noticeable in the first few weeks of use. That’s a classic sign of a performance-enhancing drug: it gives a boost when you need it most, then tapers off. Unlike steroids, which build muscle over months, Meldonium works quickly and subtly. That made it harder to detect and easier to hide.
By late 2015, over 170 athletes had tested positive for Meldonium in the previous 12 months. Many claimed they didn’t know it was banned. Some said they’d stopped taking it months before the test. WADA didn’t care. Once it’s on the list, ignorance isn’t an excuse.
Side Effects and Health Risks
For people taking Meldonium as prescribed-usually 500 mg to 1,000 mg daily for a few weeks-the side effects are mild. Some report headaches, dizziness, or increased heart rate. Others feel more alert or anxious. These are usually temporary.
But when athletes take it in higher doses, for longer periods, or combine it with other stimulants, the risks go up. There are reports of elevated blood pressure, irregular heartbeat, and even cases of liver enzyme spikes. Long-term safety data doesn’t exist for healthy adults using it for performance. No major clinical trials have been done on that population. That’s the problem: it’s being used like a supplement, but it’s a prescription drug with untested long-term effects.
Who Still Uses Meldonium Today?
Legally, Meldonium is still available in some countries-for medical use. It’s approved in Russia, Ukraine, Latvia, Belarus, and several other former Soviet states. You can buy it over the counter in pharmacies in places like Russia without a prescription. That’s partly why it became so popular in sports: it was easy to get, cheap, and not seen as dangerous.
But since the ban, its use in elite sports has dropped sharply. Most professional organizations now test for it routinely. The few athletes who still test positive are usually from countries where awareness is low, or where the drug is still marketed as a “recovery aid.” Some amateur athletes, especially in endurance sports like triathlons and long-distance running, still use it illegally. They believe the risk of getting caught is low.
The Controversy: Was the Ban Fair?
The Meldonium ban sparked heated debate. Critics said it was unfair to ban a drug that was widely used for years without being flagged. Some athletes had been taking it for a decade. Others argued that WADA waited too long to act, letting the drug become mainstream before suddenly outlawing it.
WADA responded by saying they had been monitoring its use for years. They saw a sharp rise in positive tests after 2012. They gave a six-month grace period after announcing the ban-longer than usual-to let people stop using it. But for many, that wasn’t enough. Maria Sharapova claimed she’d been taking it since 2006 for health reasons and didn’t realize it was banned. She was suspended for 15 months, later reduced to 15 months after appeal.
The real issue? Meldonium sits in a gray zone. It’s not a steroid. It doesn’t build muscle. It doesn’t increase testosterone. It just helps your body handle stress better. That’s why it’s hard to define. Is it doping? Or is it just smart physiology?
What Happens If You Test Positive Now?
Today, Meldonium is still on WADA’s prohibited list. It’s classified as a “metabolic modulator” under category S4. If you’re an athlete subject to anti-doping rules, testing positive means a ban. The standard penalty is four years for a first offense. Reduced bans are possible only if you can prove you took it before the ban and stopped immediately.
There’s one exception: if you have a documented medical need and get a Therapeutic Use Exemption (TUE) before using it. But getting a TUE for Meldonium is nearly impossible unless you have a confirmed heart condition. Even then, most sports federations are skeptical.
Alternatives to Meldonium
If you’re looking to improve endurance or recovery legally, there are safer, proven options. Creatine monohydrate is backed by over 500 studies and improves strength and recovery. Beta-alanine reduces muscle fatigue during high-intensity efforts. Beetroot juice boosts nitric oxide, improving oxygen delivery. Even proper sleep and hydration have more scientific backing than Meldonium ever did.
There’s also no evidence that Meldonium works better than these alternatives. In fact, most of them have fewer side effects and are legal everywhere.
Final Thoughts: Is Meldonium Worth the Risk?
Meldonium might help you push harder. But it’s not magic. It doesn’t replace training, nutrition, or rest. And the consequences of getting caught are severe: bans, lost sponsorships, damaged reputations. Even if you’re not a pro athlete, if you compete in any organized sport-even a local race-you’re still subject to testing.
The bigger question is why people turn to drugs like this in the first place. Pressure to perform. Fear of falling behind. Belief that everyone else is doing it. Meldonium isn’t the problem. The culture that pushes athletes to seek shortcuts is.
There’s no shortcut to real performance. Only hard work, smart training, and patience. Meldonium might give you a temporary edge. But it can’t give you the discipline, resilience, or long-term health that real champions build.
Is Meldonium legal for medical use today?
Yes, Meldonium is still legally prescribed in countries like Russia, Ukraine, Latvia, and Belarus for heart conditions such as ischemia and angina. In these countries, it’s often sold over the counter without a prescription. However, it is banned for athletic use worldwide under WADA rules.
How long does Meldonium stay in your system?
Meldonium can remain detectable in urine for weeks or even months after last use. Studies show it has a long half-life-up to 24 hours-and can be detected for up to 90 days in some cases. This is why athletes who stopped taking it months before a test still tested positive after the 2016 ban.
Can you buy Meldonium in the United States?
No, Meldonium is not approved by the FDA and is not legally sold in the United States. Any products marketed as Meldonium in the U.S. are sold illegally, often online as dietary supplements. These products are unregulated and may contain incorrect dosages or harmful contaminants.
Does Meldonium help with weight loss?
There’s no solid evidence that Meldonium causes weight loss. Some users report feeling more energetic and working out longer, which might lead to burning more calories. But the drug itself doesn’t burn fat or suppress appetite. Any weight loss is indirect and unreliable.
Why was Meldonium banned but not other similar drugs?
WADA doesn’t ban drugs just because they improve performance. They ban them when there’s clear evidence of misuse in sports, potential health risks, and violation of the spirit of sport. Meldonium was banned because it was widely used by athletes, had measurable performance benefits, and was being taken without medical supervision. Other drugs may have similar effects but aren’t as commonly abused or detected.