Meldonium landed in headlines in 2016 when a string of elite athletes tested positive for it, and the questions came fast. What is this drug? Does it actually make anyone faster? And is it dangerous to take when your heart is perfectly healthy? The science behind those questions matters far beyond the world of competitive sport, because the same pattern shows up every day in ordinary life: someone reaches for a medication that was never meant for them, hoping it will give them an edge, and assumes that a drug used safely by patients must be safe for everyone.
What Is Meldonium?
Meldonium, sold under the trade name Mildronate, is a heart medication developed in 1970 by Latvian chemist Ivars Kalvins at the Institute of Organic Synthesis in Riga. It’s prescribed mainly in Russia, the Baltics, and other parts of the former Soviet Union, where doctors use it to treat ischemia, a shortage of blood and oxygen to the heart muscle that’s usually caused by narrowed or blocked coronary arteries. The drug isn’t approved by the U.S. Food and Drug Administration, so it isn’t legally sold or prescribed in the United States.
Its mechanism is more specific than the old marketing suggested. Meldonium blocks an enzyme called gamma-butyrobetaine hydroxylase, which lowers the body’s production of carnitine. With less carnitine available, the heart shifts how it makes energy, moving away from burning fatty acids and toward burning glucose, a process that needs less oxygen to run. According to a 2016 review in the Journal of Sport and Health Science, that metabolic shift is what makes the drug useful for patients whose hearts are starved of oxygen.
Why Did Athletes Start Using Meldonium?
The World Anti-Doping Agency added meldonium to its list of prohibited substances effective January 1, 2016. Within months, positive tests piled up across biathlon, cycling, figure skating, and wrestling. The 2016 Journal of Sport and Health Science review counted 182 positive findings out of 8,320 random urine samples in the period right after the ban. A large share involved athletes from Eastern Europe, which tracks with where the drug is sold and used.
The most recognizable name was tennis player Maria Sharapova, who announced on March 7, 2016, that she had failed a drug test. She said she’d been taking meldonium for about a decade for various health concerns and hadn’t realized it had been added to the banned list. Her case put a drug almost no one in the West had heard of on front pages worldwide.
The appeal to athletes is easy to understand on paper. A drug that helps an oxygen-starved heart work more efficiently sounds like it should boost endurance and speed recovery between hard efforts. That’s the theory athletes were chasing.
Does Meldonium Actually Improve Performance?
Here’s where the story gets complicated. The evidence that meldonium makes a healthy athlete faster is weak. The 2016 Journal of Sport and Health Science review concluded plainly that “there is no compelling evidence that it may be effective in improving athletic performance, nor that its administration may be safe in healthy subjects.” The benefits that show up in cardiac patients, whose hearts are working under a real oxygen deficit, don’t clearly transfer to a young, well-trained body that has no such shortage.
So the picture is murkier than “wonder drug.” WADA banned meldonium, but the ban rests as much on principle and the unknowns of misuse as on proof of a performance edge.
Is Meldonium Dangerous?
The honest answer is that nobody fully knows, and that uncertainty is the real risk. In cardiac patients under medical supervision, meldonium is considered relatively safe, with reported side effects in fewer than 15% of users. But the same 2016 review documented serious complications in clinical settings, including diarrhea, anemia, and fatigue, and the authors explicitly warned against healthy athletes using it. No agency has studied what repeated, unsupervised, off-label use does to a healthy person over time, which means anyone taking it is running an experiment on themselves with no data and no doctor watching.
That gap in knowledge is exactly why off-label drug use is risky, whether the substance is a heart medication, a stimulant prescribed for someone else, or a sedative bought to take the edge off. A drug that’s safe under a doctor’s care can behave very differently when it’s taken to chase a result it was never designed to produce.
When Substance Use Points to Something Deeper
The meldonium story is about elite sport, but the impulse behind it is familiar to a lot of families. People reach for substances to perform, to cope, to keep up, or to quiet something that won’t settle on its own. Sometimes that pressure is tied to anxiety, depression, trauma, or another mental health condition that’s been driving the behavior all along. When substance use and a mental health condition show up together, treating only one of them tends to leave the other in place.
At Destination Hope in Fort Lauderdale, the work starts with the whole person. Our psychiatrist-led team treats primary mental health conditions and, when substance use is also part of the picture, addresses both together through dual diagnosis care. That means a real evaluation, medication management when it’s needed, and evidence-based therapy aimed at the root of what’s going on rather than the symptom on the surface. For someone whose drinking or drug use has grown alongside an untreated mental illness, addiction treatment that runs in parallel with psychiatric care gives the recovery a foundation to stand on.
If you’re worried about yourself or someone you love, you don’t have to sort out the diagnosis before you reach out. Call Destination Hope at (954) 302-4269 to talk with our team, or learn what the first step looks like on our admissions page. We’ve seen this before, and we can help.
Crisis and Emergency Resources
If you or someone you know is in a substance use or mental health crisis, help is available now. Contact the SAMHSA National Helpline at 1-800-662-HELP (4357) for free, confidential treatment referrals 24/7. Reach the 988 Suicide and Crisis Lifeline by calling or texting 988. The Crisis Text Line is available by texting HOME to 741741. For emergencies, call 911.
