Trimetazidine can cause harm without anyone noticing. Are stimulants a blessing or a curse?

This is the 3796th article of Da Yi Xiao Hu

The Beijing Winter Olympics, from opening to closing, was undoubtedly a thrilling visual feast, but the Russian Olympic team was caught up in a doping scandal because a urine sample tested positive for doping. The drug involved was actually a drug for cardiovascular disease, trimetazidine, which is a common drug for ordinary people. How could it be a banned drug?

The 2022 Hangzhou Asian Games is just around the corner, so the editor decided to introduce everyone to stimulants.

First of all, what is trimetazidine?

Trimetazidine is a drug used to treat patients with myocardial ischemia with the goal of improving the patient's energy metabolism efficiency.

In 2013, the drug was not included in the banned list. After it was included in the banned list in 2014, it was classified as "S6. Stimulants", which means it is a drug banned in competition. In 2015, trimetazidine was classified as "S4. Hormones and metabolic regulators", which means it is a drug banned at all times. In the latest anti-doping list published in 2022, trimetazidine is directly classified as "hormones and metabolic regulators".

So what are stimulants?

The English word for stimulant is “Dope”, which originally means “an opium anesthetic mixture used for horse racing.”

The stimulants we are talking about now usually refer to stimulants in sports, which are drugs that can act on human functions and help athletes improve their performance. It does not refer to drugs that cause excitement alone, but is a general term for banned drugs.

The stimulant catalogue released by my country in 2022 contains a total of 367 varieties. The following is the classification and hazards of commonly used stimulants:

Stimulants

1

Anabolic steroids

It can increase muscle growth, strength and endurance. It includes methandrone (Methandrostenolone), nandrolone, stanozolol, etc.

Hazards: Long-term use can cause enlarged breasts and infertility in men, increased body hair and even menopause in women. It may also induce high blood pressure, coronary heart disease, myocardial infarction, cerebral hemorrhage, etc.

2

β2-agonists

Improve the stability and coordination of movements. Including salbutamol (commonly used to treat asthma), etc.

Hazards: May cause skeletal muscle concussion, resulting in hypokalemia, heart rhythm disorders, etc.

3

Peptide hormones

It can significantly improve a person's aerobic fitness. Such as human growth hormone (hGH), insulin, erythropoiesis (EPO), gonadotropin, etc. Its efficacy is similar to blood transfusion technology (also banned).

Hazards: Long-term use can lead to liver and heart failure, and can also induce diabetes. Excessive use may cause cardiovascular sclerosis, venous thrombosis, myocardial infarction or cerebral infarction.

4

Anesthetic sedatives

It has a strong analgesic effect. It includes opioid alkaloids such as morphine, codeine, and pethidine.

Hazards: Can cause breathing difficulties, drug dependence, and frequent use can lead to addiction.

5

(Psycho) stimulants

Reduce fatigue and increase aggression. Including amphetamine, caffeine, ephedrine (often contained in various cold medicines), nikethamide (respiratory stimulant), strychnine (an alkaloid extracted from strychnine, 10 mg can be lethal, contained in various Chinese medicines for external use), etc.

Hazards: Long-term use may cause restlessness, insomnia, arrhythmia, paranoia and hallucinations, and may also cause cerebral hemorrhage.

6

Diuretics

Rapid weight loss to avoid doping control, such as furosemide, spironolactone, etc.

Hazards: Excessive use may cause hypokalemia, leading to fatigue, weakness, cramps, paralysis and even muscle necrosis, easily causing severe dehydration and even renal failure.

7

Beta-blockers

Reduce anxiety and agitation. Such as propranolol, metoprolol, etc.

Hazards: Sudden discontinuation of medication after long-term use can cause tachycardia, myocardial infarction, and even sudden death.

8

Hormone and metabolic regulators

Regulate the body's metabolic function. Metabolic regulators (such as trimetazidine), anti-estrogen drugs (such as clomiphene, tamoxifen) and glucocorticoid drugs (such as budesonide, dexamethasone, prednisone), etc.

Hazards: Long-term use can lead to low immunity, movement disorders, hot flashes, fluid retention, etc.

Although the use of stimulants by athletes can improve their performance, it may also cause serious damage to the body, so we do not recommend their use.

If professional athletes want to improve their athletic endurance, or need to use drugs to help the body repair after training, etc., we can choose the following safer and more reliable drugs to replace the use of stimulants according to the specific situation and needs.

1

Vitamin C

Prevent infection, scurvy and fatigue, quickly stimulate the body during intense, short exercise, and prevent vitamin loss.

2

Multivitamins

Treat fatigue, prevent vitamin deficiency caused by unbalanced diet, and prevent the loss of vitamins (A, B, D, PP) during long-term exercise or training.

3

Creatine Phosphate

Creatine is an amino acid that can improve muscle strength and is best used in combination with a protein anabolic hormone.

4

Creatine Phosphate

Compensate for muscles damaged during intense competition.

5

Glucose, fructose

Treats hypoglycemia. Restores energy faster than food.

6

Anticoagulants

Avoid erythropoietin, which thickens the blood.

7

Magnesium + Iron + Vitamin B12 + Folic Acid

It can improve the efficiency of red blood cells and enhance muscle function.

References:

[1] Li Xiaoyuan. Safety and efficacy of trimetazidine combined with diltiazem in the treatment of patients with angina pectoris[J]. China Medical Guide, 2022, 20(04): 68-70.

[2] Yu Jian. Review and reflection on the history of my country's anti-doping struggle[J]. Chinese Journal of Drug Abuse Prevention and Treatment, 2021, 27(06): 811-813+833.

[3] 2022 Doping List Announcement_General Administration of Sport of China (sport.gov.cn)

The First Affiliated Hospital of Zhejiang Chinese Medical University

Xie Xianze|Written

Wang Jianping | Audit