esanum: Why is trimetazidine on this red list?
Dr. Jean-Pierre de Mondenard: That's what I would like to know. I have asked the WADA, which issues this list. I did not get an answer. There are no studies showing that this substance has any doping effect. When in July 2020 Khadjiev went before the disciplinary chamber of the International Wrestling Federation - which expelled him - his lawyer asked WADA to produce scientific proof of the doping nature of trimetazidine. WADA provided a 2014 Polish study2 showing that it was possible to find the substance in the urine of volleyball players. This put the effectiveness of the laboratory into question, but said absolutely nothing on whether trimetazidine improves performance.
The only other study available is the results of the tests carried out in Sochi during the 2014 Winter Olympics: out of 2,134 urine and 479 blood tests, trimetazidine was found only once. I would point out that trimetazidine does not mask the doping effect of another substance either, in which case it would appear in a specific paragraph of the list of illegal products.
The World Anti-Doping Code, which is enforced by WADA, has set three criteria for a product to be on this red list. It must enhance performance, which in this case there is no evidence of. It must present a proven or potential health risk, which is the case for any drug. Finally, it must be "contrary to the spirit of sport", therefore taken with the intention of improving results. Even a placebo can meet this last criterion. These three conditions raise questions.
When it was placed on the Red List in 2014, WADA explained that trimetazidine was one of the "emerging modalities of doping". We are talking about a substance that has been on the market since 1964... In fact, when a substance that is authorised but diverted from its therapeutic indications appears to be more widely used by athletes, WADA can put it "under surveillance". For example, if it is found more and more often during testing. This is often the first step before it is put on the red list. Trimetazidine has never been placed under surveillance.
In 2014, trimetazidine was first classified as a "specific stimulant" and therefore prohibited only in competition. In the event of a test, the sanction could be reduced or even cancelled if the athlete in question showed that he or she had not taken it to improve his or her performance. But in 2015, without any supporting scientific studies, trimetazidine was reclassified in the category of "non-specified metabolic and hormonal modulators", because of its supposed action on cardiac metabolism. As a consequence, it is now prohibited even out of competition. At the first offence, the athlete is banned for four years.
Why this red list classification in 2014 and this change of category in 2015? It is a mystery, and in the absence of an explanation, we can only hypothesise that trimetazidine was banned because of its similarity to another substance without any scientific work validating this change of category.
I am not alone in questioning the presence of trimetazidine on the red list. Pascal Kintz is professor of toxicology at the University of Strasbourg (France). He is a leading expert and a judicial expert at the Court of Cassation (esanum’s note: In France, the “Cour de Cassation” is the highest court in the French judiciary). In the editorial note3 of the latest edition of the French scientific journal Toxicologie analytique et Clinique, he describes the mechanism of action of trimetazidine as "not yet fully established" and recalls its damaging side effects that would be of crucial impairment for a sportsperson: drop in blood pressure and parkinsonian-type effects. Professor Kintz even writes: "It appears to be illusory to want to find an interest in improving performance with trimetazidine".
Is this an unusual thing for them to do? If so it must have been compelling?
www.midilibre.fr
but Berezhnaya got 3 months back in 2000,
