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Kamila Valieva has been banned for four years for testing positive for trimetazidine – but what exactly is the drug and what does it do?
CNN –
A doping saga that has been ongoing since the 2022 Winter Olympics finally came to an end on Monday.
Russian figure skater Kamila Valieva received a four-year ban from competition and her results since Christmas 2021 were disqualified after the Swiss Court of Arbitration for Sport (CAS) ruled that the 17-year-old had been found guilty of an anti-doping violation after testing positive for the illegal drug trimetazidine in 2021.
The ban applies retroactively to December 25, 2021, the time the sample was taken. Valieva was only 15 years old at the time.
The results of the test only came to light during the 2022 Winter Games in Beijing, where Valieva had helped lead the Russian Olympic Committee (ROC) – the neutral banner under which Russian athletes had to compete following wider doping allegations – to first place.
The ROC's position has since been recalculated and is in third place, while the United States and Japan now receive the gold and silver medals.
But what exactly is the drug that sparked a high-profile doping scandal and ultimately led to Valieva's suspension and disqualification?
According to the European Medicines Agency (EMA), trimetazidine is “a medicine used to prevent angina attacks, which are sudden pains in the chest, jaw and back caused by physical exertion due to reduced blood flow to the heart .”
It affects metabolism, in which the body breaks down substances to convert them into energy. It increases the rate at which glucose is broken down and can be used to protect against myocardial ischemia – a reduced blood supply to the heart muscle, according to the EMA.
The EMA also states that it has been used to treat dizziness, tinnitus and reduced vision due to problems with the blood vessels.
It has been readily available in pharmaceuticals in Europe since the 1970s and is marketed under the brand name Vastarel. Trimetazidine is not approved by the Food and Drug Administration for clinical use in the United States.
What effects does it have on athletic performance and why is it banned?
Trimetazidine is not known to be a doping agent in the United States, but has been on the World Anti-Doping Agency (WADA) list of banned substances for 2024 since the 2014 edition.
It is listed as a “metabolic modulator” and its use by athletes is prohibited both in and out of competition.
Although it would not increase heart rate unlike other performance-enhancing drugs that are considered stimulants, it is believed that trimetazidine may improve endurance during physical activity.
“This medication actually causes your heart to work more efficiently,” said Dr. Elizabeth Murray, a pediatric emergency medicine physician at the University of Rochester Medical Center, told CNN's Early Start program in 2022. “It doesn't change your blood pressure very much or change your heart rate.
“An athlete wouldn't get nervous or necessarily feel completely different, but they would theoretically be able to perform at a higher level for longer. It would potentially increase their stamina.”
Lee Jin-man/AP
China's Sun Yang waves after receiving his gold medal in the men's 1500-meter freestyle swimming final at the 17th Asian Games in Incheon, South Korea, Friday, September 26, 2014.
Previously, the most high-profile case involving the drug was when Chinese swimmer Sun Yang was given a three-month ban in 2014 after testing positive for trimetazidine.
Illegal metabolic modulators have been used by athletes in a variety of sports, including cycling, boxing and weightlifting from dozens of countries including Russia, Poland, Colombia, Belgium and Germany. Former tennis world number 1 Maria Sharapova was banned in 2016 because of a positive meldonium test.
Murray said trimetazidine wouldn't normally be given to children like Valieva “unless there's a very good reason.”
Jewel Samad/AFP/Getty Images
A general view shows artists holding signs with the names of participating countries under the Olympic rings during the opening ceremony of the Beijing 2022 Winter Olympics on February 4, 2022, at the National Stadium, known as the Bird's Nest, in Beijing.
The common side effects of trimetazidine, which may affect up to 1 in 10 people, are harmless and include “gastrointestinal discomfort, tremors, and weakness,” according to the National Capital Poison Center.
According to the Poison Control Center, serious side effects could include “Parkinson’s symptoms, involuntary muscle movements, and difficulty walking.”
In 2012, the EMA completed a review of the safety and effectiveness of trimetazidine after the French Medicines Agency reported that patients taking the drug experienced symptoms of Parkinson's disease, such as tremors (tremors), muscle stiffness, difficulty walking, and Restless leg syndrome.
“These symptoms were observed in some patients with no history of Parkinson's syndrome, and in many cases their symptoms disappeared when they stopped taking trimetazidine,” said the EMA Committee on Medicinal Products for Human Use.
The EMA's Committee for Medicinal Products for Human Use ultimately concluded that “the benefits continue to outweigh the risks” in patients with problems related to angina.
However, in the treatment of tinnitus, dizziness and visual disturbances, “the benefits no longer outweigh the risks and the CHMP recommended that these uses should no longer be approved.”