Meldonium in the UFC: How Sharapova’s drug scandal affects fighters

Back in March, five-time Grand Slam champion Maria Sharapova stood behind a podium at a press conference she hurriedly called together to inform the…

By: Karim Zidan | 7 years ago
Meldonium in the UFC: How Sharapova’s drug scandal affects fighters
Bloody Elbow 2.0 | Anton Tabuena

Back in March, five-time Grand Slam champion Maria Sharapova stood behind a podium at a press conference she hurriedly called together to inform the media that she had tested positive for meldonium. The revelation indirectly shed light on a sports scandal that now involves more than 30 Russian athletes and over 200 positive tests for the substance since Jan. 1 2016.

After Sharapova’s positive test was made public, scores of Russian athletes started to fail drug tests for the same substance. Other athletes include two Ukrainian biathletes, Olga Abramova and Artem Tyschcenko, Russian cyclist Eduard Vorganov, and Russian ice dancer Ekaterina Bobrova. The drug also seeped into combat sports such as boxing when European Boxing Union (EBU) light-heavyweight champion Igor Mikhalkin tested positive for meldonium. He was later stripped of the title he defended on three occasions.

UFC lightweight Islam Machakhev was the latest to test positive for the substance when he failed his pre-fight test and was removed from the UFC on FOX 19 card less than 24 hours before his fight. Though Machakhev stood by his innocence – his manager claimed it was medication used for a heart procedure — his preliminary match-up against Drew Dober was cancelled.

So what is meldonium, and why are so many athletes testing positive for the substance?

Meldonium, an anti-ischemic drug, is medically used to treat ischemia, which is an issue concerning blood flow. It is not approved for use in the United States but is commonly available in the Russian Federation, Moldova, Ukraine, Belarus and Armenia. The medication helps improve exercise capacity in patients, as well as in healthy individuals and athletes. It has also shown benefits in dealing with diabetes and neurological disorders.

Meldonium, classified by the World Anti-Doping Agency (WADA) as a S4 substance to do with hormones or metabolic modulation, was added to the prohibited list on Jan. 1 2016 after being monitored the previous year. The reason behind this was “because of evidence of its use by athletes with the intention of enhancing performance.”

Though meldonium was an acceptable substance to ingest until recently, it was only available in the Russian Federation or the former Soviet Bloc. It is not approved by the Food and Drug Administration and is actually manufactured by a single Latvian company named Grindeks. It is generally purchased under the brand name Mildronate, which is the exact substance that Sharapova has admitted to using for the past decade during her press conference.

According to Sharapova, she was prescribed the medication by her family doctor to deal with various health concerns, including a history of diabetes and a magnesium deficiency. Once the International Tennis Federation informed her that she had failed a drug test, she realized the medication also went by the name meldonium, which was the substance added to the 2016 WADA prohibited list. She neglected to read the numerous emails that the organization had released to confirm the recent additions to the list.

WADA has come under fire for their inefficient method of notifying athletes. Despite their efforts to publicize the information ahead of the ban at the start of the year, nearly 200 tests were flagged for meldonium after Jan 1. The agency also released a statement this week that meldonium could potentially linger in the athlete’s system months after they stop ingesting it. Therefore it is unclear whether some of the positive urine tests that occurred over the past few weeks/months actually contained meldonium samples from 2015.

“Limited data exists to date on the urinary excretion of meldonium,” WADA said in a statement. “Several studies are currently being conducted involving WADA-accredited laboratories, and WADA will share these results with its stakeholders when available.”

According to WADA, meldonium has a half-life of approximately 15 hours but can remain in the system in minute doses for weeks, if not months. Therefore, the organization suggested that concessions could be given to athletes with less than 1mg of meldonium in their system prior to March 1.

“It might take several months for meldonium to leave the human organism due to its non-linear pharmacokinetics (dose-dependence),” Grindex spokeswoman Laila Klavina told “It depends on a variety of factors, such as dose, the length of treatment, individual physiological characteristics, test sensitivity and sample types (blood or urine) used in tests,”

While it remains a prohibited substance and the onus is on athletes to be fully aware of the supplements they consume, the recent inconsistencies in WADA’s testing procedure and handling of the ban could provide a loophole for some of the athletes who were flagged.

The Russian Minister of Sports, who came under fire once the latest doping scandal was publicized, quickly criticized WADA once they released the statement suggesting partial amnesty was possible.

“An athlete should be punished fairly but now it turns out that they were taking meldonium unintentionally,” Sports Minister Vitaly Mutko told “WADA has not carried out any research how long the substance stays in the human body. We filed a request and were answered that there had been no research.

“I assure you that by the year’s end the percentage of athletes suspended over positive doping tests will be the same as 3-5 years ago,” Mutko said. “It will not be at the same level as in the U.S., France or Italy… It will be around one percent of the testing base.”

Since then, the Russian Anti-Doping Agency (RUSADA) has lifted multiple bans placed on some of their athletes for meldonium tests. The latest include Nadezhda Kotlyarova, Olga Vovk, Gulshat Fazletdinova and Andrei Minzhulin.

However, the UFC’s sole meldonium case – Islam Makhachev – does not fall under the March 1 WADA deadline. Regardless, the UFC’s statement suggested that WADA’s new evaluation of the drug could have an impact on his eventual suspension.

“WADA recently announced that they are currently conducting further studies of the substance which may influence how cases involving Meldonium are evaluated. In order to ensure Makhachev receives full and fair due process, USADA, the independent administrator of the UFC Anti-Doping Policy, will consider all relevant information before making any determinations.”

Makhachev has since expressed his innocence and explained that the medication was for heart surgery he had undergone last year. It should also be noted that the fighter never publicized his condition, as this should have been disclosed on medical forms in the United States.

According to the manufacturer’s website, mildronate is “widely used for the treatment of different heart and vascular diseases, as well as for the improvement of work capacity of healthy people at physical and mental overloads and during rehabilitation period.” The regular course of treatment last between four to six weeks and is undergone “twice or thrice a year.”

It will be interesting to see how USADA handles Makhachev’s flagged drug test, particularly given the unprecedented number of drug failures for meldonium and the variables involved in the overall scandal.

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About the author
Karim Zidan
Karim Zidan

Karim Zidan is a investigative reporter and feature writer focusing on the intersection of sports and politics. He has written for BloodyElbow since 2014 and has served as an associate editor since 2016. He also writes for The New York Times and The Guardian. Karim has been invited to speak about his work at numerous universities, including Princeton, and was a panelist at the South by Southwest (SXSW) film festival and the Oslo Freedom Forum. He also participated in the United Nations counter-terrorism conference in 2021. His reporting on Ramzan Kadyrov’s involvement in MMA, much of which was done for Bloody Elbow, has led to numerous award nominations, and was the basis of an award-winning HBO Real Sports documentary.

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