Metabolic medicines

Meldonium

A metabolic medicine studied in stable angina; those results do not establish athletic enhancement.

Clinical angina research; prohibited in sport

Meldonium molecular structure — Structure reference · C6H14N2O2

Practical use

Reviewed practical notes

Keep the patient group: Stable-angina findings cannot be applied directly to healthy athletes.
Avoid mortality claims: A longer exercise test is not evidence of improved survival.
Verify local status: Medicine authorization and anti-doping eligibility are different requirements.

Randomized MILSS I trial

2026 WADA Prohibited List

Overview

Meldonium has been investigated as an addition to standard treatment for stable angina. In that setting, exercise tolerance reflects symptoms during a cardiac stress test. It is not the same question as improving performance in a healthy athlete.

Risks and limitations

A limited-duration angina trial does not settle long-term safety or interactions outside that patient group. Regional medicinal use should not be interpreted as worldwide approval, and a sports prohibition is not proof of a large performance benefit.

How to read this

The 2026 WADA list prohibits meldonium at all times. The clinical trial and sport rule answer separate questions; neither authenticates a product marketed online or establishes a safe enhancement use.

Research explained

MILSS I phase 2 trial

Who was studied

512 patients with ischemic heart disease and stable angina randomized to meldonium conditions or placebo alongside standard therapy for 12 weeks.

What was found

Some treatment conditions improved bicycle exercise time relative to placebo, while results were not consistently favorable across all conditions.

What it cannot establish

The endpoint was exercise tolerance in patients with angina. It did not establish fewer deaths, improved healthy athletic performance or a generally safe use outside clinical care.

Read the original study

Exercise time needs a clinical context

A cardiac stress test can improve because a patient tolerates ischemic symptoms better. That does not demonstrate the broad training adaptations, recovery or competition benefit implied by a general endurance claim.

Supporting source

Sport status is explicit

WADA lists meldonium under metabolic modulators prohibited in and out of competition in 2026.