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What is trimetazidine, the drug at the heart of the Valieva scandal?

Russian figure skater Kamila Valieva has been cleared to continue competing at the 2022 Winter Olympics, despite testing positive for the banned substance trimetazidine in December.

2022 Beijing Olympics - Figure Skating - Women Single Skating - Short Program - Capital Indoor Stadium, Beijing, China - February 15, 2022. Kamila Valieva of the Russian Olympic Committee warms up before the event. REUTERS/Evgenia Novozhenina

Teenage figure skater Kamila Valieva was this week cleared to continue competing at the 2022 Winter Olympics, despite recently testing positive for the banned substance trimetazidine, a drug normally used to treat angina.

CAS upholds decision to lift provisional Valieva suspension

After helping the Russian Olympic Committee (ROC) team to gold in the figure skating team event on Monday last week, Valieva, 15, was provisionally suspended by the the Russian Anti-Doping Agency (RUSADA) when the World Anti-Doping Agency (WADA) revealed she had returned a positive test in December.

However, RUSADA then lifted her ban the following day, a decision challenged by WADA, the International Olympic Committee (IOC) and the International Skating Union (ISU), who lodged an appeal with the Court of Arbitration for Sport (CAS).

On Monday, the tribunal ruled in RUSADA’s favour. “On the basis of the very limited facts of this case, and after consideration of the relevant legal issues, it [CAS] has determined that no provisional suspension should be imposed on the Athlete,” the body said in a statement.

Valieva has argued that she may have accidentally consumed medication being taken by her grandfather.

While CAS has allowed Valieva to continue competing at Beijing, where she is currently involved in the women’s single skating event, the body’s ruling only covers the lifting of her provisional suspension.

After the Winter Games are over, she still faces a potential ban and the loss of all medals she wins at the event.

Valieva leads the women's single skating event after Day 11 of the 2022 Winter Olympics.
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Valieva leads the women's single skating event after Day 11 of the 2022 Winter Olympics.ANNE-CHRISTINE POUJOULATAFP

What is trimetazidine?

Trimetazidine is a medicine most commonly used against angina pectoris, also known simply as angina, a condition described by the US’ National Institutes of Health as ”chest pain or discomfort you feel when there is not enough blood flow to your heart muscle”.

In its explanation of how the drug works, the European Medicines Agency (EMA) says: “Trimetazidine is a 'metabolic agent', a medicine which has an effect on metabolism (the process by which substances are broken down in the body).

“It is believed to protect against myocardial ischaemia (reduced blood supply to the heart muscle) by increasing the rate at which glucose is broken down.”

Because it aids blood flow to the heart, trimetazidine can serve to boost athletes’ endurance. It has been on WADA’s list of banned substances since 2014.

Trimetazidine does not have approval from the Federal Drug Administration (FDA) for use in the US. In a 2012 review of its “safety and effectiveness”, meanwhile, the EMA recommended that the medicine be used only as an “add-on to existing treatments in patients who are not adequately controlled by or who are intolerant to other medicines for angina pectoris”.

Trimetazidine has also been employed as a treatment for tinnitus, vertigo and visual-field disturbances, but the EMA now recommends against this, noting: “The benefits no longer outweigh the risks.”


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