Meldonium: the drug that got Maria Sharapova suspended from tennis

Suspended Russian tennis champ Maria Sharapova admits she made a “huge mistake” by taking a banned performance-enhancing drug called meldonium. But what is it? For what medical reasons would an athlete take it? And why is it banned?

The drug, known as meldonium or mildronate, is not approved by the Food and Drug Administration in the United States, but it is prescribed elsewhere to help protect heart tissue by regulating metabolism. It has also been used by neurological clinics to treat patients who have asthenia – an abnormal lack of energy.

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The substance had only recently come to the attention of the World Anti-Doping Agency, which started monitoring the use of the drug by athletes in 2015 and banned it outright beginning this year.

Sharapova’s drug sample was collected on January 26.

How would meldonium help an athlete?

The drug “demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system functions,” according to a study last year in the journal Drug Testing and Analysis.

Sharapova, age 14, plays her first professional tournament in March 2002. She defeated Brie Rippner at the Pacific Life Open in Indian Wells, California.

Sharapova holds up her trophy after she won Wimbledon in July 2004. The 17-year-old defeated Serena Williams in the final for her first Grand Slam title.

Sharapova serves during the 2006 U.S. Open semifinals. She advanced to beat Justine Henin in the final. It was her second Grand Slam title.

Sharapova is given a painting from the Children of Chernobyl Foundation in July 2007. That year, she became a U.N. global ambassador focused on the Chernobyl Recovery and Development Program.

Sharapova won her third major title at the 2008 Australian Open.

Off the court, Sharapova has become a fashion icon and a popular spokeswoman for many major companies. Her endorsements have included Nike, Gatorade, Canon and Cole Haan.

Sharapova falls to her knees after winning the 2012 French Open to complete the career Grand Slam. She also won the French Open in 2014.

Sharapova, left, at the London 2012 Olympic medal ceremony at Wimbledon with Serena Williams, center, and Victoria Azarenka. Sharapova finished with the silver after losing to Williams in the final.

Sharapova carries the Olympic torch in Sochi, Russia, during the opening ceremony for the 2014 Winter Olympics.

A shopper in Shanghai, China, walks past a Nike advertisement featuring Sharapova.

Sharapova signs autographs after winning a match at last year's Australian Open. She later announced she had tested positive for banned drug meldonium and was banned for two years, later reduced to 15 months.

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Side effects can include allergic reactions, indigestion, increased heart rate and changes in blood pressure, according to the drug’s prescribing label.

Meldonium is among a class of banned drugs called hormone and metabolic modulators that account for about 5% of doping in sports, according to a 2014 study by the international doping agency.

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Banned drug modulators have been used by cyclists, weightlifters, boxers, wrestlers, skiers and other athletes from more than 25 countries including Russia, Poland, Columbia, Belgium and Germany.

The agency said it added meldonium to its list of modulators “because of evidence of its use by athletes with the intention of enhancing performance.”

Why was Sharapova taking it?

In an email to CNN, Sharapova’s attorney said the tennis player took 500mg of mildronate on a regular basis for 10 years and that she was unaware the drug had another name and was banned.

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Sharapova was first prescribed the drug in early 2006, according to her attorney, after tests revealed that “she has some immune deficiency, abnormal EKG results, diabetes indicators, low magnesium and asthenia.”

The manufacturer of mildronate, Grindex pharmaceuticals, says the drug is “widely used for the treatment of different heart and vascular diseases.” It notes the substance is also used to improve “work capacity” in healthy people who are overloaded physically or mentally or who are in a rehabilitation period.

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The normal course of treatment, according to the drug’s prescribing label, is a matter of days to weeks.

It is not known why Sharapova’s doctor continued to prescribe the drug for years.