Drug therapy for athletes what is allowed what is prohibited pz pharmazeutische zeitung

No taboo in competitive sports: asthma sprays with certain active ingredients do not fall under the doping ban.

Photo: Fotolia/ Mikey Smith

For many years, asthma sprays containing beta-2 agonists and/or glucocorticoids in any concentration were banned in and out of competition. For some years now, all glucocorticoid agents and the beta-2 agonists formoterol, salbutamol and salmeterol – each with limit values – have been approved for inhalation, since they have been shown to have no endurance-enhancing effect in lung-healthy athletes (3). The limits for the three beta-2 agonists are designed so that they are generally not exceeded when used therapeutically as intended. These permitted beta-2 agonists, alone or in combination with glucocorticoids, cover many common asthma sprays.

Oral forms of the three beta-2 agonists and all other beta-2 agonists in any form are prohibited at all times. The antiasthmatic drug clenbuterol is also banned and is even counted among the anabolic substances on the banned list due to its clearly anabolic active component.

Glucocorticoids are another group of active ingredients frequently used to treat allergic and asthmatic symptoms. The regulations for this have been significantly simplified in recent years. All dosage forms are allowed out of competition. Oral, intravenous, intramuscular and rectal application of glucocorticoids is prohibited in competitions. All other types of administration, on the other hand, are also permitted during competitions, so that, for example, the use of nasal sprays, eye drops and skin creams containing corticosteroids is also permitted on competition days from the point of view of sports law.

In anaphylactic shock, adrenaline (epinephrine) is usually administered intramuscularly, which is prohibited in competitions. Antihistamines are allowed – but not in combination with pseudoephedrine. This is prohibited in competitions due to its stimulant effect.

Structure of the banned list 2017

Substances and methods prohibited at any time

S0. Non-approved substances

S1. Anabolic substances

S2. Peptide hormones, growth factors, related substances and mimetics

S4. Hormone and metabolic modulators

S5. diuretics and masking agents

M1. Manipulation of blood and blood components

M2. Chemical and physical manipulation

Substances banned in competition

Substances prohibited in certain sports

Antidiabetic drugs

For the treatment of type 1 diabetes, only insulin itself in the form of human insulins and human insulin analogues is currently available due to the absolute lack of insulin in affected individuals. Despite the undesirable effect of life-threatening hypoglycemia, insulin is misused in sports due to its muscle-building (anabolic) and muscle-depleting (anti-catabolic) effects and is thus prohibited for athletes in and out of competition.

Oral antidiabetics used for the treatment of type 2 diabetes are not prohibited due to a different mechanism of action.

Antihypertensives

" width="260" height="168" /> A steady hand is crucial here. Beta-blockers are therefore generally prohibited in shooting sports.

A variety of agents with different mechanisms of action are available for the treatment of hypertension. Relevant in the sense of the prohibition list are diuretics and beta-blockers.

Diuretics – with the exception of purely herbal ones – are prohibited for athletes at all times, because forced diuresis can be misused to disguise the use of other prohibited substances. In addition, the diuretic effect is abused in sports where opponents are divided by weight classes in order to rapidly reduce body weight shortly before a competition-related weigh-in.

The calming of the heartbeat mediated by beta-blockers causes an inner calm and steady hand, which can be exploited especially in those sports in which this brings an increase in performance. For example, the ban on beta-blockers in competition extends to billiards, darts, golf, motor racing and some disciplines of ski jumping, snowboarding and diving. In shooting sports (archery, rifle, pistol), these substances are prohibited both in and out of competitions.

Antihypotonics

Sympathomimetics such as etilefrine and midodrine are used in hypotensive circulatory disorders. Due to their stimulant effect, they are prohibited in competitions.

Cold preparations

Special care should be taken with cold preparations containing permitted analgesics such as acetylsalicylic acid and ibuprofen in combination with pseudoephedrine or the permitted analgesic paracetamol in combination with ephedrine. The pharmacy team should be vigilant in giving advice, since these preparations are not subject to prescription. If the person concerned usually feels fit and able to perform quickly after taking these drugs, it is precisely this stimulant component that is prohibited in competitions.

Hormone preparations

Hormones that have a muscle-building and thus performance-enhancing effect in strength and endurance sports are prohibited. This concerns anabolic-androgenic steroids and growth hormone (somatropin). Until the 1990s, various anabolic-androgenic steroid hormones, derived from the body's own testosterone, were still approved as drugs in Germany; however, they were withdrawn from the market due to their poor risk-benefit profile (4).

Today, only testosterone itself is used therapeutically in this country, usually to substitute the missing endogenous testosterone in male hypogonadism and to suppress the growth in length of boys with tall stature. Nevertheless, many of the anabolic steroid preparations, which are no longer approved, are available illegally on the black market and are used for doping purposes.

Somatropin, like testosterone, is a substance produced naturally in the body and is banned when supplied from the outside. It is used in the treatment of short stature in children who do not have sufficient endogenous somatropin. Also these preparations are traded on the black market.

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