Drugs in Sport 2018

Below is an extract of the list of banned drugs as detailed by WADA effective from 1 January 2018. It is valid until further notice. The list represents different doping classes to illustrate the doping definition. No substances belonging to the banned classes may be used even if they are not listed as examples. For this reason, the term "and related substances" is introduced. This term describes drugs that are related to the class by their pharmacological actions or chemical structure.

Please note that only products listed in the monthly MIMS format in this publication carry a reference to use in sport. Only products that are permitted for use in sport competition, be it subject to certain restrictions, are flagged by the use of codes alongside the relevant trade name or presentation. Product listings of medicines which may be classified as "banned in and out of competition" in the monthly MIMS format carry no reference to their use in sport.

Please refer to your monthly MIMS for products fully detailed within this publication per approved package insert.

[P/S]                This medicine or presentation contains ingredients not banned by the IOC.

[PWR]             This medicine or presentation contains ingredients where use is subject to certain restrictions.

[N/P/S]            This presentation within a product range contains substances not permitted in and out of competition and that presentation and the trade name are flagged accordingly.

[N/P/S in C]    This preparation contains ingredients that are prohibited in competition only and the trade name is flagged accordingly.

·        Listed substances are examples but not limited to, and also include analogues of substances and related substances.

·        All prohibited substances shall be considered as "Specified Substances" except Substances in classes S1, S2, S4.4, S4.5 and S6.a, and Prohibited Methods M1, M2 and M3.

 

Text Box: Substances and methods prohibited at all times (in and out of competition)

Prohibited substances

S0 NON-APPROVED SUBSTANCES

Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (eg. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved only for veterinary use) is prohibited at all times.

S1 ANABOLIC AGENTS

Anabolic agents are prohibited.

1. Anabolic androgenic steroids (AAS)

*              Exogenous: refers to a substance which is not ordinarily produced by the body naturally.

**            Endogenous: refers to a substance which is ordinarily produced by the body naturally.

 

a Exogenous* (AAS) including

·        1-androstenediol

·        1-androstenedione

·        1-androsterone

·        bolandiol

·        bolasterone

·        calusterone

·        clostebol

·        danazol

·        dehydrochlormethyltestosterone

·        desoxymethyltestosterone

·        drostanolone

·        ethylestrenol

·        fluoxymesterone

·        formebolone

·        furazabol

·        gestrinone

·        4-hydroxytestosterone

·        mestanolone

·        mesterolone

·        metenolone

·        methandienone

·        methandriol

·        methasterone

·        methyldienolone

·        methyl-1-testosterone

·        methylnortestosterone

·        methyltestosterone

·        metribolone

·        mibolerone

·        norboletone

·        norclostebol

·        norethandrolone

·        oxabolone

·        oxandrolone

·        oxymesterone

·        oxymetholone

·        prostanozol

·        quinbolone

·        stanozolol

·        stenbolone

·        1-testosterone

·        tetrahydrogestrinone

·        trenbolone

·        and other substances with a similar chemical structure or similar biological effect(s)

 

b Endogenous ** (AAS) when administered:

·        19-norandrostenediol

·        19-norandrostenedione

·        androstanolone

·        androstenediol

·        androstenedione

·        boldenone

·        boldione

·        nandrolone

·        prasterone

·        testosterone

and their metabolites and isomers, including but not limited to: 5α-androstane3α, 17α-diol; 5α-androstane-3α, 17ß-diol; 5α-androstane-3ß, 17α-diol; 5α-androstane-3ß, 17ß-diol; 5ß-androstane-3α, 17ß-diol; androst-4-ene-3α, 17α-diol; androst-4-ene-3α, 17ß-diol; androst-4-ene-3ß, 17a-diol; androst-5-ene-3α, 17α-diol; androst-5-ene-3ß, 17α-diol; androst-5-ene-3α, 17ß-diol; 4-androstenediol (androst- 4-ene-3ß, 17ß-diol); androsterone; 5-androstenedione (androst-5-ene-3,17-dione); epi-dihydrotestosterone; epitestosterone; etiocholanolone; 3ß-hydroxy-5α-androstan-17-one; 7α-hydroxy-DHEA; 7ß-hydroxy-DHEA; 7-keto-DHEA; 19-norandrosterone; 19-noretiocholanolone, 5α-androst-2-ene-17-one

2. Other anabolic agents

including but not limited to:

·        clenbuterol

·        selective androgen receptor modulators (SARMs, e.g. andarine, LGD-4033, ostarine and RAD140)

·        tibolone

·        zeranol

·        zilpaterol.

 

S2 PEPTIDE HORMONES, GROWTH FACTORS, RELATED SUBSTANCES AND MIMETICS

The following substances, and other substances with similar chemical structure or similar biological effect(s), are prohibited:

1.         Erythropoietins (EPO) and agents affecting erythropoiesis, including, but not limited to:

1.1       Erythropoietin-Receptor Agonists, e.g. Darbepoetins (dEPO); Erythropoietins (EPO); EPO based constructs [EPO-Fc, methoxy polyethylene glycol-epoetin beta (CERA)]; EPO-mimetic agents and their constructs (e.g. CNTO-530, peginesatide).

1.2       Hypoxia-inducible factor (HIF) activating agents, e.g. Argon; Cobalt; Molidustat; Roxadustat (FG-4592); Xenon.

1.3       GATA inhibitors, e.g.K-11706.

1.4       TGF-beta (TGF-β) inhibitors, e.g. Luspatercept; Sotatercept.

1.5       Innate repair receptor agonists, e.g. Asialo EPO; Carbamylated EPO (CEPO).

2.         Peptide Hormones and Hormone Modulators,

2.1       Chorionic Gonadotrophin (CG) and Luteinizing Hormone (LH) and their releasing factors, e.g. Buserelin, desmorelin, gonadorelin, goserelin, leuprorelin, nafarelin and triptorelin, in males;

2.2       Corticotrophins and their releasing factors, e.g. Corticorelin;

2.3       Growth Hormone (GH), its fragments and releasing factors, including, but not limited to: Growth Hormone fragments, e.g. AOD-9604 and hGH 176-191; Growth Hormone Releasing Hormone (GHRH) and its analogues, e.g. CJC-1293, CJC-1295, sermorelin and tesamorelin; Growth Hormone  Secretagogues (GHS), e.g. ghrelin and ghrelin mimetics, e.g. anamorelin, ipamorelin and tabimorelin; GH-Releasing Peptides (GHRPs), e.g. alexamorelin, GHRP-1, GHRP-2 (pralmorelin), GHRP-3, GHRP-4, GHRP-5, GHRP-6, and hexarelin.

3.         Growth Factors and Growth Factor Modulators, including, but not limited to: Fibroblast Growth Factors (FGFs); Hepatocyte Growth Factor (HGF); Insulin-like Growth Factor-1 (IGF-1) and its analogues; Mechano Growth Factors (MGFs); Platelet-Derived Growth Factor (PDGF); Thymosin-β4 and its derivatives e.g. TB-500; Vascular-Endothelial Growth Factor (VEGF).

Additional growth factors or growth factor modulators affecting muscle, tendon or ligament protein synthesis/ degradation, vascularisation, energy utilization, regenerative capacity or fibre type switching.

S3 BETA-2-AGONISTS

All selective and non selective beta-2 agonists including all optical isomers are prohibited.

Including, but not limited to:

·        Fenoterol;

·        Formoterol;

·        Higenamine;

·        Indacaterol;

·        Olodaterol;

·        Procaterol;

·        Reproterol;

·        Salbutamol;

·        Salmeterol;

·        Terbutaline;

·        Tulobuterol;

·        Vilanterol.

Except:

·        Inhaled salbutamol: maximum 1600 micrograms over 24 hours in divided doses, not to exceed 800 micrograms over 12 hours starting from any dose;

·        Inhaled formoterol: maximum delivered dose of 54 micrograms over 24 hours;

·        Inhaled salmeterol: maximum 200 micrograms over 24 hours

The presence in urine of salbutamol in excess of 1000 ng/mL or formoterol in excess of 40 ng/mL is not consistent with therapeutic use of the substance and will be considered as an Adverse Analytical Finding (AAF) unless the Athlete proves , through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic inhaled dose up to the maximum indicated above.

S4 HORMONE AND METABOLIC MODULATORS

The following hormone and metabolic modulators are prohibited:

1.     Aromatase inhibitors including but not limited to: 4-Androstene-3,6,17 trione (6-oxo), aminogluthetimide, anastrozole, androstatrienedione, arimistane, exemestane, formestane, letrozole, testolactone, etc.

2.     Selective estrogen receptor modulators including but not limited to: (SERMs) e.g. raloxifene, tamoxifen, toremifene, etc.

3.     Other anti-estrogenic substances including but not limited to: e.g. clomiphene, cyclofenil, fulvestrant.

4.     Agents modifying myostatin function(s) including but not limited to myostatin inhibitors.

5.     Metabolic modulators:

5.1.1       Activators of the AMP-activated protein kinase (AMPK), e.g. AICAR, SR9009; and Peroxisome Proliferator Activated Receptor δ (PPARδ) agonists e.g. 2-(2-methyl-4-((4-methyl-2-(4-(trifluoromethyl) phenyl)thiazol-5-yl)methylthio)phenoxy) acetic acid (GW1516, GW501516);

5.2       Insulins and insulin-mimetics.

5.3       Meldonium.

5.4       Trimetazidine.

S5 DIURETICS AND MASKING AGENTS

The following diuretics and masking agents are prohibited, as are other substances with a similar chemical structure or similar biological effect(s).  Including but not limited to:

·        Desmopressin, probenecid; plasma expanders, e.g. intravenous administration of albumin, dextran, hydroxyethyl starch and mannitol.

·        Acetazolamide; amiloride; bumetanide; canrenone; chlortalidone; etacrynic acid; furosemide; indapamide; metolazone; spironolactone; thiazides, e.g. bendroflumethiazide, chlorothiazide and hydrochlorothiazide; triamterene and vaptans, e.g. tolvaptan.

Except:

·        Drospirenone; pamabrom; and ophthalmic use of carbonic anhydrase inhibitors (e.g. dorzolamide, brinzolamide).

·        Local administration of felypressin in dental anaesthesia.

The detection in an Athlete's Sample at all times or In-Competition, as applicable, of any quantity of the following substances subject to threshold limits: formoterol, salbutamol, cathine, ephedrine, methylephedrine and pseudoephedrine, in conjunction with a diuretic or masking agent, will be considered as an Adverse Analytical Finding unless the Athlete has an approved TUE for that substance in addition to the one granted for the diuretic or masking agent.

 

Prohibited methods

M1 - MANIPULATION OF BLOOD AND BLOOD COMPONENTS

The following are prohibited

1.     The administration or re-introduction of any quantity of autologous, allogenic (homologous) or heterologous blood or red blood cell products of any origin into the circulatory system.

2.     Artificially enhancing the uptake, transport or delivery of oxygen, including but not limited to perfluorochemicals, efaproxiral (RSR13) and modified haemoglobin products (e.g. haemoglobin-based blood substitutes, microencapsulated haemoglobin products) excluding supplemental oxygen by inhalation.

3.     Any form of intravascular manipulation of the blood or blood components by physical or chemical means.

M2 - CHEMICAL AND PHYSICAL MANIPULATION

The following are prohibited

1.     Tampering, or attempting to tamper, to alter the integrity and validity of Samples collected during Doping Control. These include but are not limited to urine substitution and/or adulteration eg. proteases.

2.     Intravenous infusions and/or injections of more than a total of 100 mL per 12 hour period except for those legitimately received in the course of hospital treatments, surgical  procedures or clinical diagnostic investigations.

M3 - GENE DOPING

The following, with the potential to enhance sport performance, are prohibited:

1.     The use of polymers of nucleic acids or nucleic acid analogues.

2.     The use of gene editing agents designed to alter genome sequences and/or the transcriptional or epigenetic regulation of gene expression.

3.     The use of normal or genetically modified cells.

Text Box: Substances and methods prohibited in competition

 In addition to the categories S0 to S5 and M1 to M3 defined above, the following categories are prohibited In Competition.

PROHIBITED SUBSTANCES

S6 STIMULANTS

All stimulants (including all optical isomers (e.g. d- and l-) where relevant) are prohibited.

Stimulants include:

A. Non Specified Stimulants

·        adrafinil

·        amfepramone

·        amiphenazole

·        amphetamine

·        amphetaminil

·        amiphenazole

·        benfluorex

·        benzylpiperazine

·        bromantan

·        clobenzorex

·        cocaine

·        cropropamide

·        crotetamide

·        fencamine

·        fenetylline

·        fenfluramine

·        fenproporex

·        fonturacetam

·        furfenorex

·        lisdexamfetamine;

·        mefenorex

·        mephentermine

·        mesocarb

·        methamphetamine (D-)

·        p-methylamphetamine

·        modafinil

·        norfenfluramine

·        phendimetrazine

·        phentermine

·        prenylamine;

·        prolintane

A simulant not expressly listed in this section is a Specified Substance

B. Specified Stimulants.

Including, but not limited to:

·        1,3-dimethylbutylamine

·        4-methylhexan-2-amine (methylhexaneamine)

·        benzfetamine

·        cathine**

·        cathinone and its analogues, e.g. e.g. mephedrone, methedrone, and α - pyrrolidinovalerophenone;

·        dimethylamphetamine

·        ephedrine****

·        epinephrine*** (adrenaline)

·        etamivan

·        etilamfetamine

·        etilefrine

·        famprofazone

·        fenbutrazate

·        fencamfamin

·        heptaminol

·        hydroxyamfetamine (parahydroamphetamine)

·        isometheptene

·        levmetamfetamine

·        meclofenoxate

·        methylenedioxymethamphetamine

·        methylephedrine****

·        methylphenidate

·        nikethamide

·        norfenefrine

·        octopamine

·        oxilofrine (methylsynephrine)

·        pemoline

·        pentetrazol

·        phenethylamine and its derivatives

·        phenmetrazine

·        phenpromethamine

·        propylhexedrine

·        pseudoephedrine*****


*      Bupropion, caffeine, nicotine, phenylephrine, phenylpropanolamine, pipradrol and synephrine: These substances are included in the 2018 Monitoring Programme, and are not considered Prohibited Substances.

**     Cathine: Prohibited when its concentration in urine is greater tha 5 micrograms per millilitre.

***   Ephedrine and methylephedrine: Prohibited whenthe concentration of either in urine is greater that 10 micrograms per millilitre.

**** Epinephrine (adrenaline): Not prohibited in local administration, e.g. nasal, ophthalmologic or coadministration with local anaesthetic agents.

***** Pseudoephedrine: Prohibited when its concentration in urine is greater that 150 micrograms per millilitre.

·        selegiline

·        sibutramine

·        strychnine

·        tenamfetamine (methylenedioxyamphetamine)

·        tuaminoheptane

and other substances with a similar chemical structure or similar biological effect(s).

Except:

·        Clonidine

·        Imidazole derivatives for topical/ophthalmic use and those stimulants included in the 2018 Monitoring Programme*.

S7 NARCOTICS

The following are prohibited:

·        buprenorphine

·        dextromoramide

·        diamorphine (heroin)

·        fentanyl and its derivatives

·        hydromorphone

·        methadone

·        morphine

·        nicomorphine

·        oxycodone

·        oxymorphone

·        pentazocine

·        pethidine.

S8 CANNABINOIDS

The following cannabinoids are prohibited:

       Natural cannabinoids, e.g. cannabis, hashish and marijuana,

       Synthetic cannabinoids e.g. Δ9-tetrahydrocannabinol (THC) and other cannabimimetics.

Except:

       Cannabidiol

S9 GLUCOCORTICOIDS

All glucocorticoids are prohibited when administered by oral, intravenous, intramuscular or rectal routes.

Including but not limited to:

       betamethasone

       budesonide

       cortisone

       deflazacort

       dexamethasone

       fluticasone

       hydrocortisone

       methylprednisolone

       prednisolone

       prednisone

       triamcinolone

 

Text Box: Substances prohibited in particular sports

 P1 BETA-BLOCKERS

Beta-blockers are prohibited In-Competition only, in the following sports, and also prohibited Out-of-Competition where indicated.

-       Archery (WA)*

-       Automobile (FIA)

-       Billiards (all disciplines) (WCBS)

-       Darts (WDF)

-       Golf (IGF)

-       Shooting (ISSF, IPC)*

-       Skiing/Snowboarding (FIS) in ski jumping and free-style aerials/halfpipe and snow board halfpipe/big air

-       Underwater sports (CMAS) in constant-weight apnoea with or without fins, dynamic apnoea with and without fins, free immersion apnoea, Jump Blue apnoea, spearfishing, static apnoea, target shooting and variable weight apnoea.

Including, but not limited to:

·        acebutolol

·        alprenolol

·        atenolol

·        betaxolol

·        bisoprolol

·        bunolol

·        carteolol

·        carvedilol

·        celiprolol

·        esmolol

·        labetalol

·        levobunolol

·        metipranolol

·        metoprolol

·        nadolol

·        oxprenolol

·        pindolol

·        propranolol

·        sotalol

·        timolol.


*Also prohibited Out-of-competition

 

Cautionary notes: Compiled with the assistance of: Marlize Smuts, M Pharm

·        New medicines are continually being developed and launched, therefore no list is ever complete.

·        The onus rests on the patient or practitioner to check with a given sporting body whether a specific ingredient is banned or if restrictions are applicable in that given sport prior to use for conditions that are not life-threatening.

·        Different presentations of the same trade name may contain different ingredients which may affect its classification. It is therefore always wise to check the exact formulation of that presentation.

·        Never use medicines from a foreign country unless the ingredients have been checked. The composition of a product with the same trade name may vary from country to country.

·        Should you need to use an unlisted medicine, ascertain prior to use whether the product contains any banned substances.

·        The classification of the products is valid for the active ingredients listed. Active ingredients exclude alcohol, colourants, preservatives and tartrazine. Before taking any medicine, compare the active ingredients listed with those appearing on the current package insert. If one ingredient is different, the classification as indicated in MIMS is no longer valid.

·        Some tonics and vitamin-based preparations may also contain banned substances.

·        Pay particular attention to combination preparations.

Text Box: THE 2018 MONITORING PROGRAM*
The following substances are placed on the 2018 Monitoring Program:
1.	Stimulants: In-Competition Only: Bupropion, caffeine, nicotine, phenylephrine, phenylpropanolamine, pipradrol and synephrine.
2.	Narcotics: In-Competition Only: Codeine, hydrocodone and tramadol.
3.	Glucocorticoids: In-Competition (by routes of administration other than oral, intravenous, intramuscular or rectal) and Out-of-Competition (all routes of administration).
4.	2-ethylsulfanyl-1H-benzimidazole (bemitil):In and Out-of-Competition
5.	Beta-2-agonists: In and Out-of-Competition any combination of beta-2 agonists
*The World Anti-Doping Code (Article 4.5) states: "WADA, in consultation with Signatories and governments, shall establish a monitoring programme regarding substances which are not on the Prohibited List, but which WADA wishes to monitor in order to detect patterns of misuse in sport."