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What to know about Trimetazidine, the drug at the center of the Olympic doping case

Kamila Valieva, 15, tested positive for the drug Trimetazidine. (Anne-Christine Poujoulat/AFP via Getty Images)
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Russian Olympic Committee figure skater Kamila Valieva, 15, tested positive for Trimetazidine, a drug that has been banned by the World Anti-Doping Agency since 2014.

Trimetazidine, also known as TMZ, is a heart medication designed mostly for older people who suffer from angina, a condition that causes severe chest pain because of inadequate blood flow to the heart. The drug has never been approved for use in the United States, and several medical experts said it probably has more risk than benefit.

Some elite athletes have used it in a search for a competitive edge, though its ability to enhance performance is unclear.

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The drug is supposed to make the heart more efficient by relying less on fatty acids and more on glucose, which requires less oxygen. In theory, it could aid endurance athletes who have to generate high cardiac output, such as cyclists, rowers and long-distance runners, but would be unlikely to have a direct impact on a figure skater’s performance, where there is less demand on the heart, said Aaron Baggish, director of the Cardiovascular Performance Program at Massachusetts General Hospital.

There is virtually no reason a healthy teenager would be given a legitimate prescription for TMZ, Baggish said. In situations in which an athlete may need to take a drug on the banned substance list, he or she would need to receive a therapeutic use exemption for the drug and a physician would have to make the case there are no suitable alternatives, Baggish added, noting that in the case of TMZ, there are many superior drugs that treat the same condition.

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The drug could, in theory, give an athlete such as Valieva an edge by allowing her to train for longer periods of time in a sport in which medals are won by razor-thin margins, said Robby Sikka, a sports medicine physician and anesthesiologist who works with NFL and NBA teams. It also could have a psychological benefit, Sikka said, if someone in Valieva’s orbit told her it could help her performance or enable her to train even harder, and it may be able to help athletes recover faster.

“If it made her more confident to do a jump that she did, the drug’s effect is not inconsequential to her performance,” Sikka said.

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