The verdict
Our read at a glance.
Whether shifting cardiac and muscle metabolism away from fatty acids improves performance or recovery in healthy athletes.
- The signal
- Meldonium has a genuine clinical literature in the countries where it is licensed, studied in ischaemic heart disease, heart failure and cerebrovascular contexts, with registered trials and published cardiology work behind that use. The mechanism is well described. What is much thinner is controlled evidence that it improves performance or recovery in healthy trained people, which is the claim that drove its use in sport. Its most notable appearance in the international literature is pharmacokinetic and analytical work generated after the ban, examining how long excretion continues - the question that decided a large number of contested cases.
- The unknown
- Whether there is any ergogenic effect in healthy athletes at all, since almost nothing in the literature tests that directly.
- Our read
- A real drug for a real cardiac indication in the countries that license it, adopted by athletes on the strength of a mechanism rather than a trial. The most rigorous science it generated in the West was about how long it takes to leave the body.
The mechanism
How it works.
Carnitine is the shuttle that carries long-chain fatty acids into mitochondria to be burned. Meldonium inhibits gamma-butyrobetaine hydroxylase, the enzyme that makes carnitine, lowering carnitine levels and therefore restricting fatty acid transport. The cell compensates by burning more glucose. That matters in ischaemia because glucose oxidation yields more ATP per unit of oxygen than fatty acid oxidation does, so under low oxygen a heart running on glucose is better off - which is the coherent rationale behind its cardiology use. Extending that to a healthy athlete requires assuming the same substrate shift helps a well-perfused muscle with adequate oxygen, and that is precisely the step the evidence does not cover.
Safety & regulatory boundary
The consequential part.
Not approved by FDA or EMA; approved in several Eastern European countries. Prohibited in sport since 2016. Because there is no Western approval, product obtained outside those markets has no regulatory manufacturing oversight. The safety record within its licensed use is reasonable, but that record was generated in cardiac patients under supervision, not in healthy athletes self-administering.
What's next
What we're watching.
Any controlled trial with performance endpoints in healthy subjects, which would be the first real test of the claim.
Context
Why this is discussed.
The 2016 ban produced a wave of positive tests among elite athletes, which told everyone that a lot of people believed it worked.
The evidence base
19 cited references.
Registered trials7
ClinicalTrials.gov · PHASE1 · COMPLETED · 2023-04-06
ClinicalTrials.gov · NA · ENROLLING_BY_INVITATION · 2026-03-12
ClinicalTrials.gov · PHASE1/PHASE2 · COMPLETED · 2022-02-01
ClinicalTrials.gov · PHASE4 · COMPLETED · 2022-05-18
ClinicalTrials.gov · PHASE4 · COMPLETED · 2022-04-05
ClinicalTrials.gov · PHASE2 · COMPLETED · 2008-07
ClinicalTrials.gov · PHASE2 · UNKNOWN · 2013-01
Indexed literature (PubMed)12
Pușcaș A et al. · Cureus · 2024
Ponamarczuk H et al. · Postepy Biochem · 2025
Schobersberger W et al. · Br J Sports Med · 2017
Malm C et al. · Front Sports Act Living · 2026
Dambrova M et al. · Pharmacol Res · 2016
Wang D et al. · Front Pharmacol · 2022
Yang W et al. · J Transl Med · 2024
Guddat S et al. · Drug Test Anal · 2021
Đurašević S et al. · Int J Mol Sci · 2021
Temerdashev A et al. · Heliyon · 2020
Kigitovica D et al. · J Clin Med · 2025
Đurašević S et al. · Sci Rep · 2021
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