RAMB Março/Abril 2016

hat

every

physician

should

know

about

doping

and

doping

control

ssoc

ras

2016; 62(2):101-105

103

TABLE 1

Permanently prohibited substances and methods (in- and out-of-competition).

Class

Sub-classes, examples, comments

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 (e.g. 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

1. Anabolic androgenic steroids (AAS)

a) Exogenous AAS, including stanozolol and nandrolone

b) Endogenous AAS, including androstenodione and

dihydrotestosterone

2. Other anabolic agents, such as clenbuterol and tibolone

S2. Peptide hormones,

growth factors, related

substances and mimetics

The following substances are prohibited, as well as their releasing factors:

1. Erythropoiesis-stimulating agents, e.g. erythropoietins (EPO) and darbepoietin (dEPO)

2. Hypoxia-inducible factor (HIF) stabilizers, e.g. cobalt; and HIF activators, e.g. argon and xenon

3. Chorionic gonadotrophin (CG) and luteinizing hormone (LH), both prohibited in males

4. Corticotrophins

5. Growth hormone (GH)

6. Additional prohibited growth factors, e.g. fibroblast growth factors (FGFs), insulin-like growth factor-1 (IGF-

1) or mechano (MGFs), and more growth factors

S3. Beta-2 agonists

All substances in this class are prohibited, except for:

•

Inhaled salbutamol (maximum 1,600 mcg over 24 hours)

•

Inhaled formoterol (maximum delivered dose 54 mcg over 24 hours)

•

Inhaled salmeterol in accordance with the manufacturers’ recommended therapeutic regimen

The presence in urine of salbutamol in excess of 1,000 ng/mL or formoterol in excess of 40 ng/mL is presumed

not to be an intended 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 hormones and metabolic modulators are prohibited:

1. Aromatase inhibitors, e.g. aminoglutethimide

2. Selective estrogen receptor modulators, e.g. tamoxifen and raloxifene

3. Other anti-estrogenic substances, e.g. clomiphene

4. Agents modifying myostatin function(s)

5. Metabolic modulators

•

Activators of the AMP-activated protein kinase (AMPK) and peroxisome proliferator activated receptor

(PPAR

) agonists

•

Insulins and insulin mimetics

•

Meldonium

•

Trimetazidine

S5. Diuretics and masking

agents

Thiazide diuretics, e.g. chlorthalidone, indapamide and hydrochlorothiazide

Potassium-sparing diuretics, e.g. spironolactone and triamterene

Loop diuretics, e.g. furosemide

Masking agents, e.g. probenecid and plasma expanders

(Continue)

substances that may be found in his or her body. For this

reason, we consider that all medical professionals, re-

gardless of their specialty, should have – as part of their

medical knowledge wealth – the domain of basic con-

cepts of doping control, not only to provide the best ther-

apeutic alternatives, but mostly to avoid iatrogenic events

that can jeopardize the credibility and career of an ath-

lete patient.