Trimetazidine is defined as a specified substance in the WADA Prohibited substances list in 2014.
According to the Deutsche Sporthochschule in Cologne the substance was put on the list of prohibited substances after a study showed that the substance was being abused among athletes.
The WADA accredited laboratory in Warsaw identified trimetazidine in 39 of 16725 (0.23%) urine samples collected between 2008 and 2013. And the WADA laboratory in Cologne found 39 findings per year in the same period.
In 2014, the first year the substance was on the list, one athlete tested positive for trimetazidine during the 2014 Olympic Winter Games in Sochi
In it's first year on the list it was only prohibited in-competition. Since 2015 it is also prohibited out-of-competition.
High usage in Russia
According to The Associated Press (AP) the use of trimetazidine is huge in Russia. Head of cardiac ICU at Moscow Hospical No. 29, Alexei Erlikh, said to the news agency that the medicine was once heavily promoted in the country by a manufacturer and because of this "its use in Russia is catastrophically huge".
A cardiologist in Moscow, Dr. Anton Rodionov, do not believe the medicine will give any benefits for an athlete:
"The effect of the drug on healthy people is likely to be smaller than small. But on the other hand, we understand that high-achieving athletes are fighting for every millisecond, for every 0.0001%, believing, as some say, that every speck of dust is a vitamin pill. The medicine wasn’t, of course, tested on athletes, and it wasn’t designed for athletes", Rodionov said to AP.
Valieva has claimed that the substance entered her body through a medicine her grandfather uses.
Heart medicine
Trimetazidine is a medicine used to prevent angina attacks, which are sudden pains to the chest, jaw and back brought on by physical effort, due to reduced blood flow to the heart. Angina is commonly associated with a narrowing of the blood vessels that supply the heart, called the coronary arteries.
Trimetazidine is a "metabolic agent", a medicine which has an effect on metabolism (the process by which substances are broken down in the body). It is believed to protect against myocardial ischaemia (reduced blood supply to the heart muscle) by increasing the rate at which glucose is broken down.
Trimetazidine is also used to treat the symptoms of vertigo (a spinning sensation) and tinnitus (ringing sensation in the ears), and to treat reduced vision and visual field disturbances (unclear or disturbed vision) due to problems affecting the blood vessels.
Medicines containing trimetazidine have been available since the 1970s.
In the USA the medicine is not approved by the FDA according to National Library of Medicine.
How common is Trimetazidine in doping cases?
Not very. In the Anti-Doping Database we have registered 32 doping cases involving this substance.
The country with the most cases is Russia (14 - at the time of writing). Ukraine has banned 5 athletes who has tested positive for this substance. China has banned three.
Track & Field is the sport with the most cases - 7, followed by Wrestling and Swimming who both have 4 cases. In Rowing we have registered 2 athletes who has been banned for using Trimetazidine.
Statistically there are two athletes per year who gets banned for using this prohibited substance.
How long do you get banned using Trimetazidine?
Nearly 1/3 of the athletes registered in the Anti-Doping Database who has tested positive for the substance received a four year suspension. Two was given a three year suspension and 5 was given a two year suspension.
10 has been banned for less than two years. The shortest ban we have registered is six months.
Valieva was 15 at the time of the sample collection. Normally that would give her status as a protected athlete. This would normally result in a reduction of the ban. Still she was given a 4 year suspension by the Court of Arbitration of Sports (CAS).