Olympic athletes may spend years planning, training and preparing for that elusive chance to win a gold medal, but they can risk losing it all by taking something as seemingly innocuous as a common cold medication on the day of the competition.
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Common drugs — including ADHD medications and some cold and flu medications that treat symptoms — can be off-limits, according to the World Anti-Doping Association.
The list of prohibited substances nowadays includes not just performance-enhancing drugs such as steroids and EPO — erythropoietin, which can increase the amount of red blood cells in the body — which are banned for the duration of an athlete's training. The list also includes over-the-counter medications. Pseudoephedrine, commonly found in the cold and flu medication Sudafed, is banned on the day of competition. The drug is a stimulant and can make athletes more alert for a competition.
Athletes must be careful that they don't take a medication given by a doctor to clear up a bad cold, since it's up to them to stay free of banned substances on the day of competition. The U.S. Anti-Doping Association advises athletes to stop taking the drugs a few days before they have to compete.
"They have a banned list [World Anti-Doping Agency officials] put out," said Dr. Dennis Cardone, an orthopedic surgeon and a sports medicine physician at NYU Langone Medical Center. "Athletes ... it's their responsibility to make sure [their drugs are] not on the banned list."
Dietary supplements that are available in many drugstores are also ill-advised, Cardone said.
"There's a warning that most of these substances aren’t well controlled," he said, explaining that a variety of banned ingredients may show up in supplements. "In general, they should just avoid" supplements because of that risk.
The U.S. Anti-Doping Association advises that water pill supplements may contain a banned diuretic and advises athletes to avoid them. Prescription diuretics are banned, since they can cause rapid weight loss and mask other prohibited substances from appearing in urine tests.
In addition to these medications, some drugs to treat disorders like asthma and ADHD are banned. Albuterol, used to treat asthma, cannot be used in conjunction with a diuretic without a medical waiver. The drug had been used by athletes to build muscle mass. Additionally, amphetamines are banned, meaning if athletes have ADHD, they may not take the stimulants usually prescribed to help people with that disorder. Cardone said a medical waiver is available but it's uncommon for an ADHD medical waiver to be approved.
However, anti-doping regulations are more lenient now for athletes who may want to indulge in a few cups of coffee in the morning before a competition.
"Caffeine, interestingly, it used to be banned, but it isn't anymore," said Dr. Andrew Gregory, a sports medicine doctor and an associate professor of orthopedic surgery at Vanderbilt University Medical Center.