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• W2317337578 abstract "INTRODUCTION Despite the banning of ephedra, recent research and trends suggest that stimulants are still a problem in sports. Either an alarming epidemic of attention-deficit hyperactivity disorder (ADHD) has sprung up, or athletes are seeking ADHD drugs to rev up for their sport. Soon after major league baseball banned amphetamines, according to the Mitchell Report, the number of exemptions for ADHD drugs nearly quadrupled, so that in 2007 nearly 8% of all players had been diagnosed with ADHD. College baseball may be following suit. A recent survey in a college ice hockey conference found that 52% of players used stimulants, most commonly pseudoephedrine (27%), but also ephedra or amphetamines (1). Recent research on methylphenidate (Ritalin®), modafinil (Provigil®), and pseudoephedrine (Sudafed®) may fuel the temptation to abuse stimulants in sports - and raises concern about potential side effects. I will start with ephedra. EPHEDRA: GONE TODAY, HERE TOMORROW Ephedra is unsafe on the ballfield - where it's win or lose - but may help on the battlefield - where it's win or die. Military researchers find that ephedrine combined with caffeine can improve all-out cycling, anaerobic performance, muscular endurance, and 5-km and 10-km run times (2-6). But because of adverse events - including fatal heart attacks and strokes - among the general public using ephedra, the FDA banned it in 2004 (7). The ban did not last long. In 2005, a federal judge in Utah permitted the sale of low-dose ephedra capsules. In 2006, this decision was overruled, and in 2007 the U.S. Supreme court declined to review the case, thus upholding the FDA ephedra ban. Despite the ban, it seems that ephedra today still is available for sale online. Ephedra, largely by masking fatigue, also predisposes the user to exertional heatstroke and rhabdomyolysis. Ephedra was a culprit in the heatstroke death of a professional baseball pitcher and possibly the heatstroke death of a professional football player (7). Pearl: All three college wrestlers who died of exertional heat illness and/or rhabdomyolysis in the fall of 1997 were taking ephedra; one is listed as a hyperthermic death in a noted study of adverse events of ephedra (8). Ephedra played a role in a fatal heatstroke in a distance cycling race in South Africa (9). Ephedra also was tied to major exertional rhabdomyolysis and acute renal failure in three men (perhaps firefighters) undergoing intense physical training (10). Alas, ephedra and similar supplements like synephrine remain hazards for athletes (11). PROVIGIL®, RITALIN®, SUDAFED®: NEW AND OLD KIDS ON THE BLOCK Recent research may fuel the temptation to abuse stimulants in sports. In a study of modafinil (Provigil®), when 15 healthy men cycled to exhaustion at 85% of V˙O2max, the acute ingestion of modafinil, compared with placebo, prolonged exercise time by approximately 17% and reduced subjective ratings of relative perceived exertion (RPE). The authors attribute this ergogenic effect to a dampening of the sensation of fatigue (12). But this is just what can push athletes beyond normal limits into heatstroke or grave exertional rhabdomyolysis. Adding to heatstroke risk, modafinil elevates core temperature during rest and exercise in a warm environment (13). Methylphenidate (Ritalin®) can do the same. In a new study, eight well-trained male cyclists cycled in temperate or warm conditions for 60 minutes at 55% of V˙O2max and then performed a time trial. In the heat, on methylphenidate versus placebo, the cyclists completed the time trail approximately 16% faster. As a corollary, methylphenidate increased core temperature even at rest in the heat and drove it higher (than did placebo) - to as high as 104°-106°F - when cycling all-out in the heat (14). This ergogenic and thermogenic action raises health concerns, in light of growing use or abuse of Ritalin® on college campuses, by non-athletes and athletes alike. Even pseudoephedrine (Sudafed®) can be ergogenic, it seems, if one takes enough of it. In a double-blind, randomized, cross-over study, seven young male athletes ran 1500 m on a track after taking either pseudoephedrine (approximately 180 mg, 90 min pre-run) or a placebo. Times were approximately 2% faster (cut from approximately 280 s to approximately 274 s) on pseudoephedrine (15). This study may fuel the temptation to dope with pseudoephedrine, which is not banned by the NCAA. But even pseudoephedrine has some risk of serious side effects (1), including a possible link to ischemic colitis (16). BOTTOM LINE: STIMULANTS STAY Stimulants in sport increase the risk not only of heart attack and stroke, but also of exertional heatstroke and severe rhabdomyolysis. It was amphetamine-related deaths of cyclists that led to Olympic drug testing in 1968. Now alas, 40 years later in sports, risky stimulants are still on the scene." @default.
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• W2317337578 date "2008-09-01" @default.
• W2317337578 modified "2023-09-27" @default.
• W2317337578 title "Stimulants in Sports" @default.
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