Meldonium was barely on the radar until five-time Grand Slam champion Maria Sharapova revealed she recorded a positive drugs test for the substance.
The Russian, 28, has been taking the drug since 2006 for health issues.
But it was banned by the World Anti-Doping Agency (Wada) on 1 January and the former world number one has now been provisionally suspended from 12 March, meaning she could face a suspension of up to four years.
A lot of athletes take it – possibly for medical reasons – but where has it come from? Will we be hearing more about it? And can you buy it?
Watch how Sharapova revealed she failed test
What is meldonium?
Meldonium – also known as mildronate – is a drug designed to treat ischemia, a condition where there is a reduction in blood supply to body tissue. It is also said to have benefits for diabetes sufferers.
Dr Tom Bassindale, lecturer in forensic science at Sheffield Hallam University, said: “It has been developed and used in Latvia and was approved in the early 2000s to treat diabetes and various heart-related diseases through its ability to adjust the body’s use of energy, stimulating glucose metabolism and also helping to clear fatty build-up in the arteries.”
Why would an athlete benefit from it?
The ability to increase oxygen movement to muscles has seen meldonium used as a supplement for athletes, as it could have a positive effect on stamina and endurance.
Dr Bassindale said: “It’s advertised as giving a mental focus, removing external stress so you feel sharper. There is a slight central nervous system effect, like with stimulants such as caffeine, which gives you a sharper edge.
“But it will aid recovery quicker from a hard effort – whether that’s playing multiple games of tennis or a cyclist coming back the next day for another stage. There is also an endurance effect.”
Can I buy it legally?
In a word: yes. It is not licensed in the UK, so is therefore illegal to sell. But it is not illegal to import it from abroad for personal use.
Russian supplements website RUPharm told BBC Sport it is has sold 150 packets of the drug in the most recent 24 hours, compared with 850 total sales in the past 12 months.
“As a joke we now call mildronate the Sharaponate,” said a spokesperson for the website.
Most of their sales are to UK and USA customers and the majority are for sport, rather than medicinal, use.
But the UK government’s Medicines & Healthcare Products Regulatory Agency says it urges people to not buy unlicensed drugs from abroad, as there is no guarantee that customers know if the product is safe.
Is it safe?
Assuming the product is what it says on the label, there are no tests that show any serious side effects.
A Latvian manufacturer of the product – OlainFarm – says it is possible that some using the drug will suffer “headaches” and “agitation”. It is also possible for there to be some skin irritation, though this is “very rare”.
RUPharma said: “We do not know of any negative side effects, unless of course one overdoses. But that applies to any product or medicine.”
Dr Bassindale added that he would expect it to have “gone through significant testing” in Latvia.
Is it used a lot?
Last year, as part of Wada’s monitoring of meldonium, a Cologne testing centre found that 182 of 8,320 random urine samples gave positive results for the drug – a rate of 2.2%.
“That’s huge,” says Dr Bassindale. “The overall positive tests for all other doping was about 2% from 280,000 tests.”
BBC Russian’s Pavel Fendenko said the drug is frequently sold over the counter in Russia and prescribed by cardiologists.
“In 2013, the Russian government put it on a list of essential drugs – on a par with things like insulin – which makes it subject to certain price caps,” he said.
Why is it now banned?
After Wada monitored use of meldonium, it decided the drug would be included on the banned list from 1 January.
Dr Bassindale said: “When deciding whether to ban a drug, Wada looks at three things. Will it enhance performance? Is it detrimental to the health of an athlete? Is it against the ‘spirit of sport’?
“To be banned, a drug must ‘fail’ two of these three tests. Presumably, in this case, they have decided the drug is against the ‘spirit of sport’.”
Will we see more failed tests?
If 2.2% of random samples showed levels of the drug, then it is being widely used. However, it is impossible to tell how many of those samples take it for legitimate medical reasons and would therefore be able to get a therapeutic usage exemption.
But Dr Bassindale says the high-profile nature of Sharapova’s positive test may reduce the number of athletes using meldonium.
“This might have persuaded people to be much more careful,” he said.
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