doping and side effects

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Principal doping substances and their side effects

A compilation prepared for the International Cycling Union

Laurent RIVIER, Ph.D., chemist and toxicologist, Scientific Director of the SwissInstitute of Doping Analysis, Martial SAUGY, Ph.D., biochimiste, Technical Directorof the Swiss Institute of Doping Analysis, and Professor Patrice MANGIN Md Ph.D.,forensic scientist, Director of the Swiss University Institute of Forensic Medicine,Lausanne, Switzerland.

Introduction

Any sport may be defined as a game of intelligence and a challenge of ideas combined withthe expression of perfection of the human body and its movement. There are no sports whichinvolve a course on pharmacology. Unfortunately, the misuse and abuse ofpharmacologically active substances have become so widespread in present day sports thatthe safety, the health and the longevity of far too many athletes are now compromised. In asense, the initial pursuit of the sporting activity has been perverted.

Even the youngest athletes, both professionals and amateurs, have not been spared. Theirtrainers, physicians and other assistants have already given them countless pills, tablets,ointments, injections, vitamins and other potions. The goals are numerous: to stimulate, tocalm, to numb the pain caused by a wound, to enhance performance, to reduceinflammation, sometimes to suppress anxiety. As a result, many athletes have come tobelieve that successful development in the world of sports is impossible withoutpharmacologically active substances. There are not many drugs that such athletes wouldn'ttake in order to improve performance, to feel calm or to feel better. Some people say that issimply impossible to resist

It is thus essential that all athletes, beginners and professionals alike, fully understand thatthe use of a forbidden substance may have severe consequences. Indeed, athletes oftenhave no knowledge about the immediate and delayed toxic effects of many medical drugs.On the one hand, it has become very easy to obtain both approved substances and illicitdrugs. On the other hand, the seemingly medical information that is available is often ofpseudo-scientific nature. As a result, it has become difficult to differentiate acceptablepractices from hazardous techniques. In writing this document, our wish was to provide thereader with simple and straightforward information, based on our current objectiveunderstanding of the relationship between the principal doping substances and theoccasionally toxic side effects commonly observed in cases of abuse and utilization outsidethe commonly accepted medical context.

According to G.-I. Wadler et B. Hainline (authors of Lathlte et le dopage, drogues etmdicaments (The Athlete and Doping, Drugs and Medication), Collection Sport etenseignement, Editions Vigot, Paris, 1993), athlete doping and drug addiction have theirroots in pharmacological research aimed at improving athletic performance with ergogens.Conversely, doping testing in athletes is an attempt to prevent any artificial ergogenadvantage conferred by an illicit drug, as well as the associated immediate or delayed impacton the athletes health.

An athlete consumes ergogens to gain an advantage in the face of physical and emotionalchallenges in a sports competition. However, as seen in the table below, the advantages


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conferred by a particular substance must be seriously evaluated in terms of the performance-health damage ratio.

Because of practical, legal and ethical considerations, it is difficult to evaluate the effects thata substance may have on an athletes performance. Indeed, one cannot carry outpharmacological experiments on healthy individuals without a therapeutic justification.Moreover, volunteers cannot be subjected to the same conditions experienced by athletes

engaged in doping. This limitation is explained by the fact that the levels of drugs that areused in doping are 10-, 50- and sometimes even 100-fold higher than the acceptedtherapeutic values. The cheaters do not seek the therapeutic activity of a substance butsecondary effects that appear only at levels that are never reached during normal treatment.Finally, it is usually difficult to extrapolate the standard pharmacological parameters becauseof many variables, such as the degree of purity of the drug, mode of intake, the dose-response effect and the relation between time of intake and time of effort.

There are three main categories of drugs that are used by athletes today :

1. Ergogen substances or techniques that are aimed at improving performance. Typicalexamples include testosterone, anabolic steroids, stimulants such as amphetamines, andpeptide hormones such as growth hormone and erythropoietin.

2. Medical drugs. This category includes substances prescribed for treating specific medicalconditions and that are used in manners that are contrary to conventional clinicalpractice.

3. Uncontrolled substances sold on the open market for recreational purposes or pleasure.This category includes illegal drugs or drugs that are taken at very high doses relative tostandard prescription levels. The result is a modification in the mood and in theperception of the athlete.

List of substances and associated side effects:

The list presented below includes the main substances or classes of substances that causewell documented side effects on the human organism. The knowledge about certain PFCs isstill very fragmentary and we have omitted them form our compilation. Moreover, besides thesubstances listed here, there are many other pharmacologically active compounds ormedical drugs that also have sepcific side effects (see J.-P. de Mondenard : Dictionnaire dessubstances et procds dopants en pratique sportive (Dictionary of doping substances andbehaviors) ; Editions Masson, Paris, 1990). It is important to realize that the substancespresented here are normally used to treat specific diseases or serious health conditions:they have strong biological activity and are not to be consumed without forethought as if theywere some nutritional supplement, such as vitamins or amino acid concentrates. As a rule,any plan to use a pharmacologically active substance must always be validated by aphysician, who in turn must confirm the rightfulness of the approach, regardless of dosageand the health condition of the athlete.

ACTH or Corticotrophin

ACTH is used in an attempt to increase the corticosteroid levels in the blood, and to producethe associated euphoric effects on the organism. The use of these products may cause anallergic reaction, in particular in individuals that have a predisposition towards asthma,urticaria, eczema, etc. Drug injections can cause severe reactions, such as anaphylacticshock. Undesirable side effect of ACTH include many different reactions such as:


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Water retention, edemaHyperglycemia

Blood hypertension

Modification in the psyche

Osteoporosis

Decrease in resistance to infections

Amphetamines

Amphetamines were first synthesized in 1887. In addition to their principal effects,amphetamines have different activities on different levels, mediated by more or less specificreceptors in the organism. The desired effects include a sense of well-being, a decrease inthe perception of fatigue, an increase in self-confidence, in motor function and a decrease inappetite.

In contrast to anabolic drugs which are used during the athlete's training, amphetamines areusually consumed just prior to competition. Indeed, there are no positive long term effects. In

fact, most of the main pharmacological effects of amphetamines resemble those of cocaine.One athlete may want to increase his concentration and awareness, another one willconsume massive doses to become more aggressive and develop endurance, and a runner,for instance, may feel ready to deploy more instant energy and speed.

An individual may be inclined to increase the doses of amphetamines to obtain the samestimulating effects experienced in the very beginning. This results in rapid addiction. Theinitial use, the extended use and high-dosage use of amphetamines may all provoke severeside effects, as shown in the table below:

Acute or early onset side effects Chronic use side effects

Average Severe

Impatience Confusion Addiction

Vertigo Fights Weight loss

Tremors Delirium Psychosis

Irritability Paranoia Paranoid deliriumInsomnia Hallucinations Dyskinesia

Euphoria Convulsions Behavioral disorders :compulsive / stereotypical /repetitive

Uncontrolled movements Cerebral hemorrhage Vascularity

Cephalgia Angina pectoris / infarction ofthe myocardium

Neuropathies

Palpitations Blood hypertensionAnorexia Circulatory collapse

Nausea

Vomiting

A brutal withdrawal after repeated use of amphetamines may result in chronic fatigue,lethargy, somnolence and depression.

An amphetamine user may display the following external signs:


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Changes in one's judgement capacityRepeated occurrence of wounds

Increase in recuperation time

Side effects that penalize a sports activity (see above)

Repeated variations in the mood (stimulation of anxiety)

The face of amphetamine: external signs of the amphetamine user- Facial expression of anxiety- Pinched nose- Dilated pupils- Teeth grinding (bruxism)- Dry mouth- A nauseous state- Paleness of mucous membranes and on the finger tips (nails)- Cold extremities- Goose bumps- Sudation- Palpitations- Accelerated or lowered heartbeat

- Hyper or hypotension- Erection- Loss of vision in the absence of visible eye alterations (amaurosis)- Nervousness- Tics: frequent touching of one's face- Disorientation relative to people and places- Mistrust of one's entourage and the impression of being constantly watched- Incoherent speech- Violent acts- Psychosis (severe personality problem which alters the perception and understanding of

reality)Addiction

The habit is essentially psychological

There is a tendency to use dangerous associations of medical drugs

Anabolic substances (steroids)

This class of doping substances includes all steroids that possess anabolic properties,meaning that they cause an extensive increase in the muscular mass. This effect is neverisolated: a more or less pronounces androgen activity is also present. This chapter alsodeals with testosterone.

These ergogen substances are generally used without interruption and during several weekspreceeding a competition. The preferred method is "piling up" oral ingestion and injections.The amount of the substances used exceeds dramatically the standard doses recommendedin a therapeutic procedure.

There has been a report of an athlete diagnosed with AIDS and whose sole risk factor wassharing needles to inject anabolic steroids. It is not uncommon to discover that anabolicsteroids bought on the black market have not been adequately sterilized and are deliberatelymislabeled. The possible complications arising from the use of such unknown and impurepreparations are unimaginable.


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The side effects associated with the use of anabolic steroids have been scientificallyobserved and documented:

Anomalies in the function of the liver

Benign and malignant liver tumors (liver cancer)

Hypercholesterolemia (excessive blood cholesterol levels)Prostate Adenocarcinoma (prostate cancer)

Hypertension spells

Infarction of the myocardium

DiabetesSleep apnoea syndrome

Hypogonadotropic hypogonadism and testicular atrophy (decrease in the size of testicles)

Azoospermia (disappearance of sperm in the semen), reversible sterility

Feminization : gynecomastia(breast development in men) and high-pitched,castrato-likevoice

Behavioral modifications (aggressiveness, groundless violence) psychiatric troubles(addiction to anabolic products)

Humoral immunity problems

Acne

Muscular ruptureHair loss

Premature suture of the epithelial cartilage in the prepubescent child which results in anarrest of growth in the young athletes.

Irreversible virilization or masculinization in women- Husky voice (which can also become screeching)- Hirsutism : appearance of body hair in regions that are normally hairless (face, regions

between and around nipples, back, shoulders, the back of thighs, infra-umbilical andintergluteal regions): the average life span of body hair is two years and excessive bodyhair may sometimes appear as late as one year after the end of hormone absorption

- development of male pattern baldnessVirilization of the female fetus

In addition to the above-mentioned symptoms, there are subjective reactions to the intake ofanabolic substances:

Modifications in sex drive (increases and decreases)

Fainting and vertigoHeadaches

Lethargy or excessive aggressiveness

Psychiatric effects: steroid-induced rage or spells of extreme violence

Tics

Dependence

Non steroid anti-inflammatory drugs (NSAIDs)

Severe undesirable side effects of NSAID drugs are rare. The common side effects includeirritations and bleeding of the gastric mucous membranes.

The other undesirable effects are :

Skin eruptions

Ear ringing


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Edemas

Bronchial spasms

Sever diarrhea is a classic side effect of mefenamic acid (Ponstan).

Asthma and sports, see Ephedrine, beta-2 stimulants and corticosteroids

Barbiturates et Benzodiazepines

Barbiturates such as benzodiazepines and alcohol are usually not considered as ergogendrugs.However, there is scientific evidence that barbiturates and benzodiazepines may havebeneficial effects in some specific situations. Indeed, both substances are effective inreducing tremors, which is important in some easily identified sports activities. This soothingaction has been extensively studied in cases of epileptic spells.

The side effects of theses substances are significant:

Sedation

Reduced acuteness of vision

Lowered vigilance (very important when driving a motorized vehicle)

Problems with walking and keeping balance

Decrease in memorization capacityEuphoria

Withdrawal insomnia

Dependence

Tolerance

Clinical withdrawal syndromeRespiratory distress

Coma

Beta-blockers

The undesirable effects of beta-blockers stem from their inhibitory properties. Asthmasufferers in particular should avoid products belonging to this category since they can causebronchial spasms. Certain beta-blockers, such as propranolol, may cause insomnia,nightmares and even a depression syndrome.

Some male users also experience sexual difficulties, such as impotence and weakened

erection.

The use of beta-blockers should be strictly prohibited in case of asthma, cardiacinsufficiency, digestive tract hemorrhages, occult bleeding, significant bradycardia (above 50heartbeats per minute) and insulin-dependent diabetes.The following undesirable effects are observed when these drugs are used :

Hypoglycemia

Troubles with digestion


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Asthenia

Cramps

Cephalgia, vertigo, diplopiaRaynauds disease : circulation problems in the extremities upon exposure to cold ; thefingers turn pale

Insomnia, nightmares

Mood alterations (depressive tendencies) and changes in the libidoHypothernia

Cardiac insufficiency

Cardiac rhythm problemsAnaphylactic shock after a hymenoptera sting (bee, wasp, etc.)

Numerous drug interactions

Caffeine

Caffeine resembles cocaine and amphetamines in that it essentially stimulates the centralnervous system in a dose-dependent fashion. Caffeine is known to have many deleteriouseffects on the health consulting the table below, one should distinguish the chronic effects ofcaffeine from acute effects following absorption of this stimulant (which may constitutedoping behavior).

Acute intoxication, severe Acute intoxication, lesssevere

Chronic intoxication

Peptic ulcer Nervousness, excitation Increase in cholesterolemia

Delirium Irritability Increased risk of ischemiccardiopathy

Convulsions Insomnia Teratogenic activityComa Tachycardia Carcinogenic activity

Arrhythmia Blood hypertension Risk of breast fibrocysticlesions

Palpitations Problems with digestion , inparticular when coffee ismixed with milk

Death (the lethal dose isapproximately 6 litersdepending on the brewingstrength of coffee or caffeinecontent of the liquid)

Headaches

Tremors

Exaggerated fear or anxietyIncreased levels ofcholesterol and higher risk ofheart attack

Cannabis (Marijuana, Hashish, Kif, )


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Cannabis has been cultivated for centuries but cannabis-derived products have beenavailable world-wide only starting second world war. The interest in this plant stems from itspsychotropic properties. Most countries consider cannabis as an illegal drug. Over the recentpast, the quality of the drug has improved dramatically : the levels of active substances inplants bred nowadays are 10- to 30-fold higher than 15 years ago. Hence, it is difficult to stillconsider cannabis as a harmless product. Indeed, certain preparations found on the presentday market are extremely potent. Consequently, there is a corresponding increase in the

principal undesirable side effects which are listed below :

Psychiatric effects Cardiovascular effects

Panic attacks Tachycardia

Delirium Orthostatic hypotensionPsychosis Increase in carboxyhemoglobin

Loss of motivation syndrome

Broncho-pulmonary effects

Immunological effects

Rhinitis

Decrease in cellular immunity Pharyngitis

Decrease in monocyte maturity BronchitisBronchial spasms

Endocrinological effects Squamous bronchial metaplasia

Pulmonary fibrosis

Decrease in sperm production Pneumomediastinum

Inhibition of ovulation in women

Gynecomastiain men

Negative effects affecting performance

Increase in recuperation time after exerciseand in the duration of muscle aches .

Bloodshot and light-sensitive eyes

A faster onset of fatigue during exercise Mood hyper-instability: rapid switch fromeuphoria to depression

Acceleration of cardiac rhythm HallucinationsEnhanced feeling of thirst Deterioration in vigilance and coordination :

dangerous when driving a vehicle !

Loss of motivation

Cocaine

Cocaine abuse in the adult represents a significant risk. Competition merely increases thecardiovascular side effects through cardiac hyper-stimulation accompanied by arrhythmiaand heart attacks.

The principal side effects caused by cocaine are listed in the table below :

Cardiovascularcomplications

Cerebrovascularcomplications

Neuropsychiatriccomplications

Ventricular arrhythmia Cerebral infarction Convulsions

Sudden death Brain Hemorrhage Exacerbation of the Gilles dela Tourette syndrome


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Angina pectoris Meningeal hemorrhage Cephalgia

Infarction of the myocardium Transitory cerebral ischemia Visual scotoma

Aortic dissection BlindnessMyocarditis Optical neuritis

Tachycardia gyneco-obstetricalcomplications

Habit formationPremature detachment ofplacenta

Insomnia

Ear-Nose-Throatcomplications

Spontaneous abortion Mental confusion

Congenital malformations Aggressiveness

Osteolytic sinusitis Transplacental or milk-mediated Mother-infanttransfer and secondarywithdrawal syndrome

Paranoid delirium

Necrosis et perforation of thenose septum

Visual and tactilehallucinations

Loss of sense of smell Repetitive behaviors

Miscellaneouscomplications

Stereotyped movements ofthe mouth and tongue

Complications related todrug addiction

Liver toxicity Anorexia

Gastrointestinal ischemia Specific deliriumHIV infection Pneumomediastinum Thymic troubles linked to

hallucinogens

Bacterial infections Hyperthermia Sex problems

Viral hepatitis

Codeine, opiates and othermorphine derivatives

The use of pain killers is frequent in sports, especially among athletes engaged in violentactivities (such as boxing for instance). Often, the fear of losing a place or not fulfilling acontractual obligation leads to an obsession to keep the fight in spite of any type of wound orhandicap. The most common effect of this class of substances is sedation, providing habitualdoses are used. One must be aware of physical and psychological addiction induced bymany opiates which are justly classified as narcotics:

Nausea

VomitingVertigo

Memory loss

Mood problems

PruritusConstipation

Delirium

Convulsion crises

AddictionWithdrawal syndrome


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Corticosteroids

As seen in the table, the undesirables side effects associated with these substances are sosevere that they should never be administered in the absence of a medical imperative:

Hydro-electrolytic imbalance leading to edemas and increase in body weight

Increase in glycemia (blood sugar levels) and appearance of glycosuria (presence of glucosein the urine)Increase in blood pressure

Decrease in antibodies and natural defense mechanisms leading to higher susceptibilitytowards infections

Gastric pyrosis (heartburn and regurgitation) and gastrointestinal ulceration

Diffuse osteoporosis with an increased risk of fractures and delayed bone repairAlterations in the walls of blood vessels with possible formation of blood clots leading toembolism

Decrease in muscle nutrition, risk of severer muscular atrophy

Eye disorders : keratitis, glaucoma, cataractDangerous effects on the fetus

Disorders of the nervous system: convulsions, muscular cramps

Psychiatric disorders: mood alterations, insomnia, sometimes even genuine maniac-depressive psychoses

Decrease or even arrest in the growth in young athletes

Diuretics

All diuretics have the same side effects: dehydration, hypovolemia, muscular cramps, andorthostatic hypotension. Biochemical shifts in potassium levels (kaliemia) may be lifethreatening if strong modification are induced by diuretics.

Ephedrine (and phenylpropanolamines)

They are present in many innocuous pharmaceutical preparations used to treat benignconditions such as a cold. One must be very cautious in examining this class of substancessince there are over 50 derivatives which have similar effects. The table shows the acuteside effects caused by ephedrine analogs (effects are ordered by severity)

Moderate effects Severe effects

Nervousness Agitation

Irritability Confusion

Insomnia ParanoiaAnorexia Mania

Vertigo HallucinationsCephalgia Ictus / Transitory ischemic attack

Tachycardia Cerebral vascularisation

Palpitations Cerebral hemorrhageSlight increase in blood tension Severe hypertension

Myocardial ischemia

Intolerance reactions Ventricular arrhythmia

Rhabdomyolysis

Should never be combined with an anti- May cause convulsive crises in epileptics


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depressant

Erythropoietin

This peptide hormone is used in medical practice in cases of severe anemia and duringtreatment of chronic renal insufficiency, such as in dialysis patients. In each case, there is aspecific evaluation of the benefits vs. the dangers of this type of treatment. The first clinicaltrials involving erythropoietin started in 1985 and it is hence premature to draw a clear pictureof the side effects. Nevertheless a few undesirable consequences have already beenidentified:

Hypertension thrusts when the substance is introduced too rapidly

Vascular thrombosisConvulsions

Influenza-like symptoms, bone aches et shivering following the injection

Skin reactions, Allergy-like edema at the site of injection

Polyglobulism

Chorionic gonadotropin (hCG)

This natural product is classified as a stimulant because it causes an increase in theproduction of endogenous testosterone. The associated dangers depend on dosage andvary according to sex:

In women In men

Salt retention Allergic manifestations

Ovarian hyperstimulation and risk of multiplepregnancies

Nausea, vomiting

Ovarian cysts Novel distribution of fat throughout the bodyGynecomastia and possible secretion of milk

Hypercoagulability See also the chapter on anabolic drugs

Pregnancy

In terms of doping, the desired effect is the increase in cardiac capacity during the firstmonths of pregnancy. Later there is an increase in blood volume, in the number of red bloodcells and in hemoglobin. Apparently the resulting enhancement in oxygen delivery to themuscles translates into a 10% increase in the deployment of effort.

The risks stem from the vulnerability of the fetus starting with the third month of pregnancy.

A abortion planned after the key competition represents a significant danger for the woman ifit is carried out in a non-medical environment by unexperienced hands. There may also be agreat psychological impact.

Growth hormone (somatotropic hormone or somatotropin)

Uncertainties remain about the safety of exogenous hGH as a therapeutic treatment. We stilldo not know what influence it may have on normal individuals, even though there is a good


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deal of information about side effects of endogenous hGH hypersecretion in acromegaly. This condition has an associated 50% mortality at age 50 and 89% mortality at age 60.

The table below summarizes the side effects linked to the presence of high hGH levels in theadult (the same side effects are noticed in children; in addition, there is an occurrence ofgigantism due to the increase in the linear growth of bone tissue).

Tumefaction of soft tissue (may be irreversible)Hypertrophy and bone protuberance (may be irreversible), arthritis, induced acromegaly

Thickening of the skin

Hirsutism (hair growth over the entire body)

Hypersecretion of sebaceous glandsIncrease in perspiration

Peripheral neuropathies

Myopathies

Hypertrophy of the viscera : spleen, salivary glands, liver, kidneys, heartColon polyps

Cardiovascular diseases such as coronary disease, cardiomyopathy and blood hypertension

Glucose intolerance / diabetes mellitus

There have also been reports of the development of anti-growth hormone anti-bodies afteradministration of exogenous growth hormone. This causes an interference with endogenoushormone activity and necessitates an immunological surveillance. In order to avoidhyperglycemia, it is also necessary to monitor blood glucose levels. An injection of thishormone affects very fundamental processes of regulation. It may upset the balance ofthyroid and corticotropic hormones, which will have a major impact on the individual's health.

One should point out that a bovine growth hormone may be found on the market and that ahorse growth hormone may soon become available as well. These substances have noactivity on the human organism but they may cause an irreversible sensitization which canlead to severe consequences (anaphylactic shock) if the exposure is repeated. Yet anothertype of hormone may be found on the black market: the extractive growth hormone. It is

actually extracted from the pituitary gland of corpses. In this particular scenario, the industrialmethod used to purify the hormone does not guarantee the removal of other biologicalmolecules such as prions. Based on the well-known scenario of contamination that led to themad cow disease, which is transmitted by a prion, one cannot exclude a similarcontamination by a prion present in an extractive hGH preparation from an individual thatdied from the Creutzfeldt-Jakob's disease. This type of encephalitis, believed to be causedby an infectious agent resembling a slow virus, has an incubation period in humans that isclose to 15 years !

Insulin (and diabetes)

Insulin causes hypoglycemia. If the organism does not produce insulin in sufficient amounts,as is the case in certain types of diabetes, additional insulin is injected to reach normalphysiological balance. In this scenario, physical sports activities are entirely acceptable.Unfortunately, this state of balance is so difficult to maintain that many physiciansrecommend that diabetics abstain from any serious physical activity, especially sports thatdemand a high energy input. The international sports regulating bodies prohibit the non-therapeutic use of insulin for one main reason: insulin induces growth hormone release. Initself, insulin causes a number of side effects some of which are listed below:

Tremors, sweat, anxiety, agitation


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Asthenia, hypothermia, cravings

Cardiovascular problems, infarction of the myocardium

Anaphylactic shock, insulin allergyNumerous drug interactions (it is absolutely necessary to consult a physician because thereare many dangerous associations)

Alcohol consumption should be restrained, since it enhances hypoglycemia and may lead to

a hypoglycemic comaOverdose: hypoglycemia may result from poorly estimated insulin dosage, a mistake infeeding or a unforeseen physical effort that is not compensated. The symptoms ofhypoglycemia include hunger, sweat, asthenia, tremors, confusion, problems with vision,headaches, etc). Unless treated promptly, hypoglycemia may result in a coma.

Nicotine

In the present context, we will only deal with the toxic effects of passive smoking. Indeed,athletes do not consume tobacco in large amounts (passive smoking, in a closed spaceshared with smokers, is a marginal toxicological occurrence in terms of doping behavior). Onthe other hand, chewing tobacco or snuff are popular practices in certain countries which

often cause serious diseases.

Periodontal decay

Teeth abrasion

Hyperkeratosis of the mouth mucous membranesGingivitisLeukoplasia

Anomalies of the sense of taste : dysgeusia

Problems with olfaction : dysosmia

Spinocellular epithelioma of the oral cavityDependence and withdrawal syndrome

Halitosis: bad breath

PFCs (Perfluorocarbons)

These substances are all composed of fluorine, carbon and hydrogen atoms, but haveimportant structural differences. Unlike erythropoietin, all PFCs are synthetic and hencenever occurr naturally in the organism. Although they are in principle inert molecules, PFCscan dissolve large quantities of gas, including oxygen. Various PFC preparations (emulsionscontaining egg yolk lecithin or phospholipid) are currently undergoing clinical tests. The goalis to provide temporary oxygen supply to the brain and other tissues in patients that have lostimportant amounts of blood and whose vital functions are in danger. Little is known about thelong-term effects of these substances on the human organism. The toxicity of repeatedtreatment is also unclear in situations other than extensively invasive surgical operations. In

terms of tolerance by the organism, the physical and chemical state of the preparation is asimportant as its biological purity. Indeed, intra-venous injection is the only means to makePFCs participate in gas exchange. The clinical preparations currently tested have been foundto have the following side effects:

Increase in body temperature above 40C, fever et cold

Diarrhea

Kidney, liver and lung toxicity; the lesions are probably irreversible in most cases


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Blood infections if the preparations are bacteriologically impure

Embolism and thromboses (thrombocytopenia)

Risk of Aids virus transmission if needles are shared

Because of the lack of published scientific evidence, it is a completely unconscious act toattempt to use PCFs outside of the specific clinical context described above. this is true evenif the patient is closely and continuously monitored. Unfortunately, the world of sports is alsoinhabited by unscrupulous hotheads who do not worry about the aftereffects of their"experiments" on the "human guinea pigs". A hospital context is quite different from a sportscontext. One can imagine for instance that PCFs, which already very volatile at ambienttemperatures, may form gas bubbles once injected into the blood vessels. Indeed, anincrease in body temperature is inevitable during intense physical exercise, the warm seasonor upon long exposure to the sun. Given the current state of knowledge, one must absolutelyrefrain from using these products in the absence of close and extensive medical surveillance.

Probenecid

This substance is used to mask the use of doping substances, anabolic drugs in particular,

by delaying their elimination. The medical application of Probenecid is to treat goutrheumatism. It may cause the following undesirable effects:

Cephalgia

Anorexia

Nausea

Stomach achesVertigo

Frequent micturition

Anemia

Possible anaphylactic-like reactions with feverDermatitis and other skin irritations

Blood procedures (see also Erythropoietin)

Because of possible HIV infection, blood transfusions performed outside a hospital contextare simply too dangerous to be even considered as an option. This is common knowledge. Itis important to emphasize the risk of a shock if the donor and the recipient are incompatible.While homologous transfusions are safer, they also represent a significant hazard. Onlymedical surroundings can ensure the absolutely sterile conditions required by transfusion.

Testosterone : see Anabolic drugs

Vitamins

An excessive uptake of vitamin leads to well known side effects which vary with eachvitamin. The following effects are worth mentioning:

Diarrhea

Nausea


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Urticaria

Muscular weakness

FatigueCephalgia

Anorexia

Blood hypertension

Cardiac ArrhythmiaCirrhosisTeratogen activity

Conclusions

The conclusion is clear: one should never use medication or pharmacologically activesubstances without appropriate advice from a physician. If the medical drugs available todayare very potent and effective in treating disease, they also strongly affect healthy individualswhich may be tempted to use them, even though there is absolutely no therapeutic need.One must never forget that the side effects of a drug are always present but that the

beneficial effects are felt only in case of a disease that has to be treated. The magnitude ofthe side effects is of course dependent on the amount of the drug that is consumed.Unfortunately, this amount is often excessive. The athlete that relies on doping is underpressure to obtain quick results. Naturally, there is a strong temptation to increase the dosesto really push one's luck. We wish to emphasize yet another point: it is necessary to checkthe purity of all substances of uncertain origin. Some products on the black market aregrossly mislabeled and preparations for injection are often contaminated with bacteria oreven viruses. In such cases, there is a significant risk to develop a serious condition and puta definitive end to one's athletic career. Clearly, the game of doping is not worth playing.

Glossary of principal medical terms:

(The majority of the definitions below are taken from the Dictionnaire franais de Mdecine etde Biologie en 4 volumes (French Dictionary of Medicine and Biology in 4 Volumes) A.Manuila, L. Manuila, M, Nicole et H. Lambert. Paris : Masson, 1971)

Anaphylactic shock The combination of acute morbid manifestationsresulting from the reintroduction of a particularsubstance into an already sensitive organism.This shock may be an extremely dramatic eventleading to imminent death, or to a giant urticariawith congested respiratory mucous membranes(asthma). Anaphylactic shock often occurs insensitive individuals following injections of

therapeutic sera, allergens, peptide hormones,or penicillin, etc. or after insect bites.

Anemia Individual or combined decrease below normallevels in the number of red blood cells per cubicmilliliter of blood, in the hematocrit or inhemoglobin. Anemia may show various generalsymptoms: paleness of skin and of mucousmembranes, nervous disorders (fainting, vertigo,etc), dyspnea, tachycardia, digestion problems.


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It may be caused by a hemorrhage, hemolysis(extensive destruction of red blood cells), adeficiency (in protein, vitamin B12, etc.), adisorder interfering with red blood celldevelopment (infectious diseases, effects oftoxic substances, etc.), or a congenital illness.

Angina pectoris A painful constructive syndrome, whichdevelops as a crisis during a specific effort or awalk. It is localized in the retrosternal region andmay irradiate into the shoulders, arms, and jaws.It causes severe distress and an interruption ofeffort. Coronary arteriosclerosis is the mostcommon etiology. The pain is caused by thereduction of blood flow to the heart. Possibleoutcome includes chronic angina pectoris,sudden death, heart attack, and progressivecardiac insufficiency.

Anorexia A partial or complete loss of appetite.

Aortic dissection Formation of a pocket within the wall of an arterycaused by the splitting of the internal membraneof the vessel and subsequent intra-pericardialhemorrhage (synonym: dissecting aneurysm ofthe aorta). The associated pain is intense andviolent. Survival is rare.

Arrhythmia Irregularities in a rhythm. By extension, ananomaly in the heart rhythm resulting in irregularheart beats.

Arthritis Inflammation of a joint. May be acute or chronic.

Asthenia Weakening of the general state of health, of thefunctions of an organ or a system. Decrease inthe vitality of an organism.

Carboxyhemoglobin The form of hemoglobin which fixes carbondioxide thus allowing the transport of this gasfrom various tissues to the lungs.

Cecity Blindness.

Cephalgia Diffuse or widespread pain located in the cranial

region, and exacerbated by external factors(light, noise, jolts), internal factors (emotions,intellectual effort) or movement and physicaleffort.

Cholesterolemia Concentration in cholesterol of the circulatingblood, usually measured in grams per liter ofserum. Normal values oscillate around 2.5grams per liter of serum. Pathological valuesmay point to various metabolic disorders and


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liver diseases.

Circulatory collapse Side effect linked to a collapse in blood pressureand a significant slow-down in blood circulation.Also called cardio-circulatory collapse. Thesymptoms are prostration, loss ofconsciousness, cold sweat, rapid, weak and

occasionally indiscernible pulse. Could lead todeath if it isnt treated.

Cirrhosis Term invented by Laennec to describe thedisease which causes reddish granulation in theliver. This liver sclerosis may have manydifferent origins (alcohol intoxication,malnutrition, viral hepatitis, etc.). It results inliver insufficiency.

Dependence A state resulting from periodic and repeatedabsorption of a psychotropic substance (such asnarcotics, anabolic and related substances).The subject feels the need to continue drugintake and to increase dosage to reach thesame or more pronounced effects. Aninterruption in consumption leads to awithdrawal syndrome which is more or lesssevere, depending on the substance.

Dermatitis Skin inflammation. More generally, a skindisorder which may not be inflammatory innature.

Drug interactions Influence of two or more medicinal substanceson the biochemical phenomenon at the basis oftheir mode of action. Drug interactions can bebeneficial, additive, multiplicative or detrimental.

Dyskinesia Any disruption of movement: absence ofcoordination, spasms, tremors, etc.

Epithelioma Malignant cancerous tumour formed by theepithelium (one of the skin tissues).

Ergogen Which lies at the basis of and improves theefficiency of muscular work.

Gynecomastia In men, hypertrophy of mammary glands

(breasts).

Hemorrhage A more or less important discharge of bloodfrom a blood vessel.

Hypercoagulability Increase in the normal ability to coagulate of abiological fluid, mainly blood.

Hyperglycemia Increase in the amount of glucose in blood.Depending on the measurement method used,


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the increase is considered significant above 7.8mmol/L. With the exception of transienthyperglycemia caused by food ingestion, cold,emotions and altitude, most occurrences arepathologic and involve the pancreas (diabetesmellitus), the hypophysis (acromegaly) or theadrenal gland (tumours).

Hypoglycemia Decrease in the amount of sugar in blood ,below the threshold of 2.8 mmol/L. A medicinalcause for hypoglycemia usually involvesexcessive insulin absorption.

Hypovolemia Decrease in the volume of circulating blood.

Ictus In neuropathology, a sudden morbidoccurrence.

Ischemia Decrease in blood flow to a particular part of theorganism. It can be caused by avasoconstriction, an obstruction or arterialcompression.

Ischemic cardiopathy A disease caused by a low blood flow to theheart.

Keratosis More or less pronounced thickening of skinepidermis.

Lethargy Pathological state of prolonged and deep sleep,which can be avoided by the affected individualonly partially and during brief periods of time. Anapparent state of death, but without loss of vitalfunctions, which may last a few hours or severalyears.

Micturition Urination.

Motor function The sum of activities carried out by the organismnecessary for motion

Myocardial infarction Necrosis of the cardiac muscle, caused by anacute coronary thrombosis, and involving one orseveral limited, isolated foci. The overall clinicalpicture is more or less dramatic, with a

prominent characteristic pain and a drop intension. The affected person is at all timesexposed to lethal complications.

Myocarditis Acute or chronic inflammation of the heartmuscle (myocardium). It may be caused by aninfection (bacteria, viruses, parasites, fungi),chemical or medicinal agents, or other factors.The symptoms are variable. Frequentmanifestation include tachycardia, palpitations,


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signs of cardiac insufficiency, and muffledheartbeat sounds during auscultation, includinggallop rhythm.

Neuropathy A disorder affecting the central or peripheralnervous system. Usually degenerative.

Optical neuritis An inflammatory disorder of the optical nerve.

Orthostatic hypotension A drop in blood tension measuring 2 cm ofmercury or more, which takes place during thetransition from decubitus (horizontal, restingposition) to a standing, vertical position.

Osteolytic sinusitis Inflammation of the mucous membranes of thefacial sinuses. This type of sinusitis may befrontal, maxillary or sphenoidal. There are acute,chronic, purulent or non-purulent forms.Osteolytic sinusitis has a destructive action onthe proximal bones.

Osteoporosis A bone lesion characterized by the thinning andrarefaction of bone traveculae which isvisualized as a decrease in the radiologicalopacity of the skeleton. Localized or diffuseosteoporosis implies the weakening of bones.

Ovarian cyst A benign tumor of the ovaries of variable sizeand of many types.

Paranoia (paranoid delirium) From the times of Hippocrates and through theMiddle Ages, paranoia was a synonym of mentaldisease. Until the 1920's and under theinfluence of the German school, paranoiareferred to mental disorders affecting theintelligence, as opposed to emotions. Today, itdesignates a hallucinatory or interpretativesystematic delirium.

Pharyngitis Inflammation of the pharynx (schematically, thepharynx corresponds to the respiratory tractbetween the mouth and the lungs on the onehand, and the tract between the mouth and thestomach, on the other hand). Pharyngitis mayhave many causes (influenza, common cold,

other viral diseases, intoxication, etc.). Theclinical manifestations involve signs of localirritation (feelings of dryness, burns, irritations,etc.).

Pneumomediastinum A rare condition caused by physical efforts ofdifferent nature and first described by Laennecin 1837. It corresponds to the presence of air inthe mediastinum (a region located in the medianpart of the rib cage, between the two lungs).


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Polyglobulism Increase in the number of circulating red blood

cells resulting in a higher corpuscular volume,higher levels of hemoglobin and increased bloodviscosity.

Pruritus An itchy skin feeling caused by a skin disease, a

general disorder or an allergic reaction to aforeign substance.

Pulmonary fibrosis Pathological formation of fibrous tissue in thelungs. The clinical signs include irritated cough,halting respiration and cyanosis. The outcome isinvariably fatal.

Respiratory distress A decrease in the extent of respiration that canlead to death.

Rhabdomyolysis Muscle breakdown caused by an exceptionallyintense physical effort or intoxication. It resultsin abnormal levels of myoglobin in the urine(synonym: paroxystic myoglobinuria).

Rhinitis Catarrhal inflammation of the nasal mucousmembrane, sometimes a synonym of a cold.

Side effects The effect of a medical drug which is not relatedto its primary activity or therapeutic effects. Byextension, all undesirable and often toxic effectsof medication.

Squamous bronchial metaplasia Transformation of the alveolar lung tissue. It isoften linked to an inflammatory process andimplies a pre-cancerous state.

Tachycardia Acceleration of the heart rate above 100 beatsper minute.

Teratogen Which causes deformities.

Thrombosis Formation of a firm or gelatinous mass inside ablood vessel or a heart cavity , which causescomplete or partial obstruction.

Tolerance The capacity of the organism to tolerate physicalor chemical aggressions, without apparentdamage. Tolerance may be acquired afterrepeated exposure to a particular medicine.

Tumefaction Any increase in the size of a cell, a tissue, anorgan or an organism. Usually pathological.

Urticaria Skin condition characterized by the eruption ofpinkish or whitish papules, accompanied by a


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burning sensation. The cause is often anallergy (sensitization of the organism to medicaldrugs, parasites, physical agents, etc.).

Vasculitis Inflammation of blood vessels.

Visual scotoma Blind spots in the field of view which correpond

to insensitive regions of the retina. The usualcause is a lesion of the opitcal nerve.

doping and side effects

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