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 Swiss Institute of Doping Analysis, Martial SAUGY, Ph.D., biochimiste, Technical Director of 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 with the expression of perfection of the human body and its movement. There are no sports which involve a course on pharmacology. Unfortunately, the misuse and abuse of pharmacologically active substances have become so widespread in present day sports that the safety, the health and the longevity of far too many athletes are now compromised. In a sense, the initial pursuit of the sporting activity has been perverted. Even the youngest athletes, both professionals and amateurs, have not been spared. Their trainers, physicians and other assistants have already given them countless pills, tablets, ointments, injections, vitamins and other potions. The goals are numerous: to stimulate, to calm, to numb the pain caused by a wound, to enhance performance, to reduce inflammation, sometimes to suppress anxiety. As a result, many athletes have come to believe that successful development in the world of sports is impossible without pharmacologically active substances. There are not many drugs that such athletes wouldn't take in order to improve performance, to feel calm or to feel better. Some people say that is simply impossible to resist… It is thus essential that all athletes, beginners and professionals alike, fully understand that the use of a forbidden substance may have severe consequences. Indeed, athletes often have 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 illicit drugs. On the other hand, the seemingly medical information that is available is often of pseudo-scientific nature. As a result, it has become difficult to differentiate acceptable practices from hazardous techniques. In writing this document, our wish was to provide the reader with simple and straightforward information, based on our current objective understanding of the relationship between the principal doping substances and the occasionally toxic side effects commonly observed in cases of abuse and utilization outside the commonly accepted medical context. According to G.-I. Wadler et B. Hainline (authors of L’athlète et le dopage, drogues et médicaments (The Athlete and Doping, Drugs and Medication), Collection Sport et enseignement, Editions Vigot, Paris, 1993), athlete doping and drug addiction have their roots in pharmacological research aimed at improving athletic performance with ergogens. Conversely, doping testing in athletes is an attempt to prevent any artificial ergogen advantage conferred by an illicit drug, as well as the associated immediate or delayed impact on the athlete’s health. An athlete consumes ergogens to gain an advantage in the face of physical and emotional challenges in a sports competition. However, as seen in the table below, the advantages 2 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 that a substance may have on an athlete’s performance. Indeed, one cannot carry out pharmacological 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 are used in doping are 10-, 50- and sometimes even 100-fold higher than the accepted therapeutic values. The cheaters do not seek the therapeutic activity of a substance but secondary effects that appear only at levels that are never reached during normal treatment. Finally, it is usually difficult to extrapolate the standard pharmacological parameters because of 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. Typical examples include testosterone, anabolic steroids, stimulants such as amphetamines, and peptide hormones such as growth hormone and erythropoietin. 2. Medical drugs. This category includes substances prescribed for treating specific medical conditions and that are used in manners that are contrary to conventional clinical practice. 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 to standard prescription levels. The result is a modification in the mood and in the perception of the athlete. List of substances and associated side effects: The list presented below includes the main substances or classes of substances that cause well documented side effects on the human organism. The knowledge about certain PFCs is still very fragmentary and we have omitted them form our compilation. Moreover, besides the substances listed here, there are many other pharmacologically active compounds or medical drugs that also have sepcific side effects (see J.-P. de Mondenard : Dictionnaire des substances et procédés dopants en pratique sportive (Dictionary of doping substances and behaviors) ; Editions Masson, Paris, 1990). It is important to realize that the substances presented 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 they were 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 a physician, who in turn must confirm the rightfulness of the approach, regardless of dosage and 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 produce the associated euphoric effects on the organism. The use of these products may cause an allergic reaction, in particular in individuals that have a predisposition towards asthma, urticaria, eczema, etc. Drug injections can cause severe reactions, such as anaphylactic shock. Undesirable side effect of ACTH include many different reactions such as: 3 Water retention, edema Hyperglycemia 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 specific receptors in the organism. The desired effects include a sense of well-being, a decrease in the perception of fatigue, an increase in self-confidence, in motor function and a decrease in appetite. In contrast to anabolic drugs which are used during the athlete's training, amphetamines are usually 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 will consume 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 same stimulating effects experienced in the very beginning. This results in rapid addiction. The initial use, the extended use and high-dosage use of amphetamines may all provoke severe side 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 delirium Insomnia Hallucinations Dyskinesia Euphoria Convulsions Behavioral disorders : compulsive / stereotypical / repetitive Uncontrolled movements Cerebral hemorrhage Vascularity Cephalgia Angina pectoris / infarction of Neuropathies the myocardium Palpitations Blood hypertension Anorexia 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: 4 Changes in one's judgement capacity Repeated 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 never isolated: a more or less pronounces androgen activity is also present. This chapter also deals with testosterone. These ergogen substances are generally used without interruption and during several weeks preceeding a competition. The preferred method is "piling up" oral ingestion and injections. The amount of the substances used exceeds dramatically the standard doses recommended in a therapeutic procedure. There has been a report of an athlete diagnosed with AIDS and whose sole risk factor was sharing needles to inject anabolic steroids. It is not uncommon to discover that anabolic steroids bought on the black market have not been adequately sterilized and are deliberately mislabeled. The possible complications arising from the use of such unknown and impure preparations are unimaginable. 5 The side effects associated with the use of anabolic steroids have been scientifically observed 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 Diabetes Sleep 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-like voice Behavioral modifications (aggressiveness, groundless violence) – psychiatric troubles (addiction to anabolic products) Humoral immunity problems Acne Muscular rupture Hair loss Premature suture of the epithelial cartilage in the prepubescent child which results in an arrest 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 and intergluteal regions): the average life span of body hair is two years and excessive body hair may sometimes appear as late as one year after the end of hormone absorption - development of male pattern baldness Virilization of the female fetus In addition to the above-mentioned symptoms, there are subjective reactions to the intake of anabolic substances: Modifications in sex drive (increases and decreases) Fainting and vertigo Headaches 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 include irritations and bleeding of the gastric mucous membranes. The other undesirable effects are : Skin eruptions Ear ringing 6 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 ergogen drugs. However, there is scientific evidence that barbiturates and benzodiazepines may have beneficial effects in some specific situations. Indeed, both substances are effective in reducing tremors, which is important in some easily identified sports activities. This soothing action 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 capacity Euphoria Withdrawal insomnia Dependence Tolerance Clinical withdrawal syndrome Respiratory distress Coma Beta-blockers The undesirable effects of beta-blockers stem from their inhibitory properties. Asthma sufferers in particular should avoid products belonging to this category since they can cause bronchial 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, cardiac insufficiency, digestive tract hemorrhages, occult bleeding, significant bradycardia (above 50 heartbeats per minute) and insulin-dependent diabetes. The following undesirable effects are observed when these drugs are used : Hypoglycemia Troubles with digestion 7 Asthenia Cramps Cephalgia, vertigo, diplopia Raynaud’s disease : circulation problems in the extremities upon exposure to cold ; the fingers turn pale Insomnia, nightmares Mood alterations (depressive tendencies) and changes in the libido Hypothernia Cardiac insufficiency Cardiac rhythm problems Anaphylactic shock after a hymenoptera sting (bee, wasp, etc.) Numerous drug interactions Caffeine Caffeine resembles cocaine and amphetamines in that it essentially stimulates the central nervous system in a dose-dependent fashion. Caffeine is known to have many deleterious effects on the health consulting the table below, one should distinguish the chronic effects of caffeine from acute effects following absorption of this stimulant (which may constitute doping behavior). Acute intoxication, severe Acute intoxication, less Chronic intoxication severe Peptic ulcer Nervousness, excitation Increase in cholesterolemia Delirium Irritability Increased risk of ischemic cardiopathy Convulsions Insomnia Teratogenic activity Coma Tachycardia Carcinogenic activity Arrhythmia Blood hypertension Risk of breast fibrocystic lesions Palpitations Problems with digestion , in particular when coffee is mixed with milk Death (the lethal dose is Headaches approximately 6 liters depending on the brewing strength of coffee or caffeine content of the liquid) Tremors Exaggerated fear or anxiety Increased levels of cholesterol and higher risk of heart attack Cannabis (Marijuana, Hashish, Kif, …) 8 Cannabis has been cultivated for centuries but cannabis-derived products have been available world-wide only starting second world war. The interest in this plant stems from its psychotropic properties. Most countries consider cannabis as an illegal drug. Over the recent past, the quality of the drug has improved dramatically : the levels of active substances in plants bred nowadays are 10- to 30-fold higher than 15 years ago. Hence, it is difficult to still consider cannabis as a harmless product. Indeed, certain preparations found on the present day 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 hypotension Psychosis Increase in carboxyhemoglobin Loss of motivation syndrome Broncho-pulmonary effects Immunological effects Rhinitis Decrease in cellular immunity Pharyngitis Decrease in monocyte maturity Bronchitis Bronchial spasms Endocrinological effects Squamous bronchial metaplasia Pulmonary fibrosis Decrease in sperm production Pneumomediastinum Inhibition of ovulation in women Gynecomastia in men Negative effects affecting performance Increase in recuperation time after exercise Bloodshot and light-sensitive eyes and in the duration of muscle aches . A faster onset of fatigue during exercise Mood hyper-instability: rapid switch from euphoria to depression Acceleration of cardiac rhythm Hallucinations Enhanced 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 the cardiovascular side effects through cardiac hyper-stimulation accompanied by arrhythmia and heart attacks. The principal side effects caused by cocaine are listed in the table below : Cardiovascular Cerebrovascular Neuropsychiatric complications complications complications Ventricular arrhythmia Cerebral infarction Convulsions Sudden death Brain Hemorrhage Exacerbation of the Gilles de la Tourette syndrome 9 Angina pectoris Meningeal hemorrhage Cephalgia Infarction of the myocardium Transitory cerebral ischemia Visual scotoma Aortic dissection Blindness Myocarditis Optical neuritis Tachycardia gyneco-obstetrical complications Habit formation Premature detachment of Insomnia placenta Ear-Nose-Throat Spontaneous abortion Mental confusion complications Congenital malformations Aggressiveness Osteolytic sinusitis Transplacental or milk- Paranoid delirium mediated Mother-infant transfer and secondary withdrawal syndrome Necrosis et perforation of the Visual and tactile nose septum hallucinations Loss of sense of smell Repetitive behaviors Miscellaneous Stereotyped movements of complications the mouth and tongue Complications related to Liver toxicity Anorexia drug addiction Gastrointestinal ischemia Specific delirium HIV infection Pneumomediastinum Thymic troubles linked to hallucinogens Bacterial infections Hyperthermia Sex problems Viral hepatitis Codeine, opiates and other morphine derivatives The use of pain killers is frequent in sports, especially among athletes engaged in violent activities (such as boxing for instance). Often, the fear of losing a place or not fulfilling a contractual obligation leads to an obsession to keep the fight in spite of any type of wound or handicap. The most common effect of this class of substances is sedation, providing habitual doses are used. One must be aware of physical and psychological addiction induced by many opiates which are justly classified as narcotics: Nausea Vomiting Vertigo Memory loss Mood problems Pruritus Constipation Delirium Convulsion crises Addiction Withdrawal syndrome 10 Corticosteroids As seen in the table, the undesirables side effects associated with these substances are so severe 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 glucose in the urine) Increase in blood pressure Decrease in antibodies and natural defense mechanisms leading to higher susceptibility towards infections Gastric pyrosis (heartburn and regurgitation) and gastrointestinal ulceration Diffuse osteoporosis with an increased risk of fractures and delayed bone repair Alterations in the walls of blood vessels with possible formation of blood clots leading to embolism Decrease in muscle nutrition, risk of severer muscular atrophy Eye disorders : keratitis, glaucoma, cataract Dangerous 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, and orthostatic hypotension. Biochemical shifts in potassium levels (kaliemia) may be life threatening if strong modification are induced by diuretics. Ephedrine (and phenylpropanolamines) They are present in many innocuous pharmaceutical preparations used to treat benign conditions such as a cold. One must be very cautious in examining this class of substances since there are over 50 derivatives which have similar effects. The table shows the acute side effects caused by ephedrine analogs (effects are ordered by severity) Moderate effects Severe effects Nervousness Agitation Irritability Confusion Insomnia Paranoia Anorexia Mania Vertigo Hallucinations Cephalgia Ictus / Transitory ischemic attack Tachycardia Cerebral vascularisation Palpitations Cerebral hemorrhage Slight 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 11 depressant Erythropoietin This peptide hormone is used in medical practice in cases of severe anemia and during treatment of chronic renal insufficiency, such as in dialysis patients. In each case, there is a specific evaluation of the benefits vs. the dangers of this type of treatment. The first clinical trials involving erythropoietin started in 1985 and it is hence premature to draw a clear picture of the side effects. Nevertheless a few undesirable consequences have already been identified: Hypertension thrusts when the substance is introduced too rapidly Vascular thrombosis Convulsions 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 the production of endogenous testosterone. The associated dangers depend on dosage and vary according to sex: In women In men Salt retention Allergic manifestations Ovarian hyperstimulation and risk of multiple Nausea, vomiting pregnancies Ovarian cysts Novel distribution of fat throughout the body Gynecomastia 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 first months of pregnancy. Later there is an increase in blood volume, in the number of red blood cells and in hemoglobin. Apparently the resulting enhancement in oxygen delivery to the muscles 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 if it is carried out in a non-medical environment by unexperienced hands. There may also be a great psychological impact. Growth hormone (somatotropic hormone or somatotropin) Uncertainties remain about the safety of exogenous hGH as a therapeutic treatment. We still do not know what influence it may have on normal individuals, even though there is a good 12 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 the adult (the same side effects are noticed in children; in addition, there is an occurrence of gigantism 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 glands Increase in perspiration Peripheral neuropathies Myopathies Hypertrophy of the viscera : spleen, salivary glands, liver, kidneys, heart Colon 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 after administration of exogenous growth hormone. This causes an interference with endogenous hormone activity and necessitates an immunological surveillance. In order to avoid hyperglycemia, it is also necessary to monitor blood glucose levels. An injection of this hormone affects very fundamental processes of regulation. It may upset the balance of thyroid 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 a horse growth hormone may soon become available as well. These substances have no activity on the human organism but they may cause an irreversible sensitization which can lead to severe consequences (anaphylactic shock) if the exposure is repeated. Yet another type 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 industrial method used to purify the hormone does not guarantee the removal of other biological molecules such as prions. Based on the well-known scenario of contamination that led to the mad cow disease, which is transmitted by a prion, one cannot exclude a similar contamination by a prion present in an extractive hGH preparation from an individual that died from the Creutzfeldt-Jakob's disease. This type of encephalitis, believed to be caused by an infectious agent resembling a slow virus, has an incubation period in humans that is close 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 normal physiological balance. In this scenario, physical sports activities are entirely acceptable. Unfortunately, this state of balance is so difficult to maintain that many physicians recommend that diabetics abstain from any serious physical activity, especially sports that demand 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. In itself, insulin causes a number of side effects some of which are listed below: Tremors, sweat, anxiety, agitation 13 Asthenia, hypothermia, cravings Cardiovascular problems, infarction of the myocardium Anaphylactic shock, insulin allergy Numerous drug interactions (it is absolutely necessary to consult a physician because there are many dangerous associations) Alcohol consumption should be restrained, since it enhances hypoglycemia and may lead to a hypoglycemic coma Overdose: hypoglycemia may result from poorly estimated insulin dosage, a mistake in feeding or a unforeseen physical effort that is not compensated. The symptoms of hypoglycemia 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 space shared with smokers, is a marginal toxicological occurrence in terms of doping behavior). On the 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 membranes Gingivitis Leukoplasia Anomalies of the sense of taste : dysgeusia Problems with olfaction : dysosmia Spinocellular epithelioma of the oral cavity Dependence and withdrawal syndrome Halitosis: bad breath PFCs (Perfluorocarbons) These substances are all composed of fluorine, carbon and hydrogen atoms, but have important structural differences. Unlike erythropoietin, all PFCs are synthetic and hence never occurr naturally in the organism. Although they are in principle inert molecules, PFCs can dissolve large quantities of gas, including oxygen. Various PFC preparations (emulsions containing egg yolk lecithin or phospholipid) are currently undergoing clinical tests. The goal is to provide temporary oxygen supply to the brain and other tissues in patients that have lost important amounts of blood and whose vital functions are in danger. Little is known about the long-term effects of these substances on the human organism. The toxicity of repeated treatment 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 as important as its biological purity. Indeed, intra-venous injection is the only means to make PFCs participate in gas exchange. The clinical preparations currently tested have been found to have the following side effects: Increase in body temperature above 40°C, fever et cold Diarrhea Kidney, liver and lung toxicity; the lesions are probably irreversible in most cases 14 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 to attempt to use PCFs outside of the specific clinical context described above. this is true even if the patient is closely and continuously monitored. Unfortunately, the world of sports is also inhabited 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 sports context. One can imagine for instance that PCFs, which already very volatile at ambient temperatures, may form gas bubbles once injected into the blood vessels. Indeed, an increase in body temperature is inevitable during intense physical exercise, the warm season or upon long exposure to the sun. Given the current state of knowledge, one must absolutely refrain 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 gout rheumatism. It may cause the following undesirable effects: Cephalgia Anorexia Nausea Stomach aches Vertigo Frequent micturition Anemia Possible anaphylactic-like reactions with fever Dermatitis and other skin irritations Blood procedures (see also Erythropoietin) Because of possible HIV infection, blood transfusions performed outside a hospital context are simply too dangerous to be even considered as an option. This is common knowledge. It is 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. Only medical 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 each vitamin. The following effects are worth mentioning: Diarrhea Nausea 15 Urticaria Muscular weakness Fatigue Cephalgia Anorexia Blood hypertension Cardiac Arrhythmia Cirrhosis Teratogen activity Conclusions The conclusion is clear: one should never use medication or pharmacologically active substances without appropriate advice from a physician. If the medical drugs available today are very potent and effective in treating disease, they also strongly affect healthy individuals which 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 of the 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 under pressure to obtain quick results. Naturally, there is a strong temptation to increase the doses to really push one's luck. We wish to emphasize yet another point: it is necessary to check the purity of all substances of uncertain origin. Some products on the black market are grossly mislabeled and preparations for injection are often contaminated with bacteria or even viruses. In such cases, there is a significant risk to develop a serious condition and put a 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 français de Médecine et de 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 manifestations resulting from the reintroduction of a particular substance into an already sensitive organism. This shock may be an extremely dramatic event leading to imminent death, or to a giant urticaria with congested respiratory mucous membranes (asthma). Anaphylactic shock often occurs in sensitive individuals following injections of therapeutic sera, allergens, peptide hormones, or penicillin, etc. or after insect bites. Anemia Individual or combined decrease below normal levels in the number of red blood cells per cubic milliliter of blood, in the hematocrit or in hemoglobin. Anemia may show various general symptoms: paleness of skin and of mucous membranes, nervous disorders (fainting, vertigo, etc), dyspnea, tachycardia, digestion problems. 16 It may be caused by a hemorrhage, hemolysis (extensive destruction of red blood cells), a deficiency (in protein, vitamin B12, etc.), a disorder interfering with red blood cell development (infectious diseases, effects of toxic substances, etc.), or a congenital illness. Angina pectoris A painful constructive syndrome, which develops as a crisis during a specific effort or a walk. It is localized in the retrosternal region and may irradiate into the shoulders, arms, and jaws. It causes severe distress and an interruption of effort. Coronary arteriosclerosis is the most common etiology. The pain is caused by the reduction of blood flow to the heart. Possible outcome includes chronic angina pectoris, sudden death, heart attack, and progressive cardiac insufficiency. Anorexia A partial or complete loss of appetite. Aortic dissection Formation of a pocket within the wall of an artery caused by the splitting of the internal membrane of the vessel and subsequent intra-pericardial hemorrhage (synonym: dissecting aneurysm of the aorta). The associated pain is intense and violent. Survival is rare. Arrhythmia Irregularities in a rhythm. By extension, an anomaly in the heart rhythm resulting in irregular heart beats. Arthritis Inflammation of a joint. May be acute or chronic. Asthenia Weakening of the general state of health, of the functions of an organ or a system. Decrease in the vitality of an organism. Carboxyhemoglobin The form of hemoglobin which fixes carbon dioxide thus allowing the transport of this gas from 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 physical effort. Cholesterolemia Concentration in cholesterol of the circulating blood, usually measured in grams per liter of serum. Normal values oscillate around 2.5 grams per liter of serum. Pathological values may point to various metabolic disorders and 17 liver diseases. Circulatory collapse Side effect linked to a collapse in blood pressure and a significant slow-down in blood circulation. Also called cardio-circulatory collapse. The symptoms are prostration, loss of consciousness, cold sweat, rapid, weak and occasionally indiscernible pulse. Could lead to death if it isn’t treated. Cirrhosis Term invented by Laennec to describe the disease which causes reddish granulation in the liver. This liver sclerosis may have many different origins (alcohol intoxication, malnutrition, viral hepatitis, etc.). It results in liver insufficiency. Dependence A state resulting from periodic and repeated absorption of a psychotropic substance (such as narcotics, anabolic and related substances). The subject feels the need to continue drug intake and to increase dosage to reach the same or more pronounced effects. An interruption in consumption leads to a withdrawal syndrome which is more or less severe, depending on the substance. Dermatitis Skin inflammation. More generally, a skin disorder which may not be inflammatory in nature. Drug interactions Influence of two or more medicinal substances on the biochemical phenomenon at the basis of their mode of action. Drug interactions can be beneficial, additive, multiplicative or detrimental. Dyskinesia Any disruption of movement: absence of coordination, spasms, tremors, etc. Epithelioma Malignant cancerous tumour formed by the epithelium (one of the skin tissues). Ergogen Which lies at the basis of and improves the efficiency of muscular work. Gynecomastia In men, hypertrophy of mammary glands (breasts). Hemorrhage A more or less important discharge of blood from a blood vessel. Hypercoagulability Increase in the normal ability to coagulate of a biological fluid, mainly blood. Hyperglycemia Increase in the amount of glucose in blood. Depending on the measurement method used, 18 the increase is considered significant above 7.8 mmol/L. With the exception of transient hyperglycemia caused by food ingestion, cold, emotions and altitude, most occurrences are pathologic and involve the pancreas (diabetes mellitus), the hypophysis (acromegaly) or the adrenal gland (tumours). Hypoglycemia Decrease in the amount of sugar in blood , below the threshold of 2.8 mmol/L. A medicinal cause for hypoglycemia usually involves excessive insulin absorption. Hypovolemia Decrease in the volume of circulating blood. Ictus In neuropathology, a sudden morbid occurrence. Ischemia Decrease in blood flow to a particular part of the organism. It can be caused by a vasoconstriction, an obstruction or arterial compression. Ischemic cardiopathy A disease caused by a low blood flow to the heart. Keratosis More or less pronounced thickening of skin epidermis. Lethargy Pathological state of prolonged and deep sleep, which can be avoided by the affected individual only partially and during brief periods of time. An apparent state of death, but without loss of vital functions, which may last a few hours or several years. Micturition Urination. Motor function The sum of activities carried out by the organism necessary for motion Myocardial infarction Necrosis of the cardiac muscle, caused by an acute coronary thrombosis, and involving one or several limited, isolated foci. The overall clinical picture is more or less dramatic, with a prominent characteristic pain and a drop in tension. The affected person is at all times exposed to lethal complications. Myocarditis Acute or chronic inflammation of the heart muscle (myocardium). It may be caused by an infection (bacteria, viruses, parasites, fungi), chemical or medicinal agents, or other factors. The symptoms are variable. Frequent manifestation include tachycardia, palpitations, 19 signs of cardiac insufficiency, and muffled heartbeat sounds during auscultation, including gallop rhythm. Neuropathy A disorder affecting the central or peripheral nervous system. Usually degenerative. Optical neuritis An inflammatory disorder of the optical nerve. Orthostatic hypotension A drop in blood tension measuring 2 cm of mercury or more, which takes place during the transition from decubitus (horizontal, resting position) to a standing, vertical position. Osteolytic sinusitis Inflammation of the mucous membranes of the facial sinuses. This type of sinusitis may be frontal, maxillary or sphenoidal. There are acute, chronic, purulent or non-purulent forms. Osteolytic sinusitis has a destructive action on the proximal bones. Osteoporosis A bone lesion characterized by the thinning and rarefaction of bone traveculae which is visualized as a decrease in the radiological opacity of the skeleton. Localized or diffuse osteoporosis implies the weakening of bones. Ovarian cyst A benign tumor of the ovaries of variable size and of many types. Paranoia (paranoid delirium) From the times of Hippocrates and through the Middle Ages, paranoia was a synonym of mental disease. Until the 1920's and under the influence of the German school, paranoia referred to mental disorders affecting the intelligence, as opposed to emotions. Today, it designates a hallucinatory or interpretative systematic delirium. Pharyngitis Inflammation of the pharynx (schematically, the pharynx corresponds to the respiratory tract between the mouth and the lungs on the one hand, and the tract between the mouth and the stomach, on the other hand). Pharyngitis may have many causes (influenza, common cold, other viral diseases, intoxication, etc.). The clinical manifestations involve signs of local irritation (feelings of dryness, burns, irritations, etc.). Pneumomediastinum A rare condition caused by physical efforts of different nature and first described by Laennec in 1837. It corresponds to the presence of air in the mediastinum (a region located in the median part of the rib cage, between the two lungs). 20 Polyglobulism Increase in the number of circulating red blood cells resulting in a higher corpuscular volume, higher levels of hemoglobin and increased blood viscosity. Pruritus An itchy skin feeling caused by a skin disease, a general disorder or an allergic reaction to a foreign substance. Pulmonary fibrosis Pathological formation of fibrous tissue in the lungs. The clinical signs include irritated cough, halting respiration and cyanosis. The outcome is invariably fatal. Respiratory distress A decrease in the extent of respiration that can lead to death. Rhabdomyolysis Muscle breakdown caused by an exceptionally intense physical effort or intoxication. It results in abnormal levels of myoglobin in the urine (synonym: paroxystic myoglobinuria). Rhinitis Catarrhal inflammation of the nasal mucous membrane, sometimes a synonym of a cold. Side effects The effect of a medical drug which is not related to its primary activity or therapeutic effects. By extension, all undesirable and often toxic effects of medication. Squamous bronchial metaplasia Transformation of the alveolar lung tissue. It is often linked to an inflammatory process and implies a pre-cancerous state. Tachycardia Acceleration of the heart rate above 100 beats per minute. Teratogen Which causes deformities. Thrombosis Formation of a firm or gelatinous mass inside a blood vessel or a heart cavity , which causes complete or partial obstruction. Tolerance The capacity of the organism to tolerate physical or chemical aggressions, without apparent damage. Tolerance may be acquired after repeated exposure to a particular medicine. Tumefaction Any increase in the size of a cell, a tissue, an organ or an organism. Usually pathological. Urticaria Skin condition characterized by the eruption of pinkish or whitish papules, accompanied by a 21 burning sensation. The cause is often an allergy (sensitization of the organism to medical drugs, 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 usual cause is a lesion of the opitcal nerve.
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