The abuse of diuretics as performance‐enhancing drugs and masking agents in sport doping: pharmacology, toxicology and analysis

Cadwallader, Amy B.; Torre, Xavier de la; Tieri, Alessandra; Botrè, Francesco

doi:10.1111/j.1476-5381.2010.00789.x

Cited by 118 publications

(96 citation statements)

References 65 publications

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“…Sometimes the creatinine level is elevated [4,35]. TD abuse is often found in cases of eating disorders, weight-loss attempts and sport doping [30][31][32][33][34]36].…”

Section: Discussionmentioning

confidence: 99%

Gitelman syndrome DD thiazide diuretics abuse

Keller

Beule²,

Dippold³

2014

Open Medicine

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AbstractIntroduction. Gitelman syndrome (GS) is a rare inherited disorder. Mutations in SLC12A3 gene that encode tubular Na+Cl-cotransporter (NCCT) cause hypokalemic metabolic alkalosis, salt loss, hypomagnesaemia and hypocalciuria. The symptoms include weakness, vertigo, hypotension, tetany, paresthesia and nausea. Diagnostic criteria are a normal urine concentrating ability, normal glomerular filtration rate (GFR), hypomagnesaemia (<0,65mmol/l), hypokalemia (<3,6mmol/l) and hypocalciuria (<0,1mmol/mmol creatinine). Previously, the diagnosis was made by exclusion. Today, genetic analysis can ensure diagnosis. Thiazide diuretics (TD) abuse with similar abnormalities can make the differential diagnosis difficult. Causal therapy of GS does not exist. The substitution of potassium and magnesium are therapeutic strategies. Case presentation. A 41-year-old obese woman presented at the emergency department with recurrent episodes of hypokalemia with concomitant weakness, muscle cramps, polyuria and collapse. The results of laboratory testing of blood and urine led to the suspected diagnosis of GS. In the follow-up examinations, the results were inconsistent. Therefore, a transient thiazide diuretics abuse was assumed. Discussion. This case demonstrates the difficulties in making the diagnosis of GS on the basis of only clinical and laboratory tests, without the use of genetic analysis. The differentiation between GS and thiazide diuretic abuse is especially difficult.

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“…Sometimes the creatinine level is elevated [4,35]. TD abuse is often found in cases of eating disorders, weight-loss attempts and sport doping [30][31][32][33][34]36].…”

Section: Discussionmentioning

confidence: 99%

Gitelman syndrome DD thiazide diuretics abuse

Keller

Beule²,

Dippold³

2014

Open Medicine

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“…Since 1988, the use of diuretics in sports is prohibited (Cadwallader, de la Torre, Tieri, Botrè, 2010), both during and out of competition. This is due to the fact that athletes use diuretics for many reasons: to reduce their body weight or to limit the excessive water retention caused by the abuse of anabolic steroids and to mask the presence of banned substances in urine.…”

Section: Diureticsmentioning

confidence: 99%

“…Therefore, when urine samples are taken to carry out the doping test, the research of these substances is always carried out (Thevis, Schänzer 2005). However, if the athlete is suffering from a disease that requires treatment with diuretics, the doctor may request the their use for therapeutic purposes (TUE) to WADA and therefore to be considered negative for anti-doping controls (Cadwallader et al 2010).…”

Section: Diureticsmentioning

confidence: 99%

Trend of Drug Abuse in 2011– 2014 in Italy

Sacco

Macchiarella

Amato

et al. 2017

Central European Journal of Sport Sciences and Medicine

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Doping, although was born as a medication and not with the purpose of enhancing performance, is a widespread practice in all sports, between amateur and gym-goers. The Italian sports federations were in second place worldwide for positive doping-test, after Russia. This review focuses on the analysis of data collected by Italian National Olympic Committee (CONI) in the 2012-2014 period, showing that the most commonly used substances were anabolic androgenic agents, glucocorticoids, diuretics and stimulants. Prevention in doping could be a key to limit the damage caused by this harmful practice both, for the physical health and the athlete's moral integrity and anti-doping campaigns should be direct as much as possible to young people, since about two-thirds of adolescents appear to be dissatisfied with their body. Even coordination between the various professionals that surround athletes could help fight doping by planning specific training and adapted to the individual athlete, taking into account the actual physical limitations and physical features of each.

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“…76 The use of diuretics is banned both in and out of competition and diuretics are routinely screened for by antidoping laboratories. 76 …”

Section: Diuretic Abusementioning

confidence: 99%

Diuretics: a review

Wile

2012

Ann Clin Biochem

117

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Diuretics, in one form or another, have been around for centuries and this review sets out to chart their development and clinical use. Starting with the physiology of the kidney, it progresses to explain how diuretics actually work, via symports on the inside of the renal tubules. The different classes of diuretics are characterized, along with their mode of action. The clinical use of diuretics in conditions like congestive cardiac failure and hypertension, as well as some rarer, but clinically important, conditions is then examined. An account is given of the adverse effects of diuretics and how they come about. Common adverse effects like hypokalaemia and hyponatraemia are examined in some detail, and other electrolyte disturbances like hypomagnesaemia also gain a mention. Diuretic use in chronic kidney disease is examined and new guidelines that have been introduced are presented. A section on diuretic abuse is included as this is becoming an all too common clinical scenario, and the sometimes tragic consequences of this abuse are emphasized. Diuretics also find a role in the diagnosis of forms of renal tubular acidosis and this role is explored. Finally, a selection of some of the newer approaches to diuretic therapy are presented, often the consequence of the increasing development of molecular biology, and some of the novel compounds -which may be in drug formularies of the future -are revealed.

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The abuse of diuretics as performance‐enhancing drugs and masking agents in sport doping: pharmacology, toxicology and analysis

Cited by 118 publications

References 65 publications

Gitelman syndrome DD thiazide diuretics abuse

Gitelman syndrome DD thiazide diuretics abuse

Trend of Drug Abuse in 2011– 2014 in Italy

Diuretics: a review

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