Meldonium

Meldonium, sold as Mildronate, was developed at the Latvian Institute of Organic Synthesis (PMID: 12242052) and is a licensed cardiovascular medicine in Latvia and a number of eastern European and post-Soviet countries. It has never been approved in the United States or the European Union as a whole. Most English-speaking readers first heard of it in 2016, when it appeared on the WADA prohibited list and a wave of positive tests followed.

Its mechanism is unusual and worth understanding. Meldonium is the most potent clinically used inhibitor of the carnitine transporter OCTN2, and it also inhibits gamma-butyrobetaine hydroxylase, the enzyme that makes carnitine. Blocking both lowers tissue carnitine, and since carnitine is the shuttle that carries long-chain fatty acids into mitochondria, the cell shifts from burning fat toward burning glucose (PMID: 12242052; PMID: 26850121). Under low-oxygen conditions glucose oxidation needs less oxygen per unit of ATP, which is the basis for the anti-ischemic claim.

The best human trial is MILSS I, a randomized, double-blind, placebo-controlled study of 512 patients with stable angina across 72 centers in four countries, testing four daily doses against placebo on top of standard therapy over twelve weeks. The primary endpoint was change in bicycle exercise time. Two lower dose groups did not separate from placebo. The 1000 mg group increased total exercise time by a mean of 35 seconds compared with a 7 second decrease on placebo, and the highest dose group did worse than the middle one (PMID: 22186118). That is a real but modest effect in patients whose exercise was limited by cardiac ischemia.

Whether it helps healthy athletes is a different question, and the sports medicine reviews are not encouraging. A narrative review concluded that the performance benefit is speculative and discussed without sound scientific evidence (PMID: 27465696), and a 2026 review revisiting the ergogenic evidence reached similar conclusions (PMID: 42344756).

The pharmacokinetics are the strangest part. Because meldonium competes with carnitine for OCTN2-mediated transport, it accumulates in muscle during treatment and then leaves slowly by diffusion. In 32 healthy athlete volunteers given oral meldonium for three weeks, plasma steady state took several days and urinary elimination continued for months after the last dose (PMID: 30328291). In mice, giving carnitine or gamma-butyrobetaine speeds elimination by competing for the same transporter (PMID: 27983775). This is why athletes tested positive long after they stopped, and it is also why meldonium residues have been found in milk as a possible inadvertent doping route (PMID: 34448364).

Capsules sold as meldonium dihydrate are a foreign prescription drug being distributed outside any prescribing system.

Meldonium is available in capsule form.

Compare prices, payment methods, shipping, and COA scores across 1 vendor.

1 of the vendors BodyHackGuide tracks list Meldonium (1 listing). The lowest listed price BodyHackGuide has recorded for Meldonium is $69.99. No Meldonium listing recorded as in stock carries a milligram count, so BodyHackGuide states no price per milligram for Meldonium.

BodyHackGuide holds 1 third-party certificate record for Meldonium, from Disguised Alpha. No editor has read any of BodyHackGuide's 1 certificate record for Meldonium. The laboratory named on BodyHackGuide's Meldonium certificate record is Freedom Diagnostics Testing, and the test date on it is 23 August 2026. Each vendor page on BodyHackGuide shows how many certificate records BodyHackGuide holds for that vendor and links to each record that has its own page.