Health Tips / Anti-Doping: 2024 Guide for Prescribers

The World Anti-Doping Code, published by the World Anti-Doping Agency (WADA), harmonises anti-doping regulations across sports in all countries. The Prohibited List of Substances and Methods is one of the International Standards that are mandatory for all signatories of the Code. The List is a list of substances and methods which are prohibited in sport. Some of these substances are contained in medicinal products marketed in Ireland. However, in recognition of the fact that some prohibited substances may be necessary for legitimate medical treatment, the Code permits athletes and their physicians to apply for a Therapeutic Use Exemption (TUE).

Sport Ireland Therapeutic Use Exemption (TUE) Policy 

If a medication is prohibited and requires a TUE, athletes should first consider the use of a reasonable permitted alternative treatment. If there is no permitted alternative athletes should adhere to the Sport Ireland TUE Policy which states that athletes on the Sport Ireland Registered Testing Pool must apply for a TUE before using the substance (a Pre-Test TUE); athletes not on the Registered Testing Pool may take the substance, and if required, apply for a Post-Test TUE, but should ensure that a medical file* for use of the medication is in place. Athletes who compete at an International Level or who are on their International Federation Registered Testing Pool should check and comply with the TUE requirements of their International Federation.

*Medical file: See Glossary of MIMS Ireland.

Athletes should be advised to declare the use of all medications and supplements taken in the 7 days prior to the drug test on the doping control form (regardless of if they have completed and submitted a TUE). 

Full details, TUE Application Form and guidelines on the TUE Policy are available at www.sportireland.ie/anti-doping/athlete-zone/athlete-zone/therapeutic-use-exemptions

Summary of the WADA 2024 Prohibited List

Substances and Methods Prohibited In- and Out-of-Competition 

Prohibited Substances 

S0 Non-Approved Substances: Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (e.g. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved for veterinary use only) is prohibited.

S1 Anabolic Agents are prohibited. Examples include danazol, osilodrostat, testosterone, stanozolol, tibolone and selective androgen receptor modulators (SARMs).

S2 Peptide Hormones, Growth Factors, Related Substances, and Mimetics: 

The following substances, including other substances with similar chemical structure or similar biological effect(s) and their respective releasing factors are prohibited:

1 Erythropoietins (EPO) and agents affecting erythropoiesis including, but not limited to:

1.1  Erythropoietin-Receptor Agonists, e.g. darbepoetins (dEPO); erythropoietins (EPO); methoxy polyethylene glycol-epoetin beta (CERA);

1.2 Hypoxia-inducible factor (HIF) activating agents, e.g. cobalt; daprodustat; molidustat; roxadustat, vadadustat; xenon, etc. Vitamin B12 is not prohibited;

1.4 Transforming Growth Factor-beta (TGF-b) signalling inhibitors, e.g. luspatercept; sotatercept. 2 Peptide Hormones and their Releasing Factors:

2.1 Testosterone-stimulating peptides in males including: chorionic gonadotrophin (CG), luteinizing hormone (LH), gonadotrophin-releasing hormone (GnRH, gonadorelin) and its agonist analogues (e.g. buserelin, deslorelin, goserelin, histrelin, leuprorelin, nafarelin and triptorelin), kisspeptin and its agonist analogues;

2.2 Corticotrophins and their releasing factors, e.g. corticorelin and tetracosactide;

2.3 Growth hormone (GH), its analogues and fragments including lonapegsomatropin, somapacitan and somatrogon;

2.4 Growth hormone releasing factors including growth hormone-releasing hormone (GHRH) and its analogues and growth hormone secretagogues (GHS) and its mimetics (e.g. lenomorelin (ghrelin), macimorelin) and GH-Releasing Peptides (GHRPs).

3 Growth Factors and Growth Factor Modulators including, but not limited to:

Fibroblast Growth Factors (FGFs); Hepatocyte Growth Factor (HGF); Insulin-like Growth Factor-1 (IGF-1) and its analogues; Mechano Growth Factors (MGFs); Platelet-Derived Growth Factor  (PDGF); Thymosin-b4 and its derivatives e.g. TB-500; Vascular-Endothelial Growth Factor (VEGF) and any other growth factor affecting muscle, tendon or ligament protein synthesis/degradation, vascularisation, energy utilisation, regenerative capacity or fibre type switching.

S3 All Beta-2 Agonists are prohibited except:

      • Inhaled salbutamol (maximum 1600μg over 24 hours in divided doses, not            to exceed 600μg over 8 hours, starting from any dose);

      • Inhaled formoterol (maximum delivered dose of 54μg over 24 hours)

      • Inhaled salmeterol (maximum dose of 200μg over 24 hours);

      • Inhaled vilanterol (maximum dose of 25μg over 24 hours).

To use any other inhaled beta-2 agonist, including terbutaline, indacaterol, olodaterol, formoterol (at delivered doses >54μg over 24 hours), salmeterol (at doses >200μg over 24 hours), vilanterol (at doses >25μg over 24 hours) and salbutamol (at doses >1600μg over 24 hours or > 600μg over 8 hours; such as by nebuliser), an athlete must adhere to the TUE Policy paying particular attention to the requirements of a medical file*. Formoterol is declared in terms of the delivered dose e.g. a Turbohaler device labelled as containing 6μg of formoterol delivers 4.5μg. Check the specific delivered dose of the device when calculating formoterol doses.

S4 Hormones and Metabolic Modulators such as aromatase inhibitors (e.g. exemestane, formestane, letrozole), selective oestrogen receptor modulators (SERMS, e.g. bazedoxifene, raloxifene, tamoxifen, toremifene), other anti-oestrogenic substances (e.g. clomifene, fulvestrant), agents preventing activin receptor IIB activation, including myostatin inhibitors and metabolic modulators including insulins and insulin mimetics and trimetazidine are prohibited.

S5 Diuretics and Masking Agents: Diuretics (furosemide; spironolactone; thiazides; amiloride; indapamide, etc., including substances with a similar chemical or biological effect), desmopressin, probenecid, plasma expanders (e.g. IV administration of albumin, dextran, hydroxyethyl starch and mannitol, etc.), vaptans (e.g. tolvaptan) are prohibited. Note: Drosperinone, topical ophthalmic use of carbonic anhydrase inhibitors (e.g. dorzolamide, brinzolamide) and local administration of felypressin in dental anaesthesia are permitted.

A TUE is not required for topical ophthalmic administration of a carbonic  anhydrase  inhibitor  (e.g. dorzolamide, brinzolamide) or for local administration of felypressin in dental anesthesia in conjunction with a threshold substance (formoterol, salbutamol, cathine, ephedrine, methyephedrine and pseudoephedrine are all threshold substances).

Prohibited Methods 

M1 Manipulation of blood and blood components by (1) the administration or reintroduction of any quantity of autologous, allogenic (homologous) or heterologous blood or red blood cell products of any origin into the circulatory system, except donation by Athletes of plasma or plasma components by plasmapheresis performed in a registered collection centre, (2) the use  of products that enhance the uptake, transport or delivery of oxygen e.g. modified haemoglobins, voxelotor or (3) any form of intravascular manipulation of the blood or blood components by physical or chemical means is prohibited. Supplemental oxygen, by inhalation, is not prohibited.

M2 Chemical or physical manipulation such as tampering or attempting to tamper to alter the integrity and validity of a sample such as sample substitution and/or adulteration (e.g. addition of proteases to sample) is prohibited.

IV infusions and/or injections of more than 100ml per 12 hour period are prohibited and require a TUE except for those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations. Emergency infusions will require a retroactive TUE.

M3 Gene and cell doping. 

Substances and Methods Prohibited In-Competition Prohibited Substances 

S6 Stimulants including their related substances and their optical isomers are prohibited. Examples include amfetamine, lisdexamfetamine, modafinil , solriamfetol and pseudoephedrine at urinary concentrations >150μg/ml.

Pseudoephedrine is found in many over the counter medicines available in pharmacies including many multi-ingredient products used as cough and cold remedies, hayfever and decongestant treatments. Athletes should stop taking any pseudoephedrine containing products at least 24 hours before competition. For therapeutic applications during the in-competition period, athletes should consider the use of alternative permitted medications after prior consultation with their doctor or pharmacist, or apply for a TUE for the use of pseudoephedrine for therapeutic purpose(s).

Local administration (e.g. nasal, ophthalmologic) of adrenaline or co-administration with local anaes- thetic agents is not prohibited. Administration of imidazoline derivatives (e.g. xylometazoline, tramazoline etc.) is not prohibited when used by dermatological, otic, nasal and ophthalmological routes.

S7 Narcotics: Prohibited narcotics include tramadol, buprenorphine, dextromoramide, fentanyl and its derivatives, hydromorphone, methadone, morphine, nicomorphine, oxycodone, pethidine.

Athletes should stop taking any tramadol containing products at least 24 hours before competition. For therapeutic applications during the in-competition period, athletes should consider the use of alternative permitted medications after prior consultation with their doctor or pharmacist, or apply for a TUE for the use of tramadol for therapeutic purpose(s).

Note: Codeine, dextromethorphan, dihydrocodeine, pholcodine and tapentadol are permitted.

S8 Cannabinoids (natural and synthetic) including cannabimimetics are prohibited except cannabidiol (CBD), which is available in Ireland as a food supplement (please see Sport Ireland’s Supplements and Sports Food Policy). Athletes should be aware that some CBD products extracted from cannabis plants may also contain THC and other cannabinoids that could result in a positive test.

S9 Glucocorticoids are prohibited and require a TUE when administered by ANY injectable, oral (including oromucosal – buccal, gingival, sublingual), or rectal routes. Dental-intracanal application is not prohibited. Glucocorticoids administered by other routes (including inhaled and topical) are not prohibited when used within the manufacturer’s licensed doses and therapeutic indications and do not require a TUE. Injectable routes include intravenous, intramuscular, periarticular, intra-articular, peritendinous, intratendinous, epidural, intrathecal, intrabursal, intralesional (e.g., intrakeloid), intradermal, and subcutaneous.

Substances Prohibited in Specific Sports 

P1 Beta-Blockers: Prohibited in-competition in certain sports such as automobile (FIA), golf (IGF), mini-golf (WMF) and darts (WDF). Prohibited both in- and out-of-competition in Archery (WA), under water sports in all subdisciplines of freediving, spearfishing and target shooting (CMAS), and Shooting (ISSF, IPC).

This summary is deliberately concise and is intended to be used as a guide only. For an authoritative reference source consult the complete World Anti-Doping Code, The 2024 Prohibited List and the International Standard for TUE (ISTUE) which are available from Sport Ireland or www.wada-ama. org. WADA have undertaken to update the Prohibited List regularly. All information correct at time of going to press.

• Anti-Doping: 2024 Guide for Prescribers
• Athletes Fluid Requirements
• Changes to the Prohibited List 2024
• Drugs abuse in sports
• Ephedra prohibited in the US
• IOC Study on Sports Supplements
• Irish Sports Council's Policy on Treatment of Hayfever
• Nandrolone
• Supplements
• THG
• What is EPO?