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Health Tips / Changes to the Prohibited List 2022

WADA PROHIBITED LIST 2022: PRESCRIBERS SHOULD BE AWARE OF SIGNIFICANT CHANGES TO GLUCOCORTICOID INJECTIONS FROM 01/01/2022

The World Anti-Doping Code, published by the World Anti-Doping Agency (WADA), harmonises anti-doping regulations across all sports and 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 Prohibited List identifies the substances and methods prohibited in- and out-of-competition, and substances prohibited in particular sports. The updated 2022 Prohibited List has recently been published by WADA. Changes for prescribers to note for 2022 include the prohibition, in competition, of glucocorticoid (GC) administration by injection and a change to the dosing intervals for salbutamol.

 

S3. Beta-2 agonists

Daily dosing intervals of salbutamol have been modified to reduce the risk of a potential positive test arising after high doses are taken at once.

From 01 January 2022, the following daily dosing time intervals for salbutamol apply: 600 micrograms over 8 hours starting from the time any dose is taken (previously this was set at 800 micrograms over 12 hours). The total permitted daily dose of salbutamol continues to be 1600 micrograms over 24 hours. If an athlete requires a salbutamol treatment in excess of the limits above, then a TUE should be sought.

 

S9. Glucocorticoids

WADA prohibits the in-competition administration of Glucocorticoids by all injectable routes

From 1 January 2022, the administration of glucocorticoids (GC) via any injectable route, during the in-competition period, is prohibited by WADA. Previously, administration of GC via oral, rectal, IV and IM routes was prohibited in-competition due to clear evidence of systemic effects however this ban has now been extended to include any in-competition injection of GC (e.g., intravenous, intramuscular, periarticular, intra-articular, peritendinous, intratendinous, epidural, intrathecal, intrabursal,intralesional (e.g., intrakeloid), intradermal, and subcutaneous). Current data shows that even at licensed therapeutic doses ‘local’ GC administration can result in similar systemic concentrations to those of prohibited routes. This presents issues including the potential for performance enhancement and risk to the health of the athlete.

 

Depending on the GC selected, and the dosage administered, GC can remain in the body at levels high enough to result in an Adverse Analytical Finding (AAF) for days to weeks after administration. Therefore, to reduce this risk, WADA have provided a table of washout periods to assist with decision making when prescribing and administering GC for athletes subject to doping control. Athletes should follow the minimum washout periods described (see table below).

 

Rectal and Oral routes (which includes buccal, gingival, oromucosal and sublingual routes) remain prohibited in-competition. Inhaled and topical application routes (includes dental-intracanal, dermal, intranasal, ophthalmological and perianal routes) of GC administration remain permitted once the administration is in accordance with the manufacturer’s approved dosing regimen.

 

Athletes must adhere to Sport Ireland’s TUE Policy and the Irish Anti-Doping Rules 2021 regarding Pre- and Post-test TUEs.

 

In all cases, if there are any reasonable permitted alternatives to GCs then the physician should document why the GC was the most appropriate treatment.

 

If a GC must be administered to an athlete by a prohibited route,during the in-competition period* then a Therapeutic Use Exemption is required. The athlete and physician should preparethe medical file and apply for the TUE as soon as possible.*(from 11.59 pm on the day before a competition that the athlete is scheduled to participate, unless WADA have agreed a different period for a given sport).

 

Route  Glucocorticoid  Washout Period 
 Oral 

All glucocorticoids

3 days

Except: triamcinolone; triamcinolone acetonide

10 days
Intramuscular  

Betamethasone; dexamethasone; methylprednisolone

5 days

Prednisolone; prednisone

10 days

Triamcinolone acetonide

60 days

 ‘Local’ injections (including intraarticular,periarticular, peritendinousand intratendinous)

 

All glucocorticoids;

3 days

Except: prednisolone; prednisone; triamcinolone acetonide; triamcinolone hexacetonide 10 days

Sources: WADA 2022 Summary of Major Modifications and Explanatory Notes; Ventura R et al, British Journal of Sports Medicine 2021;55:631-642.

 

If a GC needs to be administered to an athlete, by a prohibited route, during the washout period a TUE may be required. The athlete and physician should prepare the medical file in case a TUE application is required. If there is an Adverse Analytical Finding(AAF) then the application should be submitted.

 

If a GC needs to be administered out-of-competition, prior to the washout period commencing, then it is unlikely that a TUE will be required however the athlete and physician should prepare the medical file. In the unlikely event of an AAF the athlete should submit the TUE application.

 

More information is available from Sport Ireland at (01) 8608818or https://www.sportireland.ie/anti-doping/athlete-zone/athletezone/how-to-check-your-medications.

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Last update: 21/12/2021 13:16 • Previous update: 21/12/2021 13:16