What is it?
What is meldonium?
8Mildronate is a brand of meldonium. In Malta, its 500 mg hard capsules are authorised as a prescription medicine. That registration concerns a specific medicinal product and indication, not healthy-user cognitive enhancement.
What the clinical trial actually tested
3MILSS I enrolled 512 patients with stable angina for 12 weeks alongside standard treatment. The strongest exercise-time signal was at 1000 mg/day; the two lowest dose groups did not outperform placebo. These results concern disease-limited exercise, not healthy-person productivity.
What newer sports research adds
9A 2026 narrative review found a lack of high-quality placebo-controlled evidence for consistent performance gains in healthy athletes. Small human studies exist, but bias and weak methods limit their meaning. The sporting ban is not a measure of proven benefit.
Names, aliases and forms
Mechanisms of action
Why carnitine metabolism matters
4Meldonium inhibits carnitine biosynthesis and the OCTN2 transporter. This alters fatty-acid handling and favours glucose metabolism. A biochemical mechanism alone cannot predict better focus or endurance.
Potential effects and evidence map
Grade D for healthy-user nootropic claims. Cardiovascular trials and human biomarker studies establish a medical and pharmacological context, but a 2026 review finds athlete performance studies too biased to establish consistent benefit. Evidence for healthy-adult cognition remains inadequate.
A stable-angina trial found improved exercise tolerance in patients receiving standard care; this does not establish better endurance in healthy users.
Metabolic changes do not demonstrate a dependable mental-energy benefit.
Reliable healthy-adult focus and attention benefits have not been established.
Typical dosages and timing
The Irish leaflet specifies meldonium dihydrate, with a 4-6-week course. This is a prescription schedule for a cardiac indication, not a studied healthy-user nootropic regimen. Capsule strength and the amount taken per day are different quantities.
Timing & effect horizon
The labelled oral course lasts weeks. Neither that schedule nor a positive doping test tells you how long a cognitive effect lasts. A reliable onset, felt duration or cycling schedule for healthy-user nootropic use has not been established.
Safety, side effects and risk profile
Can potentiate some blood-pressure and vasodilator medicines; medication review is needed.
The leaflet discourages pregnancy use and excludes breastfeeding during treatment.
Avoid use with a known allergy to meldonium or an excipient. The leaflet does not recommend use during pregnancy or in children, and says breastfeeding must not continue during treatment. These are separate cautions, not proof of common harm in healthy non-pregnant adults.
Interactions and cautions
Meldonium can strengthen the effects of glyceryl trinitrate, nifedipine, beta-blockers and other blood-pressure-lowering or vasodilator medicines. Prescribers may need to adjust treatment.
Legal and regulatory status
As of 13 October 2026, the WADA 2026 Prohibited List includes meldonium among metabolic modulators prohibited at all times, in and out of competition. This is an anti-doping rule for covered sport, separate from national medicine law.
As of 13 October 2026, Malta's Medicines Authority lists Mildronate 500 mg hard capsules as an authorised prescription-only medicine. This does not establish the status of every formulation or permission to buy or import it elsewhere. Check the destination country's medicines authority.
How it compares
Meldonium reduces carnitine availability; it is not a carnitine supplement. A human biomarker study found an average 18% reduction in plasma carnitine after four weeks. That metabolic change is not itself evidence of a performance benefit.
Practical buying and quality notes
- The catalog includes ampoule products, including rows with incorrect capsule or quantity metadata. Check the actual package and route before comparing offers. Injectable ampoules are not oral capsules; the dose context on this page concerns oral capsules only. Suspect per-capsule or per-gram calculations should not guide a purchase.
- The Irish 500 mg capsule contains meldonium dihydrate, equivalent to 401.14 mg meldonium. Compare like-for-like labelled forms and pack counts; do not assume an anhydrous mass and a dihydrate mass are interchangeable.7
- Check the manufacturer, batch, expiry, strength, route and local authorisation. Compare package prices only after those details match. A retailer listing does not establish authenticity or permission to import.
FAQ
Does the WADA ban prove meldonium works?
9No. A prohibition does not quantify the size or reliability of a benefit. The 2026 evidence review found that robust, consistent performance improvement in healthy athletes remains unproven.
References
- World Anti-Doping Agency. The 2026 Prohibited List, effective 1 January 2026.
- Rabin O, Uiba V, Miroshnikova Y, et al. Meldonium long-term excretion period and pharmacokinetics in healthy athlete volunteers. Drug Test Anal. 2019.
- Dzerve V, MILSS I Study Group. Mildronate dose-response clinical trial in stable-angina exercise tolerance. Medicina (Kaunas). 2011.
- Dambrova M, Makrecka-Kuka M, Vilskersts R, et al. Pharmacological effects of meldonium: biochemical mechanisms and biomarkers of cardiometabolic activity. Pharmacol Res. 2016.
- Schobersberger W, Dunnwald T, Gmeiner G, Blank C. Meldonium pharmacology and sport-performance context. Br J Sports Med. 2017.
- Malta Medicines Authority. Mildronate 500 mg hard capsules: Summary of Product Characteristics.
- HPRA. Mildronate 500 mg hard capsules: patient leaflet, revised May 2024.
- Malta Medicines Authority. Mildronate 500 mg hard capsules, MA1419/00401.
- Malm C, Svensson M. Meldonium and human sport performance: a narrative review evaluating the evidence for ergogenic potential. Front Sports Act Living. 2026;8:1822778.
- Liepinsh E, et al. Mildronate treatment alters gamma-butyrobetaine and L-carnitine concentrations in healthy volunteers. J Pharm Pharmacol. 2011;63:1195-1201.