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evidence Since its inclusion on the WADA Prohibited List in 2016, Meldonium has attracted substantial attention as a potential performance-enhancing substance ( Mechanistic cardio-protective rationale During intense or prolonged exertion, elite athletes may develop cardiac remodeling, transient myocardial hypoxia, oxidative stress, and accumulation of acylcarnitines, factors that can compromise function and promote arrhythmias ( -oxidation, promoting glucose oxidation (e.g., via pyruvate dehydrogenase and hexokinase), and thereby improving myocardial energy efficiency under hypoxic conditions ( Experimental work suggests modulation of PPAR- /PGC-1 linked pathways, suppression of mitochondrial ROS, and improved recovery of cardiac function after ischemic or metabolic insult ( Safety assessment and toxicity In Russian and Eastern European literature, Meldonium is generally described as a low-toxicity compound ( From a chemical standpoint, Meldonium's trimethylhydrazinium moiety is a potential toxicophore