No fault or negligence after an adverse analytical finding due to a contaminated supplement: mission impossible. Two examples involving trimetazidine
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Pascal Kintz
Abstract
Since several years, sports authorities, including national anti-doping organisations and the World Anti-Doping Agency (WADA) have published that the consumption of food supplements can be at risk for athletes due to potential contamination by prohibited substances. Despite these warnings, supplements are largely used by elite athletes and doping violations involving supplements are weekly reported in the media. Anabolic steroids, selective androgen receptor modulators (SARMs), metabolic modulators, stimulants and diuretics are among the most frequently detected substances in contaminated supplements. The author was involved in 2 cases where trimetazidine was identified as the source of the doping violation but the sport authorities sentenced both athletes. Case 1: trimetazidine in urine at 0.1 ng/mL; trimetazidine negative in 3 × 2 cm hair segments (LOQ at 1 ng/g [pg/mg]); trimetazidine at 4 ng/tablet in the supplement. Case 2: trimetazidine in urine at 0.1 and 1.6 ng/mL on 2 occasions; trimetazidine negative in 6 × 1 cm hair segments (LOQ at 1 ng/g [pg/mg]); trimetazidine at 7.2 μg/tablet in the supplement. Despite all pharmacological parameters were consistent with minute amounts of trimetazidine intake during a scenario of proven contamination, the presence of trimetazidine in the urine samples was recognized as an anti-doping rule violation and the athletes were sanctioned with a period of ineligibility of 6 months. From a forensic perspective, contamination is not doping. To avoid these conflicting issues with contaminations, the debate should move to the interest of using hair test results and the need of implementing a threshold for reporting the presence of a drug in urine at very low concentration.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: The author has accepted responsibility for the entire content of this manuscript and approved its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The author states no conflict of interest.
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Research funding: None declared.
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Data availability: All data are available upon reasonable request.
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© 2025 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Editorial
- Advancing diagnostic stewardship through claims-based utilization analysis: toward a system-wide vision of diagnostic excellence
- Review
- Biomarkers in body fluids and their detection techniques for human intestinal permeability assessment
- Mini Review
- Challenges of using natriuretic peptides to screen for the risk of developing heart failure in patients with diabetes: a report from the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee on Clinical Applications of Cardiac Bio-Markers (C-CB)
- Opinion Papers
- Reference intervals in value-based laboratory medicine: a shift from single-point measurements to metabolic variation-based models
- Overview of laboratory diagnostics for immediate management of patients presenting to the emergency department with acute bleeding
- What Matters Most: an Age-Friendly approach to pathology and laboratory medicine
- No fault or negligence after an adverse analytical finding due to a contaminated supplement: mission impossible. Two examples involving trimetazidine
- General Clinical Chemistry and Laboratory Medicine
- Utilization analysis of laboratory tests using health insurance claims data: advancing nationwide diagnostic stewardship monitoring systems
- Evaluating large language models as clinical laboratory test recommenders in primary and emergency care: a crucial step in clinical decision making
- A novel corrective model based on red blood cells indices and haemolysis index enables accurate unhaemolysed potassium determination in haemolysed samples – Hemokalc project
- Validation of (self-collected) capillary blood using a topper collection system as alternative for venous sampling for 15 common clinical chemistry analytes
- Acoustophoresis-based blood sampling and plasma separation for potentially minimizing sampling-related blood loss
- Clinical validation of a liquid chromatography single quadrupole mass spectrometry (LC-MS) method using Waters Kairos™ Amino Acid Kit reagents
- Robustness of steroidomics-based machine learning for diagnosis of primary aldosteronism: a laboratory medicine perspective
- Investigation of the possible cause of over-estimation of human aldosterone in plasma, using a unique, non-synthetic human aldosterone-free matrix
- Performance of afternoon (16:00 h) serum cortisol for the diagnosis of Cushing’s syndrome
- MAGLUMI® Tacrolimus (CLIA) assay: analytical performances and comparison with LC-MS/MS and ARCHITECT Tacrolimus (CMIA) assay
- Assessment of 2023 ACR/EULAR antiphospholipid syndrome classification criteria in a Spanish cohort
- Comprehensive evaluation of antiphospholipid antibody testing methodologies in APS diagnosis: performance comparisons across assay systems and clinical subtypes
- Candidate Reference Measurement Procedures and Materials
- Exploring commutable materials for serum folate measurement: challenges in cross-method harmonization
- Reference Values and Biological Variations
- Reference ranges for ionized calcium in plasma in Danish children aged 0 days to 3 years using laboratory registry data
- A step forward in pediatric hemophagocytic lymphohistiocytosis and autoimmune disease: pediatric reference interval for serum soluble IL-2 receptor and soluble CD163
- Cancer Diagnostics
- Cellular expression of PD-1, PD-L1 and CTLA-4 in patients with JAK2V617F mutated myeloproliferative disorders
- Diabetes
- Serum N-glycans as independent predictors of the incidence of type 2 diabetes: a prospective investigation in the AEGIS cohort
- Infectious Diseases
- An assessment of molecular diagnosis of tuberculosis and multi-drug resistant tuberculosis testing and quality assessment: findings of an international survey
- Letters to the Editor
- Targeting low-value laboratory care
- Is time a significant factor in the release of potassium from lithium heparin plasma and serum?
- External quality assessment in resource-constrained laboratories: a survey of practices and perceptions in Nepal
- Is successfulness of platelet clump disaggregation by vortexing influenced by platelet measurement methods?
- Oligoclonal banding analysis: assessing plasma use and time interval requirements for paired CSF and blood
