How Prescription Drugs Affect Athletic Performance (guest blog)
Although most athletes are considered generally healthy, even those in top physical health succumb to illness or an accident that requires pharmaceutical intervention. While drugs may be a quick fix, sometimes they come with unwanted side effects that negatively affect performance. For example, Chris Bosh of the Miami Heat suffered from blood clots in the lungs and was forced to take a blood thinner named Xarelto. But, because of the risk of unstoppable bleeding caused by the drug, he missed several games.
There are a number of other health issues that can affect athletes that may require medications. These include:
- Illness and infection
- High blood pressure (hypertension)
- Chronic pain and inflammation
As a result of these conditions, athletes may find themselves on antibiotics, blood pressure medications, NSAID pain killers and asthma drugs, to name a few medications. Each of these medications comes with its own risks and side effects.
Over-training can leave many athletes at risk for illness and infection. For example, clinical studies show that athletes involved in power and speed sports also use more antibiotics more often than people in the same age group who are not athletes. Fluoroquinolones such as Levaquin, Cipro and Avelox and the most widely used antibiotics in the U.S. because they treat several illnesses.
However, these drugs have a hidden danger that is especially detrimental to athletes: tendon damage. In 2008, the U.S. Food and Drug Administration added a black box warning for tendonitis and tendon rupture. Researchers say these drugs damage tendons by affecting collagen in the body. The walls of the aorta, the largest blood vessel in the body that takes blood back to the heart, are also lined with collagen. Now, scientists find these antibiotics are also linked to rupture and tearing in the walls of the aorta.
Scientists recommend that doctors find alternative medication or use sunscreen and probiotics to prevent infections in athletes.
High Blood Pressure (Hypertension) Medications
High blood pressure is a common problem. In fact, it is the most common cardiovascular problem among athletes. For athletes and other physically active people, certain classes of blood pressure drugs can impair performance. One example is the drug Benicar (olmesartan). It is linked to severe gastrointestinal problems that can cause severe weight loss and health problems from malnutrition.
The following drug classes affect athletes in specific ways:
- Thiazide diuretics. These drugs can cause hypovolemia, a condition where the liquid portion of the blood is too low. Symptoms include weakness, fatigue, fainting, rapid heart rate and dizziness.
- Loop diuretics. These drugs may cause hypovolemia, low blood pressure when standing up (ortostatic hypotention) and electrolyte imbalance.
- Potassium-sparing diuretics. These drugs can cause hypovolemia.
- Beta blockers. These drugs can affect the heart rate and impair energy metabolism.
Doctors recommend that the first lines of treatment for many hypertensive athletes include renin-angiotensin system blockers and calcium antagonists which are tolerated better.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Chronic pain and muscle injuries are also common. Sports medicine doctors often use NSAIDs, such as Advil (ibuprofen), to treat these conditions. Some athletes even take NSAIDs to prevent pain during activity. One 2010 study by Ziltener et al. found that high school football players took these drugs daily, and 29 percent of college football players took them on the day of the game as a preventative measure.
While many people are familiar with the stomach side effects of NSAIDs, new studies link these drugs to negative impacts on the musculoskeletal system and cell metabolism. Some studies also show they inhibit the body’s ability to use protein. Study authors do not recommend these drugs for use with muscle injuries, bone fractures (or stress fractures) or chronic tendonopathy. They also say the shortest treatment periods should also be used.
Asthma Medications (Beta-2 Agonists)
Endurance athletes may also develop asthma. In fact, asthma medication is more frequently used in elite athletes than in the general population. It is most common among cyclists, swimmers, long-distance runners and cross-country skiers.
Doctors may prescribe long-acting beta-2 agonists such as Symbicort (formoterol and budesonide) and Advair (salmeterol and fluticasone) or short acting drugs to prevent exercise induced asthma such as ProAir (albuterol) and Ventolin HFA (albuterol HFA). These drugs may cause irregular heartbeat and muscle tremor which can impair athletes that require steady hands and muscle control.
Treating Disease and Improving Performance with Diet and Nutrition
Now more than ever, there is a push towards using food as medicine. In the case of athletes, proper nutrition can improve performance and may even decrease or eliminate the need for medications. For instance, many athletes don’t consume enough energy to meet their requirements. Compared to non-athletes, male and female athletes are at a higher risk for disordered eating. According to one 2015 study by Palacio et al., professional female dancers consumed less than 70 percent of their daily energy needs.
While many resources exist for diet and exercise, the best thing to do to improve performance and avoid taking medications that affect your well-being and health is to speak with a professional nutritionist and trainer. In some cases, medications are necessary, but the side effects may not be worth the risk.
Bio: Michelle Y. Llamas is a senior staff writer at Drugwatch.com. She researches and writes about dangerous drugs and medical devices and hosts the podcast Drugwatch Radio. She has been published in peer-reviewed journals and appeared on radio shows.
Bruno, R.M. et al. (2011). Hypertension in Special Populations: Athletes. Medscape. Retrieved from http://www.medscape.com/viewarticle/747755_4
Alaranta, A. et al. (2008). Use of prescription drugs in athletes. Sports Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18489193
Fayock, K et al. (2014). Antibiotic Precautions in Athletes. Sports Health. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065554/