Corticosteroids, such as cortisone, prednisone, and dexamethasone, are commonly prescribed to treat injuries or to manage chronic inflammatory conditions like arthritis. The anti-doping status of each corticosteroid depends on several factors, including the route of administration (how you take it).
Keep reading to learn more about this class of substances, while keeping in mind that the World Anti-Doping Agency (WADA) Prohibited List is updated every year and these rules are subject to change.
What are corticosteroids?
Corticosteroids are a class of medications that resemble cortisol, a hormone produced naturally by the adrenal glands. Cortisol is involved in regulating metabolism and immune responses.
What are corticosteroids used for in medicine?
Corticosteroids generally reduce inflammation in the body, and are used medically to treat asthma, arthritis, lupus, allergies, injuries, pain, rashes, and many other maladies.
These substances are available as:
- pills or tablets (oral route of administration)
- creams or lotions (topical route of administration)
- rectal suppositories (rectal route of administration)
- eye drops (ophthalmic route of administration)
- many injectable formats, such as intramuscular injections (into the muscle), intravenous injections (into a vein), subcutaneous injections (into or under the skin), intra-articular injections (into joints), and epidural (into the spinal column).
There are some corticosteroid preparations that are available as over-the-counter medications, such as hydrocortisone creams, and there are many prescription-only corticosteroid medications.
Are corticosteroids prohibited in sport?
The anti-doping status of corticosteroids depends on several factors, including the exact substance in question, how it is administered (by mouth, by injection, used topically, etc.) and whether you are competing.
In general, corticosteroids are prohibited in-competition when taken by systemic routes, meaning by mouth (oral), intramuscular injection, intravenous injection, and rectally. The reason for this is that certain routes of administration result in a higher level of corticosteroids circulating in the blood.
Corticosteroids are permitted when administered through other routes, including corticosteroid inhalers, injections into joints, and topical creams to treat rashes or allergic reactions. By these routes of administration, the glucocorticosteroids (generally) remain closer to the location of use, and do not result in higher circulating concentrations.
Since there are so many factors that impact whether a corticosteroid is prohibited, USADA strongly recommends you check your medication and route of administration on Global DRO.
What do you mean by in-competition?
“In-competition” is defined as the period commencing 12 hours before a competition in which the athlete is scheduled to participate through the end of the competition and the sample collection process related to the competition.
What if I need to use a prohibited corticosteroid in-competition?
If you need to use a corticosteroid in-competition by a systemic route of administration (orally, by intramuscular or intravenous injection, or rectally) you should apply for a Therapeutic Use Exemption (TUE).
If I don’t want to get a TUE, how long before a competition should I stop using corticosteroids?
The time it takes for glucocorticoids to clear from an athlete’s body depends on many variables and cannot be predicted by USADA. An athlete’s doctor or pharmacist may help determine clearance times, but be sure to read this Clearance Time FAQ.
For questions about specific products, substances, and methods, contact USADA’s Drug Reference Line at email@example.com or call (719) 785-2000, option 2.