{:en}Meldonium is manufactured and sold as Mildronate in Latvia. Not available in the US Banned by WADA as of January 2016 Meldonium works by decreasing the availability of L-carnitine, which helps mitochondria use fat for muscular energy.

Reducing available L-carnitine shifts the source of energy production from fat to glucose. Aerobic glucose oxidation consumes less oxygen than fatty acid oxidation and increases the effectiveness of ATP generation. In ischemic conditions (lack of oxygen), meldonium appears to prevent ATP transport impairment. Ironically, L-carnitine, which meldonium inhibits, is used as a supplement for athletic performance.

Two decades of research have been inconclusive L-carnitine is available in the US as the prescription drug Carnitor® All published clinical studies, except one are in Russian. Abstracts of randomized controlled trials have reported the efficacy of meldonium in cardiovascular disease, including agina. Only one abstract mentioned adverse effects, stating that none occurred. No long-term studies. No studies on the effect of meldonium on human athletic performance