Ask Vivomed’s Pharmacist – EPO abuse in sport

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Ask Vivomed’s Pharmacist – EPO abuse in sport

Erythropoietin or more commonly known as EPO/CERA is a protein hormone produced in the kidneys when blood oxygen levels are low. Its secretion stimulates the production of red blood cells by binding to receptors in the bone marrow facilitating the transport of oxygen to cells throughout the body. Patients suffering from kidney failure or associated anaemia have a reduced ability to produce EPO naturally and are often administered the hormone synthetically. Unfortunately, the use of EPO is not confined to the clinical environment and has been widely abused in both amateur and professional sports since the 1980’s. EPO is banned, in and out of competition, under the World Anti-Doping code’s list of prohibited drugs.

EPO Benefits

Maximal oxygen transport (VO2max) is pivotal in almost all endurance sports from cross country skiing to cycling, therefore the ability to increase this component will offer a significant enhancement to performance. The use of EPO in healthy individuals causes an artificial increase in red blood cell volume and oxygen carrying capacity. Increased oxygen carrying capacity enables the working muscles to receive a greater supply of oxygen allowing them to work for longer. While increasing one’s VO2max allows performance of a greater intensity without utilising the anaerobic system, responsible for the production of metabolic waste products such as lactic acid.
Possibly the most widely known case of EPO misuse is that involving multiple tour de France winner Lance Armstrong from the 1990’s to early 2000’s where he admitted its use along with several other performance enhancing drugs.

Ask Vivomed's Pharmacist - EPO abuse in sport
Lance Armstrong- 7 Time Tour De France Winner


While the spotlight is mainly focused on the benefits of EPO there are some significantly dangerous side effects associated with its misuse. The increased blood thickness from the over production of red blood cells means the blood cannot travel as easily to its intended destination, putting a greater strain on the heart and causing an increase in blood pressure. The following side effects are linked to EPO misuse;
• Stroke
• Heart Attack
• Hypertension
• Increased risk of blood clotting
• Heart failure
• Seizures
• Pulmonary embolism
• Pure red cell aplasia

Ask Vivomed's Pharmacist - EPO abuse in sport
Increased Red Blood Cell Count

Detection of EPO

The first tests for EPO were introduced back in 2000 for the Sydney Olympic Games which involved an initial blood screening followed by a urine sample test. At present the most viable method of detection is through urine testing alone.
Unfortunately, there are over 100 variants of EPO meaning the testers are always in a game of catch up. The world anti-doping agency (WADA) are continually working on new detection methods that will help supplement the current modality which will help maximise the chances of detecting EPO in athlete samples. Samples are to be stored for a period of 8 years meaning retesting is possible as detection methods advance.
The introduction of the athlete biological passport (ABP) in 2009 helps monitor selected biological variables e.g. blood count over time. In doing so, this provides the relevant anti-doping agencies information on any fluctuations which may indicate the use of a performance enhancing substance. In the case of EPO, raised haemoglobin & red blood cell count (haematocrit) are generally used as key indicators.


While EPO is often portrayed in the media as one of the most widely used performance enhancing drugs in endurance sport, little is mentioned of the significant, detrimental side effects associated with its abuse. The development of EPO was solely intended for the use of kidney failure patients who are dependent on dialysis and unable to produce EPO in sufficient amounts, not for performance enhancement in healthy individuals. Detection methods are continually being modified or developed in an attempt to achieve a clean sport.

Useful Links

World Anti-Doping Agency-

For more information about drugs in sport and how to make sure your club and players are staying within the rules please see this article about sports team drug ordering.

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