SELECTIVE ??- 2 AGONIST ABUSE AND POLYPHARMACY IN COMPETITIVE BODYBUILDING- A CASE STUDY

Abstract

462 The availability of androgens by prescription for athletic performance and physique enhancement has decreased due to the Anabolic Steroid Control Act of 1990. But, recreational and competitive athletes continue to abuse androgens procured from the black market and have turned to other drugs in hopes of obtaining a competitive advantage and/or altering body composition. A 29 year old Caucasian male presented himself requesting a prescription for albuterol sulfate, a long acting selective β-2 agonist. He stated he needed it for asthma, but upon a physical examination and accompanying blood work it was discovered he was abusing androgens and other ergogenic substances for bodybuilding purposes. The compounds he admitted to taking were: caffeine (1800 mg/day), herbal ephedra (3600 mg/day), bumetanide (unspecified), tamoxifen citrate (10 mg/day), oxymetholone (150mg/day), methenolone acetate (35 mg/day) and liothyronine (100 mcg/day). Hematology revealed the following: BUN 26, SGOT 178, SGPT 169, LD 351, triclycerides 118, total cholesterol 113, LH <1.0, FSH <0.3. After the initial visit, the patient refused further evaluation. The long-term consequences of abusing selective β-2 agonists combined with other lipolytic/thermogenic and anabolic agents is not well understood, but deserves further research. The practice of multiple substance abuse is putting this individual at high risk for liver function abnormalities and cardiovascular disease later in life. Polypharmacy is particularly common among those in the bodybuilding subculture. While the side effects of high dose androgen use are well established, much less is known about other drugs such as the combination of caffeine, aspirin, ephedrine, and selective β-2 agonists. Data in laboratory animals (minipigs, rodents, and dogs) recorded the occurrence of cardiac arrhythmias, and sudden death (with histological evidence of myocardial necrosis) when β-agonists and methylx-anthines were administered concurrently. The most widely abused selective β-2 agonist in athletic circles is clenbuterol. Interestingly, it has been used as a repartitoning agent in livestock and is commonly used by pre-contest bodybuilders in combination with caffeine, ephedrine and aspirin and sometimes thyroid hormone to induce lipolysis. Clenbuterol is not available in the United States and is scarce on the black market. According to our patient many athletes are going to physicians seeking legitimate means for obtaining a long acting selective β-2 agonist with pharmacokinetics similar to clenbuterol. In the United States the two compounds most resembling clenbuterol and candidates for abuse by athletes are albuterol sulfate and salmeterol xinafoate (long acting inhalant). Physicians should be aware of the potential misapplication of these compounds and of possible fraud by patients seeking to use these drugs for physique augmentation.