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Things to be careful of at the pharmacy
Over-the-counter medicines
Society of Sports Pharmacy
This information is based on the World Anti-Doping Agency (WADA) list of prohibited substances and is designed to assist sports pharmacists in providing accurate medication guidance and to prevent unintentional doping among athletes .
Since over-the-counter medications can be purchased at pharmacies without a prescription, athletes are susceptible to doping risks as they may consume them without properly checking the ingredients. Therefore, the vigilance and recommendations for safe alternatives by sports pharmacists are of the utmost importance.
1. 🤧 Cold/Rhinitis Medicine (Stimulant: S6)
💊 Hazardous Ingredients and Checkpoints
Representative examples include stimulant ingredients (S6) such as pseudoephedrine and methyl ephedrine , which are commonly found in cold medicines, rhinitis medicines, and general cold medicines . These are prohibited substances during competitions.
When providing medication guidance to athletes, you must clearly inform them that extreme caution should be exercised when taking the product before and after a competition, as the washout period required for the substance to be eliminated can take anywhere from a minimum of 15 hours to a maximum of 4 to 5 days or more.
✅ Recommendation for safe alternatives/measures
Considering the competition schedule, priority should be given to recommending a replacement with safe ingredients. For nasal congestion symptoms, preparations that do not fall under S6 or topical nasal sprays with low systemic absorption may be considered.
For symptoms of runny nose and sneezing, second and third-generation antihistamines such as cetirizine, loratadine, and fexofenadine are recommended, and acetaminophen or NSAIDs can be used for pain or fever reduction.
2. 😷 Cough medicine (Beta-2 agonist: S3)
💊 Hazardous Ingredients and Checkpoints
Trimethoquinol, an ingredient in cough medicines, is classified as a beta-2 agonist (S3) and is a permanently prohibited substance that is banned at all times, regardless of the competition period. Since this ingredient may be included in over-the-counter combination cough medicines sold in pharmacies, you must immediately notify the user that it is the highest-risk prohibited substance and stop taking the medicine as soon as it is discovered.
✅ Recommendation for safe alternatives/measures
Products containing trimethoquinol must be immediately replaced with other ingredients as soon as they are discovered. For cough relief, a combination product containing dextromethorphan (antitussive) that does not fall under S3 is recommended , and for phlegm removal, a combination product containing guaifenesin (expectorant) is recommended.
In particular, acetylcysteine (NAC) is very useful for athletes as it offers a dual 'medicine + supplement' effect, as its antioxidant and hepatoprotective effects have a positive impact on the recovery from exercise fatigue. In addition, safe expectorants such as ambroxol, carbocysteine, and bromhexine can be suggested.
3. 👄 Topical preparations for oral mucosa (Glucocorticoid: S9)
💊 Hazardous Ingredients and Checkpoints
Steroid-containing stomatitis medication is a glucocorticoid (S9) and is a prohibited substance during competition.
In particular, since oral administration (inside the mouth, under the tongue) is prohibited due to the risk of systemic absorption following the 2022 WADA regulation changes, caution must be exercised when taking topical formulations, such as ointments or adhesive patches, during competitions .
✅ Recommendation for safe alternatives/measures
When treating stomatitis, non-steroidal treatments that do not contain steroids should be recommended first. Products containing dexpanthenol or azulene sulfonate can be alternatives. For sore throat and oral inflammation, lozenges containing NSAIDs (e.g., flurbiprofen) can be safely used.
4. 🌿 Herbal and Natural Medicine Preparations (Stimulants: S6)
💊 Hazardous Ingredients and Checkpoints
Herbal medicines or herbal preparations containing Ephedra have a very high risk of doping. Ephedrine and pseudoephedrine, which are the main components of Ephedra, are substances prohibited during competitions and are classified as stimulants (S6), just like cold medicines.
In particular, mixed herbal preparations taken for weight loss or physical enhancement must be clearly disclosed to have a very high risk of unintentional doping due to the significant uncertainty of their ingredients.
* Herbal medicines or preparations containing Ephedra : Galgeun-tang, Socheongryong-tang, Mahaenggamseok-tang, Galgeun-tang-ga-cheongung-sini, Ganghwal-yupung-tang, Geopung-jibodan, Bangpung-tongseong-san, Yeongseon-jetong-eum, Ojeok-san, etc.
✅ Recommendation for safe alternatives/measures
Athletes should be strongly advised to choose products that do not contain ephedra or to be prescribed alternative medications with clearly identified ingredients.
As a general rule, the consumption of traditional herbal medicines with unknown ingredients is not recommended due to the difficulty of doping control.