According to the WADA Prohibited List, all glucocorticoids are prohibited when administered by oral, intravenous, intramuscular or rectal route.
Note: from 2022 onwards, all types of injections of glucocorticoids will be banned in-competition by the World Anti-Doping Agency (WADA).
Authorised routes of administration
The following routes of administration (i.e., how the medication is administered or taken) are authorised and hence do not require a TUE for the use of glucocorticoids:
- Dermatological – on the skin;
- Auricular – in or on the ear;
- Buccal – inside the mouth (without swallowing);
- Gingival – on the gums;
- Nasal – inside the nose, either by topical application or nasal spray;
- Ophthalmic – on or in the eye;
- Perianal – around the anus;
- Inhalation – through the mouth via an inhaler or “puffer”;
- Intradermal injection – into the skin;
- Epidural injection – into the spine;
- Intra-articular injection – into a joint capsule;
- Periarticular injection – around a joint;
- Peritendinous injection – around a tendon.
Prohibited routes of administration – systemic administration
You must complete a full TUE application before taking glucocorticoids by any of the following systemic routes:
- Orally – through the mouth, usually in the form of pills or tablets or syrup or drops;
- Intravenous injection – injection into a vein;
- Intramuscular injection – injection into a muscle;
- Rectally – into the rectum usually in the form of a suppository or rectal application of a cream.
Local injection of glucocorticoids – “8-days rest period”
In case of a local injection of glucocorticoids, which is subject also to the UCI Medical Rules, the rider must rest and is declared as medically unfit to compete for at least 8 days (article 13.3.055 of the UCI Medical Rules).
Therefore, any injection that falls within the scope of the injection ban policy must be immediately reported in writing, within a maximum of 24 hours, to the UCI Doctor (by e-mail: firstname.lastname@example.org).
B. Beta-2 agonists for asthma
Whether or not you need to apply for a TUE before using a beta-2 agonist for the treatment of asthma depends on the medication. Please pay utmost attention to the substance which is included in your inhaler.
Inhaled salbutamol (maximum 1600 micrograms over 24 hours in divided doses not to exceed 800 micrograms over 12 hours starting from any dose), inhaled formoterol (maximum delivered dose 54 micrograms over 24 hours), inhaled salmeterol (maximum delivered dose of 200 micrograms over 24 hours) and inhaled vilanterol (maximum 25 micrograms over 24 hours) are not prohibited and therefore do not require a TUE.
For inhaled salbutamol, you must obtain a TUE if you need to take more than 1600 micrograms over 24 hours in divided doses not to exceed 800 micrograms over 12 hours starting from any dose. This threshold is not valid if you are using any substances in the category of diuretics and masking agents. In this case, you must have a TUE for each substance.
You must obtain a TUE if you need to inhale more than 54 micrograms per day of formoterol. This threshold is not valid if you are using any substances in the category of diuretics and masking agents. In this case, you must have a TUE for each substance.
You must obtain a TUE if you need to inhale more than 200 micrograms per day of salmeterol.
You must obtain a TUE if you need to inhale more than inhaled 25 micrograms per day of vilanterol.
You must obtain a TUE if you take salmeterol, salbutamol and/or formoterol by any other routes of administration.
Terbutaline or other Beta-2 agonist
If you take terbutaline or any other beta-2 agonist not mentioned above for the treatment of asthma, you must submit a TUE request for asthma and your full medical file through ADAMS to confirm the diagnosis of asthma and/or its clinical variants.
The medical file should include:
- A detailed medical history and clinical review;
- Lung function test with spirometry;
- Bronchodilator response;
- Bronchial provocation tests.
To assist your doctor in completing the correct tests, and providing the correct medical information, we suggest that he or she consults the WADA Guidelines on Asthma.
C. Injections – “No Needle” Policy
We remind you that the use of injections to administer drugs or substances without a clear and recognised medical indication is prohibited under the UCI Medical Rules. This applies to any substance that is injected whether endogenous or exogenous, prohibited under the UCI Anti-Doping Rules (ADR) or not, and to any type of injection (article 13.3.052 of the UCI Medical Rules).
Accordingly, the injection that falls under the “No Needle Policy” must be reported immediately and in writing not later than 24 hours afterwards to the UCI Doctor (email@example.com).