Status of Glucocorticoid Medication in Sport
GLUCOCORTICOIDS GIVEN IN-COMPETITION
All Glucocorticoids (GC) given via oral, any injectable route (i.e. joint/soft tissue, IV, IM etc) and rectal routes are prohibited in-competition.
In-competition period begins from 11:59pm the day prior to the commencement of competition.
Athletes who require an in-advance Therapeutic Use Exemption (TUE) will need to apply prior to receiving a GC in the in-competition period. If the treatment is urgent however, then the athlete should be treated, and a TUE application can be made retroactively.
GLUCOCORTICOIDS GIVEN PRIOR TO COMPETITION
If an athlete is prescribed a GC prior to competition, they should discuss the wash-out period with their doctor to determine if the GC may be detected in their urine if they are tested in competition.
If the GC was given in the wash-out (pre-competition) period and is detected in the athlete urine sample, the athlete will be notified and can the apply for a retroactive TUE.
The athlete and their doctor should ensure that there is a medical record kept with details of the diagnosis and treatment that would satisfy a TUE request.
See below the WADA GC Washout Table:
| Route | Glucocorticoid | Washout period |
|---|---|---|
| Oral* |
All glucocorticoids:
Except: triamcinolone; triamcinolone acetonide |
3 days
10 days |
| Intramuscular |
Betamethasone; dexamethasone; methylprednisolone
Prednisolone; prednisone
Triamcinolone acetonide |
5 days
10 days
60 days
|
| Local injections (including periarticular, intra-articular, peritendinous and intratendinous) |
All glucocorticoids:
Except: prednisolone; prednisone, triamcinolone acetonide, triamcinolone hexacetonide |
3 days
10 days |
| Rectal |
All glucocorticoids:
Except: triamcinolone diacetate, triamcinolone acetonide |
3 days
10 days |
*Oral routes also include e.g. oromucosal, buccal, gingival and sublingual.
Ref: WADA Glucocorticoids and Therapeutic Use Exemption [PDF]
Applying for a TUE
When applying for a TUE, the medical record should include (whether in advance or retroactive):
- a typed clinical letter from the doctor
- an application form signed by the athlete and the doctor.
- a medical diagnosis where a GC injection is the recognised treatment.
- information that a permitted alternative was tried, not available, or not considered the best treatment option.
- the GC type given, dose and by what means (such as a copy of the radiologist's report if the injection is given under ultrasound or X-ray guidance).
If the athlete is eligible to apply for a retroactive TUE, they need to prepare a medical file (as above) in case they are required to complete doping control and subsequently apply for a retroactive TUE.
Resources
More detailed information regarding GC injections is available in the following resources.