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.

Reference: WADA Glucocorticoids and Therapeutic Use Exemption Requirements [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.