Drugs that can Influence Athletic Performance


I’m big into bicycling.  Sometimes I will make the mistake of referring to an organized ride as a “race”, but I try to always use “event”. Like many athletes, I’ve found that it is most effective to compete against myself rather than to try to be trying to outdo others.  My goal for most long events is just to survive.

Some of my rides can be pretty long and grueling because of the sun and heat of the day. I have survived a number of 100 mile rides, mostly for charity.  

When I rode my first 100-mile ride, an August Diabetes Tour de Cure, I barely finished. I ate and drank what I could along the route, but arrived at the finish line only a few minutes before they closed the event.  The medical team ran out to meet me. I desperately needed water and in retrospect wish I had requested 2 liters of intravenous D5LR when they asked if I needed any help.

How Do Drugs Influence Athletic Performance?

Behind the scenes during long events, the body is working to maintain homeostasis, a stable internal environment that allows body systems to function efficiently. The physiologic challenges during athletic endeavors include control of temperature, blood pressure and fluid balance. These are interrelated as sweating causes loss of fluids and salts that can lower blood pressure and disturb fluid and salt balance.

Diuretics and ACE inhibitors are drugs that are commonly taken for blood pressure, but which can compromise athletic performance under certain conditions.  I know … we can envision how that diuretic might actually make you run faster on your way to the bathroom.  But let’s think about what these drugs do.

The goal of most diuretics is to encourage the body to lose salt (sodium chloride) and water along with it since salt leaves the body with water. By decreasing blood volume slightly, diuretics can lower blood pressure.  

ACE inhibitors are one of the go-to drugs for hypertension. They are also a category of medication that encourages water loss and which could influence athletic performance negatively in certain patients and under certain conditions, particularly in long events where maintenance of volume and electrolytes are important.

ACE stands for angiotensin converting enzyme. This enzyme is a step in the renin-angiotensin-aldosterone system, a mechanism by which the body senses and maintains blood pressure under conditions where salt and water must be conserved. This is an ancient mechanism that would come into play when you’re walking across the desert, for example.  Or when you find yourself in a long survival event like a marathon or 100-mile bike ride in scorching heat.  

As always, you should consult your physician before making any medication changes or before starting an exercise program. For most athletes and most events, you can accommodate by drinking extra water and by incorporating electrolyte sports drinks, like Gatorade™ or Powerade™ into your survival event. For some athletes attempting long and grueling events, your prescriber may suggest discontinuing your diuretic or ACE inhibitor on the day of, and maybe a day or two beforehand.

Good decisions about medications require individual medical information and patient history, and prescription medication changes should only be made with the approval of your prescriber. Your community pharmacist or prescriber can help you make the best medication choices.  Talk to them. 

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.