Sports Pharmacy: What Providers Should Know About Medications, Anti-Doping Rules, and Athlete Care

Caring for an athlete introduces a question most providers rarely have to ask: Is this medication allowed in their sport?

A medication may be appropriate for an individual's medical circumstances while also being restricted by the organization governing their sport. Supplements, IV hydration, recovery plan, and even route of administration can raise questions that don't come up with most patients.

This is where sports pharmacy can become particularly valuable.

Sports pharmacy brings medication management, supplement education, anti-doping awareness, and individualized care into the broader sports medicine conversation. And the "athlete" in that conversation isn't necessarily an Olympian or professional competitor. It can include collegiate and high school athletes as well as recreational and aging athletes pursuing their own physical-wellness goals.

For providers, the challenge is understanding how an athlete's medications, health needs, sport, and governing organization fit together.

Sports Pharmacy Is About More Than a Prohibited Substances List

For providers working with athletes, one of the biggest challenges is context.

Which anti-doping rules apply to this athlete? What happens when a medically appropriate medication appears on a prohibited list? Can the route of administration change how a medication is taken? What should providers consider when evaluating supplements? And how do recovery, hydration, hormones, medications, and other interventions fit into the same clinical picture?

Those questions can become especially important as an athlete's regimen grows more complex.

In this Strive Session, clinical pharmacists Joey Elkins and Valerie Richards explore the growing role of sports pharmacy and the considerations providers may encounter when caring for athletes.

The webinar examines questions including:

• How do medication restrictions differ across athletic organizations?
• What is a therapeutic use exemption (TUE), and when might one become relevant?
• Why do dose, timing, and method of administration matter?
• What should providers know about medications and applications commonly discussed around recovery and physical function?
• What should providers look for when evaluating supplements used by competitive athletes?

The session also explores considerations that can be surprisingly easy to overlook, including IV hydration rules, supplement certification, coordination between multiple prescribers, and the fact that "athlete" can describe patients across a wide range of ages and levels of competition.

Watch the full Strive Sessions webinar to go deeper on sports pharmacy and what it means for your athletes.

What Is Sports Pharmacy?

Sports pharmacy applies pharmacy expertise to the specific medication and health considerations that can arise when caring for athletes.

That can include reviewing individualized medication regimens, educating athletes and providers about prohibited substances, evaluating supplement use, supporting medication adherence, and collaborating with other professionals involved in an athlete's care.

An athlete may be receiving care from multiple physicians or specialists. Looking at medications collectively can help identify questions that might be missed when each part of the athlete's care is considered separately.

Travel can introduce another layer of complexity. Training schedules, competition schedules, changes in routine, and environmental factors can all affect how an athlete manages medications and other aspects of care.

The result is a broader question than simply "What medication is this patient taking?"

Providers may also need to ask:

What does this medication mean within the context of this particular athlete?

Prohibited Medications in Sports: Why the Governing Organization Matters

One of the most important distinctions in sports pharmacy is that anti-doping requirements are not necessarily universal across every athlete or competition.

The relevant rules may depend on whether the athlete competes under an organization such as the World Anti-Doping Agency (WADA), the NCAA, or another professional or sport-specific governing body. For athletes subject to WADA rules, providers can consult the WADA Prohibited List to review substances and methods prohibited in and out of competition.

That means identifying the athlete's governing organization can be an important early step when reviewing medications.

Categories discussed in connection with prohibited or restricted substances can include anabolic agents, certain peptide hormones and growth factors, stimulants, diuretics and masking agents, glucocorticoids, cannabinoids, and other substance classes.

But simply knowing a medication's name may not tell the entire story.

Depending on the applicable rules, considerations can include:

• the substance itself
• the athlete's medical circumstances
• dose or threshold requirements
• route of administration
• timing relative to competition
• the rules of the specific governing organization
• whether an exemption process applies

The takeaway for providers is simple: don’t assume a medication is permitted just because it’s medically appropriate.

Therapeutic Use Exemptions (TUE) and Medically Necessary Regimen

What happens when an athlete has a documented medical condition that requires a medication restricted by their sport?

This is where a therapeutic use exemption (TUE) may become relevant.

A TUE can provide a pathway within applicable anti-doping frameworks for certain athletes who medically require otherwise prohibited medications.

This distinction matters because the presence of a medication on a prohibited list does not, by itself, explain the athlete's complete clinical situation.

The provider may need to understand both sides of the equation: the patient's medical needs and the requirements established by the organization governing competition.

How Route, Dose, and Timing Can Affect Anti-Doping Rules

Anti-doping rules aren't always as simple as whether a substance appears on a prohibited list.

Route of administration is one example discussed in the session, and threshold-based restrictions can introduce another layer of complexity for certain medications.

Some formulations or medication classes may also receive attention from anti-doping organizations even when they are not prohibited.

For providers, these distinctions point to a straightforward but easily overlooked reality:

Reviewing medications for a competitive athlete may require more context than a standard medication review.

The sport, governing organization, route, timing, dosage, medical indication, and current anti-doping rules can all influence the questions that need to be asked.

Sports Pharmacy Beyond Medication Management

Medication management is only one part of sports pharmacy.

Athletes may also present with concerns involving pain, recovery, hydration, energy, body composition, hormones, skin and hair, supplementation, and ongoing health conditions.

An athlete focused on recovery, for example, may simultaneously be using supplements, managing an injury, adjusting nutrition, monitoring wearable data, and taking prescription medications.

Rather than considering each intervention independently, providers and pharmacists can look at the broader regimen and ask how each piece fits into the athlete's health circumstances and goals.

Supplements for Athletes: Look Beyond the Front of the Label

Supplements are another major consideration in sports pharmacy.

Protein and creatine are among the common examples discussed in athlete care, but the larger provider question is how to evaluate the products an athlete is actually using.

Start with the label. Are the ingredients and amounts clearly listed, or are they hidden in a proprietary blend?

For competitive athletes, the next question is whether the supplement has been independently tested for prohibited substances. Understanding what certification a product carries—and exactly what that certification establishes—can be particularly important for athletes subject to anti-doping requirements.

Providers should avoid assuming that every supplement marketed toward athletes has undergone the same level of review.

Sports Pharmacy for Competitive and Recreational Athletes

Sports pharmacy isn't only for professional or Olympic athletes.

The medication needs of a professional competitor may be very different from those of a high school athlete, a recreational runner, or a 60-year-old who trains several days a week.

Yet all can benefit from care that accounts for their individual circumstances.

Age, health conditions, medications, training demands, competition requirements, nutrition, recovery, and personal goals can create very different considerations from one athlete to another.

For providers, sports pharmacy ultimately reinforces a familiar principle:

The patient comes before the category.

Understanding what the individual is trying to accomplish—and what medical, medication, and competition-related factors surround that goal—can lead to better-informed conversations across the care team.

The Role of Sports Pharmacy in Athlete Care

Sports pharmacy expands the medication conversation beyond the prescription itself.

For competitive athletes, that can mean understanding prohibited-substance rules and determining when additional anti-doping review may be necessary. For other athletes, it may mean looking more closely at medication regimens, supplements, recovery strategies, adherence, or coordination across multiple providers.

In either case, the opportunity is the same: look at the whole person rather than viewing medications, supplements, performance goals, and health concerns as isolated decisions.

For providers working with athletes, a pharmacist familiar with these considerations can become another resource in navigating that complexity.

Every athlete has individual needs. Their medications should reflect them. Partner with Strive to explore patient-specific medication options for the patients in your care.

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This information is intended for educational purposes only and does not constitute medical advice. The creators of this content disclaim any liability for decisions made based on the information presented. The information provided relates to patient-specific compounding. Compounded medications are specially prepared for identified individual patient needs based on a valid prescription from a prescribing healthcare practitioner and, as such, have not been reviewed or approved by the U.S. Food and Drug Administration (FDA) for safety or efficacy. Compounded drugs are intended for patients whose prescriber has determined their medical needs are not met by an available FDA-approved drug. Prescribers should use their independent clinical judgment when determining appropriateness for individual patients.