Athlete Guide to the 2020 Prohibited List
This guide is intended to provide practical guidance on how the UFC Prohibited List may affect an athlete. This guide is not intended to be exhaustive, or a substitute for the Prohibited List, and therefore should be read in conjunction with the Prohibited List.
Ultimately, the athlete is solely responsible for the substances in his or her body and the methods used to administer those substances. Athlete support personnel are also liable for anti-doping policy violations if determined to be complicit.
If you are using any medications at all, a good place to start is by always checking the permitted or prohibited status on UFC.GlobalDRO.com.
Further information on the topics contained in this guide can be obtained by consulting the references and resources below.
The UFC Prohibited List can be downloaded.
UFC Global DRO (UFC.GlobalDRO.com) is a searchable online database of medications that details the prohibited and permitted status of relevant medications available in Australia, New Zealand, Canada, Japan, Switzerland, the United Kingdom, and the United States.
USADA, along with the UFC Global DRO website, only provides the UFC Prohibited List of permitted or prohibited substances and methods. UFC Global DRO does not provide information on the permitted or prohibited status of dietary supplement products. Make sure to also check your medications with the relevant Athletic Commission(s), as they may prohibit some medications and methods that are permitted under the UFC Prohibited List, and vice versa.
An athlete is not permitted to use any prohibited substance or method unless a valid Therapeutic Use Exemption (TUE) has been issued by USADA, and the TUE is either formally recognized by, or also issued by the relevant Athletic Commission(s). Determine if you need a TUE by clicking here. Contact USADA’s Drug Reference Department for questions on TUEs at email@example.com or about the status of medications at firstname.lastname@example.org.
**USADA does not provide medical advice or recommendations. An athlete should make all treatment-related decisions with his/her physician in consultation with the UFC Prohibited List.**
Athlete Quick links
Substances Prohibited at All Times
(Both In-Competition and Out-Of Competition)
The first section of the Prohibited List discusses substances and methods that are prohibited at all times, both in-competition and out-of-competition.
S0. Non-Approved Substances
Non-approved refers to substances that are not approved by any governmental organization anywhere in the world for medical use. This might include drugs in pre-clinical or clinical trials, undergoing research and development, discontinued (taken off the market), designer drugs, or substances approved only for veterinary use.
In order for a substance to be prohibited under S0, a substance must meet three criteria:
- Be “non-approved” anywhere in the world (as defined above)
- Have the potential to be performance enhancing
- Not fit in other sections of the Prohibited List
What you need to know:
- Avoid using any product that says it is a research chemical, or “not for human use.”
S1. Anabolic Agents (Steroids)
Anabolic agents are substances that build muscle and are more commonly called steroids. The list of anabolic agents is extensive and even if one is not specifically listed, it is still prohibited. If it is a metabolite or has “a similar chemical structure or similar biological effect(s)” to an anabolic agent, it is prohibited.
What you need to know:
- Prescription testosterone is a prohibited steroid. Just because your doctor prescribes it doesn’t mean you can use it in sport. You must first get an APPROVED TUE before using testosterone in sport, or you are committing an anti-doping policy violation.
- Clenbuterol is sometimes prescribed outside of the U.S. to treat asthma. Clenbuterol is considered an anabolic agent.
- Clenbuterol may be used in some countries (such as China, Mexico, and Guatemala) to “bulk up” livestock. In order to ensure that valid meat contamination cases are dealt with fairly, clenbuterol may be reported as an atypical finding if detected in an athlete’s sample below a certain concentration.
- DHEA and the related compounds 7-hydroxy-DHEA and 7-keto-DHEA are prohibited in sport as anabolic agents, but they can be purchased legally in the U.S. as an ingredient in dietary supplements.
- SARMS (Selective Androgen Receptor Modulators), such as andarine, ostarine, LGD-4033, and RAD-140 are prohibited under this category. The unfortunate reality is that some dietary supplement manufacturers illegally put SARMs in their products, and some omit these substances from the label entirely or use misleading names to confuse consumers. For a few examples, see the High Risk List on Supplement411.org. The use of any supplement is at an athlete’s own risk. To reduce that risk, UFC athletes should only use supplements certified by Certified Supplement providers identified on the UFC Prohibited List.
S2. Peptide Hormones, Growth Factors, Related Substances, and Mimetics
This section includes substances that increase red blood cell count, blood oxygenation, or oxygen-carrying capacity (such as EPO and Hypoxia inducible factors (HIF stabilizers)), and other drugs to treat anemia.
Also prohibited are pituitary gland hormones, and many growth hormones, growth factors, and hormone-releasing factors (sometimes called “secretagogues”) and any “other growth factor or growth factor modulators affecting muscle, tendon, or ligament protein synthesis/degradation, vascularization, energy utilization, regenerative capacity or fiber type switching.”
The list of S2 agents is long and even if a substance is not specifically listed, it is still prohibited if it has “a similar chemical structure or similar biological effect(s).”
What you need to know:
- Many drugs in this category are still in clinical trials and are not approved for medical use. However, many unapproved drugs can be purchased on the black market. Make sure to only use approved medications to treat anemia and check the status on UFC.GlobalDRO.com.
- Cobalt is on the Prohibited List, but there are trace quantities in some foods and vitamins. For example, vitamin B12 (also called cobalamin) contains trace amounts of cobalt, but B12 is permitted.
- Some products marketed as dietary supplements claim to contain, or boost, the release of EPO, IGF-1, or growth hormones, or they claim to contain growth factors. To be safe, athletes should simply avoid any dietary supplement that claims to contain a prohibited substance no matter what the level. By the same token, athletes should avoid dietary supplements that claim to deliver the same effects as performance-enhancing drugs. Please visit UFC.USADA.org/supplements to learn how to reduce your risk.
- Human chorionic gonadotrophin (hCG) is prohibited in sport at all times for males. However, it is a Food and Drug Administration (FDA)-approved prescription medication for the treatment of female infertility. It is not approved as a weight loss drug. The FDA warns consumers to avoid “homeopathic” hCG weight-loss products because they are illegal. These are sold in the form of oral drops, pellets, and sprays and can be found online and in some retail stores.
- Even though Platelet Rich Plasma (PRP) contains some growth factors, PRP itself is not prohibited. Be aware, though, that individual growth factors are still prohibited when given separately as purified substances as described in S.2.5.
- Stem cell injections may or may not be prohibited, depending on how the product is manipulated or modified for use. Contact email@example.com for specific guidance.
- Colostrum is not specifically listed as prohibited; however, these contain certain quantities of IGF-1 and other growth factors that are prohibited and can influence the outcome of anti-doping tests. Therefore, use of such products is not recommended.
S3. Beta-2 Agonists
Beta-2 agonists are used to treat asthma. When inhaled, they relax the muscles in the airways making it easier to breath. Beta-2 agonists are usually inhaled by a metered dose inhaler or by a nebulizing device, but they can also be given orally. Beta-2 agonists can also be mixed with other medications in an inhaler, like corticosteroids.
What you need to know:
- All beta-2 agonists are prohibited at all times by any route of administration (oral, inhaled, injected), and require a TUE. The only exceptions are:
- Albuterol (also called salbutamol) by inhalation maximum 1600 micrograms over 24 hours in divided doses not to exceed 800 micrograms over 12 hours starting from any dose;
- Formoterol by inhalation through a metered dose inhaler in dosages less than 54 mcg in any 24-hour period.
- Salmeterol by inhalation through a metered dose inhaler in dosages not to exceed 200 mcg in any 24-hour period.
- In order to calculate how many puffs you can have per day, you need to find the medication and dosage on your inhaler and then multiply it by the number of puffs per day you have been prescribed, and then compare that dosage to the permitted dosage range. As an example, albuterol is commonly delivered in a dosage of 90 micrograms per actuation. You might see “90 MCGs per actuation” or just 90mcgs. This means you are getting 90 micrograms per “puff.” If the permitted dosage is 800 mcgs over 12 hours, which means you could use up to 8 puffs in 12 hours and still stay within the permitted dosage range (90mcgs x 8 = 720 micrograms).
- If you use albuterol, formoterol or salmeterol by a nebulizer, you need a TUE. Nebulizers use a much larger amount of beta-2 agonists than a metered dose inhaler (MDI), making it possible to exceed the permitted dosages for albuterol, formoterol, or salmeterol.
- If you need to use more than the permitted dosage of albuterol, formoterol, or salmeterol, then you must apply for a TUE.
- Purified isomers of albuterol and formoterol, namely levalbuterol and arformoterol, are prohibited at all times and the permitted dosage thresholds DO NOT APPLY TO THESE PURIFIED ISOMERS. If you are prescribed levalbuterol (Xopenex) or arformoterol (Brovana) you need to apply for a TUE.
- If you are taking a medication that falls into the category of “Diuretics or Masking Agents” on the UFC Prohibited List in conjunction with any beta-2 agonist, then you must have a TUE for both the diuretic and your inhaler, EVEN IF you are using the “permitted dosage” for albuterol, formoterol, or salmeterol as described above. The use of diuretic negates the permitted dosage of these three medications.
- The presence in urine of salbutamol in excess of 1000 ng/mL, or formoterol in excess of 40 ng/mL, is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding (AAF).
- Some inhalers have more than one active ingredient. Make sure to check all active ingredients on UFC.GlobalDRO.com.
- Some cold and flu medications have oral beta-2 agonists in them. Make sure to read the ingredient label for any over-the-counter or prescription medications you are using and check the status of each ingredient on UFC.GlobalDRO.com.
S4. Hormone and Metabolic Modulators
Hormones and metabolic modulators are a group of substances that are not limited to hormones themselves. This group of substances often modifies how hormones work, either by blocking the action of a hormone or by increasing the activity of a hormone. There are many substances that fall into the category of “Hormone or Metabolic Modulator.” Some of these substances are discussed here.
Aromatase inhibitors are hormone modulators that bind to aromatase and stop it from working. The aromatase enzyme is responsible for synthesizing estrogen in the body by turning testosterone and other androgens into estrogen. Aromatase inhibitors like exemestane, anastrozole, and letrozole are FDA-approved drugs that are used to treat some kinds of breast cancer. Some cancers grow faster in the presence of estrogen. By blocking the synthesis of estrogen there is less estrogen circulating in the body.
Likewise, Selective Estrogen Receptor Modulators (SERMs) (like tamoxifen and raloxifene) bind to estrogen receptors in breast tissue and block the effect of estrogen. Athletes in strength sports, or athletes who are trying to prevent the effects of estrogen on their bodies, might abuse aromatase inhibitors or SERMs.
Clomiphene is prohibited at all times as an anti-estrogenic substance. Clomiphene is a SERM that is used in female fertility brand name prescription medications, such as Clomid. In women, clomiphene acts on the pituitary gland to stimulate the release of specific hormones responsible for ovulation. In men, clomiphene can alter testosterone levels by interfering with the negative feedback loop of the hypothalamic–pituitary–gonadal axis. Clomiphene is not FDA-approved for use by men for any condition and TUEs are unlikely to be granted to men who receive off-label prescriptions for clomiphene.
Another group of metabolic modulators are agents that prevent activin receptor IIB activation.
Myostatin is a growth factor that controls and limits the amount of muscle a person makes. Myostatin inhibitors (substances that block the action of myostatin) can cause an increase in muscle mass. A number of experimental compounds that modify myostatin are being evaluated to treat muscle wasting diseases, but there are currently no FDA-approved medications that modulate myostatin.
Other metabolic modulators include substances that affect how the body processes energy. For example, substances that mimic the effects of insulin can change how the body processes sugar, causing a person to burn more or less glucose. Insulin is also anabolic (muscle building), so substances that mimic the effects of insulin could build muscle.
Substances that activate AMP-activated protein kinases, for example AICAR, show promise in protecting cells against oxidative damage during stroke or in certain diseases like diabetes. Similarly, substances that activate peroxisome proliferator activated receptor modulators (PPARs) like GW1516, GW0742, and L1655041 are experimental drugs under study to treat diabetes, lipid disorders, and metabolic syndrome. AMP-activated protein kinases and PPARs are experimental drugs with no approved medical use at this time. Despite not being approved for human use, these substances are synthesized by clandestine laboratories around the world.
Meldonium is a drug registered for use in some Baltic countries, but it is not approved for use in the U.S., Canada, or Western Europe. Meldonium has very long urinary excretion times so it is especially difficult to estimate clearance times for this substance.
All of the substances discussed in this section are prohibited in sport at all times. Please consult the Prohibited List for more examples of substances in this class.
What you should know:
- An athlete diagnosed with insulin-dependent diabetes is required to submit a TUE for use of insulin.
- Female athletes using clomiphene for fertility purposes must submit a TUE before use.
- Many of the substances in this category are sold on body building or steroid websites as dietary supplements or as products that say they are “for research purposes only” or “not for human use.” In addition to being prohibited in sport, such products can pose serious health risks. Athletes are advised not to use such products.
S5. Diuretics and Masking Agents
Masking agents are prohibited, including diuretics (water pills), desmopressin, probenecid, and plasma expanders, which increase blood volume.
What you should know:
- Drosperinone, pamabram, carbonic anhydrase inhibitors used as eye drops (dorzolamide and brinzolamide), and the local administration of Felypressin for dental anesthesia are permitted.
- Spironolactone is sometimes prescribed for acne, but it is a prohibited medication. Please read more on spironolactone.
- Hydrochlorothiazide is a commonly prescribed diuretic. It is often abbreviated as HCTZ and prescribed in combination with other medications (for example, lisinopril). Make sure to check all of your medications on UFC.GlobalDRO.com and also search for abbreviated terms, like HCTZ, to find out if they stand for a prohibited ingredient.
- The use of any amount of a threshold substance (i.e., albuterol, cathine, ephedrine, formoterol, methylephedrine, and pseudoephedrine) at the same time as a diuretic or other masking agent requires a TUE for the threshold substance AND the diuretic/masking agent. This means two TUEs are needed.
- Some dietary supplements that claim to be “natural” water pills may contain prescription diuretics that are not listed on the label. The use of any dietary supplement is at the athlete’s own risk. For a list of Certified Supplement providers, click here.
Methods Prohibited At All Times
(Both In and Out-of-Competition)
M1. Manipulation of Blood and Blood Components
Blood doping, the use of red blood cells from any source, or otherwise artificially enhancing the uptake, transport, or delivery of oxygen, is prohibited. Any type of intravenous (IV) manipulation of the blood or blood components by physical or chemical means is prohibited. This also means that blood or portions of a person’s blood cannot be reinjected.
What you should know:
- Supplemental oxygen (e.g., temporarily breathing an oxygen rich air mixture) administered by inhalation is permitted.
- Use of hyperbaric or hypobaric tents is permitted. Similarly, training or sleeping/living at high altitudes is permitted. Cryogenic chambers for whole body cryotherapy are permitted.
- Whole blood donation, when no blood is returned to the donor, is permitted.
- Hemodialysis is prohibited under M1.1, as blood is taken out from the patient (in a closed circuit) and reintroduced into the circulatory system. An athlete needing this treatment requires a TUE.
- Donating plasma or plasmapheresis (when the rest of the blood components are reinjected into the donor) is prohibited for the donor because the donor’s own red blood cells and other blood components are being reintroduced into the circulatory system after the plasma has been separated.
- Intravenous laser therapies, such as ozone therapy and/or ultraviolet light therapies, which includes the removal, treatment, and manipulation of blood or blood components, are prohibited.
M2. Chemical and Physical Manipulation
Tampering or attempting to tamper with a collected sample to affect its integrity or validity is prohibited. This includes providing synthetic urine or urine that is not the athlete’s own, or any modification of the urine sample, such as addition of proteases.
All IV infusions and/or injections of any substance (including those for re-hydration) of more than 100 mL (~3.4 oz.) per 12-hour period are prohibited both in and out of-competition, except for those legitimately received during a hospital treatment, surgical procedure, clinical diagnostic investigation, and/or those that are determined to be medically justified and within the standard of care by a licensed physician and administered by a licensed medical professional. IV infusions that do not meet the above criteria require a TUE and will be strictly evaluated under the UFC TUE Policy.
Small volume intravenous injections (under 100 mL) are permitted as long as the substance delivered is not prohibited. If a prohibited substance is administered intravenously or via injection, a TUE is necessary regardless of volume.
When applying for a TUE, a precise description of the clinical situation and specific medical indication for the IV infusion must be given in the TUE application, to include a complete medical file, diagnosis, and physical exam at minimum. Emergency TUEs will be considered in exceptional circumstances. Please note that the health and well-being of the athlete must always remain the priority in emergency circumstances.
M3. Gene Doping & Cell Doping
With the potential to enhance sport performance, the use of polymers of nucleic acids or nucleic acid analogues, or the use of normal or genetically-modified cells is prohibited. Gene editing technology designed to alter genome sequences and/or the transcriptional or epigenetic regulation of gene expression, in both germ line and somatic cells, such as CRISPR/Cas 9, are also prohibited when they have the potential to enhance performance.
Substances and Methods Prohibited
This section focuses on substances that are prohibited in-competition only. These substances are not tested for out-of-competition.
In-competition means the period commencing at noon on the day of weigh-ins and ending upon the completion of the post-Bout sample or specimen collection. If post-Bout sample collection is not initiated by USADA within a reasonable time, not to exceed one hour following the athlete’s post-Bout medical clearance, then the in-competition period will expire at that time.
Out-of-competition refers to any period that is not in-competition.
Definitions for in-competition and out-of-competition are taken from the UFC Anti-Doping Policy.
An athlete must ensure that all substances prohibited in-competition have been completely cleared from his/her body before an event period. This means the substances are not detectable in the athlete’s sample. It is not possible for USADA to list specific stop times to ensure clearance for substances prohibited in-competition. If the on-going or daily use of a substance is needed, or the medication cannot be stopped before an event long enough to allow it to clear from the body, an application for a TUE should be submitted. The best way to start this process is by filling in the TUE Pre-Check form. After filling in this form, USADA will notify you if a TUE is needed.
All stimulants and their optical isomers are prohibited, except for clonidine, imidazole derivatives for topical/ophthalmic use, and stimulants in the Monitoring Program.
What you should know:
- An athlete who has been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) and is taking stimulants should apply for a TUE for their medication.
- Some medications used to treat Parkinson’s and/or narcolepsy are prohibited in-competition. If you are taking medications to treat these conditions, make sure to check the status on UFC.GlobalDRO.com and apply for a TUE if necessary.
- Some non-drowsy or 24 hour cold and flu medications contain pseudoephedrine, which is prohibited in-competition.
- Athletes should discontinue taking the standard daily dose of 240mg or less of pseudoephedrine AT LEAST 24 HOURS prior to the time defined as “in-competition.” Be advised that, in some cases, such as slow metabolism or drug interactions, this may not be enough time for the medication to clear the body. USADA recommends avoiding pseudoephedrine-containing cold and flu products for several days in advance of competition.
- If you need to be on a diuretic for any reason, and you also need to use a medication that has pseudoephedrine in it, you need a TUE for BOTH the diuretic and pseudoephedrine.
- There are many novel and designer stimulants in dietary supplements. Please check all ingredients on UFC.GlobalDRO.com to find out if they are prohibited and visit UFC.USADA.org/supplements for a list of Certified Supplements.
- Levmetamfetamine (nasal decongestant inhaler), epinephrine (inhaler), and racepinephrine (nebulizer) are prohibited in-competition but are found in some cold and flu products, as well as products used to treat mild breathing difficulties. Read the label of your cold and flu, or allergy product carefully and check the active ingredients on UFC.GlobalDRO.com.
- Common cough, cold, and flu active ingredients are in the label below.
Certain narcotics are prohibited in-competition: Buprenorphine; Dextromoramide; Diamorphine (heroin); Fentanyl and its derivatives; Hydromorphone; Methadone; Morphine; Nicomorphine; Oxycodone; Oxymorphone; Pentazocine; Pethidine (meperidine). Use of these narcotics in-competition requires an approved TUE.
What you should know:
- Opium, the latex extract of the poppy plant, contains morphine and is therefore also prohibited. Poppy seeds can contain trace amounts of opium.
- Several of these narcotics are made as extended-release or slow-release products and will take longer to clear from the body.
- Codeine, hydrocodone, and tramadol are currently permitted.
The following cannabinoids are prohibited:
- Natural cannabinoids, such as cannabis, marijuana and hashish.
- Synthetic cannabinoids, such as Δ9-tetrahydrocannabinol (THC) and other cannabimimetics
- Cannabidiol (CBD)
What you should know:
- Please read the detailed educational articles on THC and marijuana.
- CBD is not prohibited. However, CBD extracted from cannabis plants may contain varying concentrations of THC and other natural cannabinoids, all of which are still prohibited. Please read our educational article on CBD.
- An athlete should be aware that THC may be retained in fat tissue following frequent, repeated use and may be detected weeks after use. Also, significant weight loss over a short-period of time has caused THC metabolites stored in fat to be released in detectable levels, even if not used recently. USADA strongly advises athletes not to consume cannabinoids at any time.
- An athlete who chooses to consume hemp products may be at risk for a positive anti-doping test, even though many of these products claim not to contain THC.
- While the use of medical marijuana may be decriminalized in some states, it is still illegal under federal law. USADA will consider a TUE application for medical marijuana, but only for certain conditions.
The systemic use of glucocorticoids (often also called “glucocortico steroids” or “steroids” by prescribers) is prohibited in-competition. Prohibited and systemic routes include oral intake (taken by mouth and swallowed, such as prednisone or Medrol Dose Pack), a systemic injection into the vein (intravenous or IV) or muscle (intramuscular or IM), or rectal use (e.g., suppositories or inserted creams). Glucocorticoids are commonly prescribed to reduce pain and inflammation.
What you should know:
- An athlete who is prescribed oral, rectal, IV, or IM glucocorticoids may take these medications out-of-competition without submitting a TUE, as long as the prohibited substance has cleared their system prior to the time defined as “in-competition.”
- If an athlete needs to use glucocorticoids by a systemic route (oral, IM, IV or rectal) before or during competition, he or she must obtain a TUE.
- If you are not sure if you need a TUE or not, based on your competition level or clearance time or the corticosteroid, please fill out a TUE-Pre-check form.
- The time it takes for glucocorticoids to clear from an athlete’s body depends on many variables and cannot be predicted by USADA. An athlete’s doctor or pharmacist may help determine clearance times, but make sure to read the Clearance Time FAQ on the TUE page. Doctors and pharmacists often refer to the half-life of a drug, but this is different from the clearance time of the parent compound and metabolites.
- Injections of glucocorticoids into joints (intra-articular) and epidural spaces (into the spine) are permitted, but an injection into a muscle (IM) is prohibited.
- Inhalation of glucocorticoids (e.g., for asthma) is permitted. Make sure your inhaler is being used correctly and that you are not swallowing the product. If you’re not sure your medication is being delivered to your lungs properly through correct inhaler technique, please consult your physician.
- Topical use of glucocorticoids (e.g., anti-rash cream, hemorrhoid creams used on the surface, etc.) is permitted. Be aware, however, that some hemorrhoid suppositories or inserted rectal creams contain glucocorticoids and are prohibited in-competition.
- Make sure to consult UFC.GlobalDRO.com or the UFC Prohibited List for any glucocorticoid you are prescribed.