{"id":428,"date":"2026-07-13T09:00:29","date_gmt":"2026-07-13T06:00:29","guid":{"rendered":"https:\/\/tatd.org.tr\/sportibbi\/?p=428"},"modified":"2026-07-13T11:21:22","modified_gmt":"2026-07-13T08:21:22","slug":"acil-serviste-sik-kullandigimiz-ilaclar-ve-sporcularda-doping-riski","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/sportibbi\/genel\/acil-serviste-sik-kullandigimiz-ilaclar-ve-sporcularda-doping-riski\/","title":{"rendered":"Acil Serviste S\u0131k Kulland\u0131\u011f\u0131m\u0131z \u0130la\u00e7lar ve Sporcularda Doping Riski"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Yazar: Uzm. Dr. Sena \u00d6zge Aslan <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Edit\u00f6r: Dr. \u00d6\u011fr. \u00dcyesi \u00d6mer Yusuf Erdurmu\u015f<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Travma, akut a\u011fr\u0131lar veya kronik hastal\u0131k alevlenmeleri nedeniyle sporcular da s\u0131k\u00e7a acil servise ba\u015fvurur. Ancak sporcu hastalarda tedavi planlarken g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gereken ek bir konu vard\u0131r: Doping kurallar\u0131. Acil serviste rutin olarak kulland\u0131\u011f\u0131m\u0131z baz\u0131 ila\u00e7lar, yak\u0131n zamanda m\u00fcsabakaya \u00e7\u0131kacak sporcularda doping testlerinin pozitif sonu\u00e7lanmas\u0131na neden olabilir. Peki bu ila\u00e7lar neler? Nelere dikkat etmeliyiz? Gelin birlikte inceleyelim.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">A\u011fr\u0131 Kesiciler: Narkotikler&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Travmalarda, \u015fiddetli kar\u0131n a\u011fr\u0131lar\u0131nda a\u011fr\u0131n\u0131n h\u0131zl\u0131 ve etkili kesilmesi i\u00e7in s\u0131kl\u0131kla uygulad\u0131\u011f\u0131m\u0131z ila\u00e7 grubu olan narkotikler\u00a0m\u00fcsabaka d\u00f6neminde yasakl\u0131d\u0131r. Tramadol, morfin, fentanil bu ila\u00e7 grubunda acil servislerde s\u0131kl\u0131kla tercih edilen narkotiklerdir. \u0130yi haber \u015fu ki bu ila\u00e7lar yaln\u0131zca m\u00fcsabaka d\u00f6neminde yasak ancak eliminasyon s\u00fcreleri de\u011fi\u015fken oldu\u011fundan m\u00fcsabakaya yak\u0131n d\u00f6nemde kullan\u0131mlar\u0131 pozitif test riskini art\u0131rabilir<sup>1<\/sup>.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u00d6nemli not:<\/strong>&nbsp;Kodein i\u00e7erikli ve parasetamol gibi yayg\u0131n a\u011fr\u0131 kesiciler listede&nbsp;yok.<strong>&nbsp;<\/strong>Bu ila\u00e7lar mevcut WADA yasakl\u0131lar listesinde yer almamaktad\u0131r.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">En Kritik Grup: Glukokortikoidler&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Acil serviste en s\u0131k kullan\u0131lan ve en b\u00fcy\u00fck riski ta\u015f\u0131yan ila\u00e7 grubu bu. Anafilaksi, ciddi alerjik reaksiyon, ast\u0131m ata\u011f\u0131nda ve KOAH alevlenmesi gibi onlarca durumda rutin olarak veriliyor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u00d6rnek senaryo:<\/strong>&nbsp;Sporcu ast\u0131m ata\u011f\u0131 ile acile geliyor, 1 mg\/kg metilprednizolon IV yap\u0131l\u0131yor, 5 g\u00fcnl\u00fck oral prednizon yaz\u0131l\u0131yor. Sporcu k\u0131sa s\u00fcre sonra m\u00fcsabakaya kat\u0131l\u0131rsa, kullan\u0131lan preparata ve eliminasyon s\u00fcresine ba\u011fl\u0131 olarak doping testi pozitif sonu\u00e7lanabilir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Riskli olanlar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Metilprednizolon (Prednol) \u2014 enjeksiyon\/oral<\/li>\n\n\n\n<li>Deksametazon \u2014 enjeksiyon\/oral<\/li>\n\n\n\n<li>Prednizolon\/Prednizon \u2014 oral<\/li>\n\n\n\n<li>Hidrokortizon \u2014 enjeksiyon<\/li>\n\n\n\n<li>Betametazon \u2014 enjeksiyon<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Kritik nokta:<\/strong>\u00a0WADA&#8217;ya g\u00f6re bu ila\u00e7lar enjeksiyon, oral veya rektal yolla verildi\u011finde m\u00fcsabaka d\u00f6neminde yasak. Ama inhaler, nazal sprey, cilt kremi, g\u00f6z damlas\u0131 gibi topikal formlar lisansl\u0131 dozda kullan\u0131ld\u0131\u011f\u0131nda serbest. Yani ayn\u0131 ilac\u0131n formu her \u015feyi de\u011fi\u015ftiriyor<sup>2,3<\/sup>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>&nbsp;<\/strong><\/h4>\n\n\n\n<h2 class=\"wp-block-heading\">Beta-2 Agonistler&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Ast\u0131m ve bronkospazm i\u00e7in kullan\u0131lan Beta-2 Agonistler de bu listede yerini almakta: Salbutamol, formoterol, salmeterol belirli inhalasyon dozlar\u0131 i\u00e7inde istisna kapsam\u0131ndad\u0131r. Bu dozlar\u0131n a\u015f\u0131lmas\u0131 veya farkl\u0131 uygulama yollar\u0131n\u0131n kullan\u0131lmas\u0131 doping ihlaline neden olabilir<sup>1<\/sup>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u00d6nemli:&nbsp;<\/strong>Salbutamol idrarda 1000 ng\/mL&#8217;nin \u00fczerinde tespit edilirse doping kabul ediliyor. Bunu a\u015fmamak izin verilen maksimum inhalasyon dozu 24 saatte 1600 mcg&#8217;dir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Stim\u00fclanlar (S6):&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Doping riski denildi\u011finde akla genellikle steroidler gelir; ancak g\u00fcnl\u00fck pratikte s\u0131k kulland\u0131\u011f\u0131m\u0131z baz\u0131 &#8220;masum g\u00f6r\u00fcnen&#8221; ila\u00e7lar da pozitif test sonucuna yol a\u00e7abilir<sup>1<\/sup>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ps\u00f6doefedrin<\/strong>&nbsp;\u2014 so\u011fuk alg\u0131nl\u0131\u011f\u0131nda s\u0131kl\u0131kla tercih edilir.. \u0130drarda 150 mcg\/mL \u00fczerinde yasak. \u00d6nemsiz gibi g\u00f6r\u00fcnen so\u011fuk alg\u0131nl\u0131\u011f\u0131 tedavisi, m\u00fcsabakada teste tak\u0131labiliyor.<\/li>\n\n\n\n<li><strong>Efedrin<\/strong>&nbsp;\u2014 baz\u0131 bronkodilat\u00f6rlerde, e\u015fik: 10 mcg\/mL<\/li>\n\n\n\n<li><strong>Metilefedrin<\/strong>&nbsp;\u2014 \u00f6ks\u00fcr\u00fck \u015furubunda<\/li>\n\n\n\n<li><strong>Epinefrin (adrenalin)<\/strong>&nbsp;\u2014&nbsp;&nbsp;lokal uygulamalarda muafiyet bulunmaktad\u0131r. Anafilaksi gibi hayat\u0131 tehdit eden durumlarda gerekli tedavi geciktirilmemelidir.<\/li>\n\n\n\n<li><strong>Kokain<\/strong>&nbsp;\u2014 Kokain halen baz\u0131 KBB uygulamalar\u0131nda lokal anestezik ve vazokonstrikt\u00f6r olarak kullan\u0131labilmektedir.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Di\u00fcretikler (S5)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Listeyi incelerken en \u00e7ok \u015fa\u015f\u0131rd\u0131\u011f\u0131m ila\u00e7 grubu di\u00fcretikler \u00e7\u00fcnk\u00fc\u00a0maskeleme maddesi\u00a0olarak da de\u011ferlendiriliyor. Bu ila\u00e7 grubu di\u011fer doping maddelerinin idrardaki konsantrasyonunu d\u00fc\u015f\u00fcrebiliyorlar. Bu y\u00fczden WADA bunlar\u0131 \u00f6zellikle s\u0131k\u0131 tutuyor. Furosemid kadar mannitol de WADA taraf\u0131ndan maskeleyici ajan olarak de\u011ferlendirilmektedir<sup>1<\/sup>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Yasakl\u0131lar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Furosemid (Lasix), mannitol, hidroklorotiazid, spironolakton<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">IV S\u0131v\u0131 tedavisi<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">WADA, hastane tedavileri, cerrahi i\u015flemler ve tan\u0131sal giri\u015fimler d\u0131\u015f\u0131nda 12 saat i\u00e7inde 100 mL&#8217;nin \u00fczerindeki intraven\u00f6z inf\u00fczyon veya enjeksiyonlar\u0131 yasak y\u00f6ntem olarak kabul etmektedir. \u00d6zellikle son y\u0131llarda pop\u00fclerle\u015fen &#8220;vitamin serumu&#8221; veya &#8220;enerji serumu&#8221; uygulamalar\u0131 bu kural kapsam\u0131nda ciddi risk ta\u015f\u0131maktad\u0131r. Acil serviste uygulanan tedaviler bu kural\u0131n istisnas\u0131d\u0131r; ancak sporcuya uygulanan tedavinin ayr\u0131nt\u0131l\u0131 \u015fekilde belgelenmesi \u00f6nemlidir \u00e7\u00fcnk\u00fc sporcu gerekirse Tedavi Ama\u00e7l\u0131 Kullan\u0131m \u0130stisnas\u0131 (TAK\u0130)\u00a0\u00a0ba\u015fvurusu yapabilir<sup>1<\/sup>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><a><\/a><strong>&nbsp;<\/strong><\/h4>\n\n\n\n<h2 class=\"wp-block-heading\">Beta-Blokerler (P1)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Bu grup t\u00fcm sporcular i\u00e7in de\u011fil, belirli sporlar i\u00e7in yasakl\u0131: Ok\u00e7uluk, otomobil sporlar\u0131, bilardo, dart, golf, mini golf, at\u0131c\u0131l\u0131k, sualt\u0131 sporlar\u0131.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Metoprolol, propranolol, esmolol, labetalol, bisoprolol. Golf veya ok\u00e7uluk yapan bir sporcu i\u00e7in ciddi risk.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Beta-Blokerler Neden Sadece Baz\u0131 Sporlarda Yasak?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Beta-blokerler adrenalin etkisini bloke eder: kalp yava\u015flar, eller titremez, yar\u0131\u015fma bask\u0131s\u0131 hissedilmez. Ok\u00e7uluk, at\u0131c\u0131l\u0131k ve golfte ba\u015far\u0131 titremesiz ele ve sakin kalp at\u0131\u015f\u0131na ba\u011fl\u0131d\u0131r. 70 metre mesafedeki hedefi vurmak i\u00e7in 1-2 milimetrelik el titremesi bile fark yarat\u0131r. Beta-bloker bunu ortadan kald\u0131r\u0131r, yani yapay avantaj sa\u011flar. Ama bir ko\u015fucu veya futbolcu ayn\u0131 ilac\u0131 al\u0131rsa kalp yeterince h\u0131zlanamaz, kaslar oksijensiz kal\u0131r, performans d\u00fc\u015fer. Dayan\u0131kl\u0131l\u0131k sporcusu i\u00e7in doping de\u011fil, handikapt\u0131r. Bu nedenle beta-blokerler yaln\u0131zca hassas ni\u015fan alma ve ince motor kontrol gerektiren sporlarda yasaklanm\u0131\u015ft\u0131r<sup>1<\/sup>.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" width=\"904\" height=\"990\" src=\"https:\/\/tatd.org.tr\/sportibbi\/wp-content\/uploads\/sites\/22\/2026\/07\/Resim1.png\" alt=\"\" class=\"wp-image-430\" style=\"aspect-ratio:0.9131365288582396;width:600px;height:auto\" srcset=\"https:\/\/tatd.org.tr\/sportibbi\/wp-content\/uploads\/sites\/22\/2026\/07\/Resim1.png 904w, https:\/\/tatd.org.tr\/sportibbi\/wp-content\/uploads\/sites\/22\/2026\/07\/Resim1-274x300.png 274w, https:\/\/tatd.org.tr\/sportibbi\/wp-content\/uploads\/sites\/22\/2026\/07\/Resim1-768x841.png 768w, https:\/\/tatd.org.tr\/sportibbi\/wp-content\/uploads\/sites\/22\/2026\/07\/Resim1-585x641.png 585w\" sizes=\"(max-width: 904px) 100vw, 904px\" \/><figcaption class=\"wp-element-caption\">WADA 2026 Yasakl\u0131 Maddeler Listesi<\/figcaption><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\"><a><\/a>Acil Hekimi \u0130\u00e7in Ak\u0131lda Kalacak 5 Nokta<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Oral ve enjeksiyon glukokortikoidler sporcularda risklidir.<\/li>\n\n\n\n<li>Salbutamol tamamen serbest de\u011fildir; doz s\u0131n\u0131rlar\u0131 vard\u0131r.<\/li>\n\n\n\n<li>Ps\u00f6doefedrin i\u00e7eren so\u011fuk alg\u0131nl\u0131\u011f\u0131 ila\u00e7lar\u0131 pozitif teste neden olabilir.<\/li>\n\n\n\n<li>Furosemid ve mannitol maskeleyici ajan kabul edilir.<\/li>\n\n\n\n<li>Hayat\u0131 tehdit eden durumlarda tedavi ertelenmez; ancak uygulanan tedavi mutlaka belgelenmelidir.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">\u00d6zet<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Acil servise ba\u015fvuran ve hayati riski olan sporcularda \u00f6rne\u011fin ast\u0131m ata\u011f\u0131, anafilaksi, a\u011f\u0131r travma gibi klinik durumlarda tedaviden ka\u00e7\u0131nmak s\u00f6z konusu olamaz. \u00d6ncelik her zaman hastan\u0131n sa\u011fl\u0131\u011f\u0131d\u0131r. Ancak kar\u015f\u0131s\u0131ndaki hastan\u0131n sporcu oldu\u011funu bilen bir hekim i\u00e7in birka\u00e7 ek ad\u0131m b\u00fcy\u00fck fark yarat\u0131r:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Uygulanan tedaviyi net bi\u00e7imde belgeleyen bir epikriz d\u00fczenlemek<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Yak\u0131n zamanda m\u00fcsabakas\u0131 varsa doping testi riskini hastaya a\u00e7\u0131k\u00e7a bildirmek&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gerekti\u011finde TAK\u0130 ba\u015fvurusuna y\u00f6nlendirmek.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Sporcular ve ekipleri ise ila\u00e7 kontrol\u00fc i\u00e7in WADA&#8217;n\u0131n \u00fccretsiz arac\u0131 Global DRO&#8217;yu kullanabilir. \u0130la\u00e7 ad\u0131n\u0131 girerek o ilac\u0131n yasakl\u0131 olup olmad\u0131\u011f\u0131n\u0131 an\u0131nda \u00f6\u011frenmek m\u00fcmk\u00fcn: globaldro.com<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">K\u0131sacas\u0131, sporcu hastalarda do\u011fru tedaviyi vermek kadar verilen tedavinin antidoping kurallar\u0131 a\u00e7\u0131s\u0131ndan sonu\u00e7lar\u0131n\u0131 bilmek de modern acil t\u0131p prati\u011finin bir par\u00e7as\u0131 haline gelmi\u015ftir.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">Kaynak\u00e7a<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>World Anti-Doping Agency. <em>The 2026 Prohibited List: International Standard<\/em>. Montreal (QC): World Anti-Doping Agency; 2026. Available from: <a href=\"https:\/\/www.wada-ama.org\/en\/resources\/world-anti-doping-program\/prohibited-list\">https:\/\/www.wada-ama.org\/en\/resources\/world-anti-doping-program\/prohibited-list<\/a><\/li>\n<\/ol>\n\n\n\n<ol start=\"2\" class=\"wp-block-list\">\n<li>World Anti-Doping Agency. <em>Glucocorticoids and Therapeutic Use Exemptions Guidelines<\/em>. Montreal (QC): World Anti-Doping Agency; 2025. Available from: <a href=\"https:\/\/www.wada-ama.org\/en\/resources\/world-anti-doping-program\/prohibited-list\">https:\/\/www.wada-ama.org\/en\/resources\/world-anti-doping-program\/prohibited-list<\/a><\/li>\n<\/ol>\n\n\n\n<ol start=\"3\" class=\"wp-block-list\">\n<li>Ventura R, Daley-Yates P, Mazzoni I, Collomp K, Saugy M, Buttgereit F, et al. A novel approach to improve detection of glucocorticoid doping in sport with new guidance for physicians prescribing for athletes. <em>Br J Sports Med<\/em>. 2021;55:e1. doi:10.1136\/bjsports-2020-103512<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Yazar: Uzm. Dr. Sena \u00d6zge Aslan Edit\u00f6r: Dr. \u00d6\u011fr. \u00dcyesi \u00d6mer Yusuf Erdurmu\u015f Travma, akut a\u011fr\u0131lar veya kronik hastal\u0131k alevlenmeleri nedeniyle sporcular da s\u0131k\u00e7a acil servise ba\u015fvurur. Ancak sporcu hastalarda&hellip;<\/p>\n","protected":false},"author":177,"featured_media":429,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","_tatd_show_on_main_site":"","footnotes":""},"categories":[1,10014,10015],"tags":[10018,10030,10017,10021,10031],"class_list":["post-428","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","category-sosyal-blog-yazisi","tag-acil-tip","tag-doping","tag-spor","tag-spor-acilleri","tag-sporcu-sagligi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/posts\/428","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/users\/177"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/comments?post=428"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/posts\/428\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/media\/429"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/media?parent=428"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/categories?post=428"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/tags?post=428"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}