✓ No active regulatory warningsFDA MedWatch, EMA EudraVigilance, WHO VigiBase, WADA Prohibited List · 2026-05-29
⚠ Serum creatinine rises with supplementation, which may falsely suggest impaired renal function. Cystatin C is the appropriate kidney function marker in creatine users [2].
⚠ Not on the WADA Prohibited List. Permitted by IOC, FIFA, NCAA, and all major sports organizations [2].
🥗 Food first — build your daily Typical 3–5 g
Check the foods you regularly eat — the bar fills toward your daily target.
Herring (85g)1.1 g
Beef (85g)0.9 g
Salmon (85g)0.85 g
Pork (85g)0.7 g
Tuna (85g)0.68 g
Cod (85g)0.55 g
Check your regular foods above
☑ Risk checker
Vegetarian/vegan diet (no dietary creatine; 20–30% lower muscle stores) [2]
Low meat/fish intake in elderly [1]
Inborn errors of creatine synthesis (cerebral creatine deficiency syndromes — rare genetic disorders) [1]
Select factors
🔬 Lab interpreter
Recommended test
Serum creatinine
Serum creatinine
Reference range / target
Expected 10–20% increase from baseline. This does NOT indicate kidney damage — it reflects increased creatinine production from larger creatine pool [3]
Expected 10–20% increase from baseline. This does NOT indicate kidney damage — it reflects increased creatinine production from larger creatine pool [3]
When to test
Baseline before starting supplementation; creatine raises creatinine 10–20% as normal metabolic byproduct
Full lab monitoring ↓Baseline before starting supplementation; creatine raises creatinine 10–20% as normal metabolic byproduct
⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Most extensively studied ergogenic aid with over 500 published trials [2]. Loading: 20 g/day (4 x 5 g) for 5–7 days, then 3–5 g/day maintenance. Alternative: 3–5 g/day without loading (saturation in 3–4 weeks) [2]. No alternative form (HCl, ethyl ester, buffered) has demonstrated superiority over monohydrate in any peer-reviewed comparison [2]. Creatine elevates serum creatinine — use cystatin C for kidney function assessment in users.
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
Insufficient safety data in human pregnancy. Not currently recommended during pregnancy or lactation.
👦 Pediatric: See guidance
The American Academy of Pediatrics does not recommend creatine supplementation for individuals under 18 years of age due to limited safety data in developing populations. Adolescent athletes commonly
🏃 Athletes: Specific dosage data under clinical review
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Specific dosage data under clinical review
How to take
🍽 Timing: Post-workout for maximal muscle uptake (enhanced by exercise-induced blood flow and GLUT4 translocation). On rest days, timing is flexible [1].
💊 With food: Take with a carbohydrate-containing meal or shake (~50 g carbs) to stimulate insulin and enhance creatine transport into muscle [1].
🚫 Avoid: Dissolve powder completely before drinking. Do not take with very hot liquids (>60°C accelerates conversion to creatinine). Ensure adequate hydration (additional 500 mL water per day minimum) [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['Creatine monohydrate', 'preferred', 'The most studied form with over 500 published trials. Highest purity available as Creapure (German-manufactured). All novel forms (hydrochloride, ethyl ester, buffered) have failed to demonstrate superiority in head-to-head comparisons [2].'] | Standard | Check label | |
| ['Creatine hydrochloride', '', 'Marketed as more soluble and requiring lower doses. No peer-reviewed evidence of superior efficacy or bioavailability compared with monohydrate.'] | Standard | Check label | |
| ['Micronized creatine monohydrate', '', 'Mechanically processed for finer particle size. Improved mixability in liquid but identical bioavailability to standard monohydrate.'] | Standard | Check label |
3 Common questions
Does creatine cause kidney damage? ▼
No. In individuals with healthy kidneys, creatine supplementation at recommended doses (3–5 g/day) does not impair renal function, as demonstrated in multiple long-term studies (up to 5 years of continuous use) [2]. Creatine does increase serum creatinine (a breakdown product), which may falsely suggest impaired kidney function on blood tests. Cystatin C is a more reliable kidney function marker in creatine users. Individuals with pre-existing kidney disease should consult their nephrologist.
Do I need a loading phase? ▼
Loading (20 g/day for 5–7 days) achieves muscle saturation in approximately one week, while 3–5 g/day without loading reaches the same saturation point in 3–4 weeks [2]. Both approaches produce identical end results. Loading may cause temporary GI discomfort and water weight gain. For most individuals, daily low-dose supplementation without loading is sufficient.
Is creatine monohydrate really the best form? ▼
Yes. No alternative form (hydrochloride, ethyl ester, buffered, magnesium chelate, nitrate) has demonstrated superior efficacy in any peer-reviewed head-to-head comparison with creatine monohydrate [2]. Marketing claims for newer forms are not supported by published evidence. Monohydrate is also the most cost-effective option.
Does creatine cause hair loss? ▼
One study from 2009 reported increased dihydrotestosterone (DHT) levels with creatine loading in rugby players, leading to speculation about hair loss in genetically predisposed individuals. This finding has not been replicated, and no study has directly measured hair loss as an outcome of creatine supplementation [1]. The evidence is insufficient to establish a causal relationship.
4 Clinical evidence
Strong
Increased high-intensity exercise performance: meta-analysis of 22 trials demonstrated an average 8% improvement in maximal strength and 14% improvement in repetitions to fatigue [1]. Lean body mass increase: 1–2 kg over 4–12 weeks of resistance training with creatine supplementation, primarily from increased intracellular water retention and enhanced training capacity [2]. Phosphocreatine resynthesis rate: 20–40% faster recovery between high-intensity exercise bouts [1]. HIGH
Moderate
Cognitive function: 5–20 g/day improved short-term memory and reasoning in sleep-deprived individuals and vegetarians (who have lower baseline creatine stores) [1]. Traumatic brain injury recovery: preclinical and preliminary clinical data suggest neuroprotective effects via maintenance of brain ATP levels [1]. Sarcopenia prevention in older adults: combined with resistance training, creatine supplementation enhances muscle mass and strength gains beyond training alone [2]. MODERATE
Insufficient
5 Safety, toxicity & adverse events
Relative
⚠ Pre-existing renal disease — creatine increases creatinine (a kidney function marker), complicating monitoring; not nephrotoxic in healthy individuals
⚠ Concurrent nephrotoxic drugs (NSAIDs, aminoglycosides) — additive renal stress
⚠ Bipolar disorder — one case report of mania
🚩 Red flags
● Pre-existing kidney disease — not because creatine is nephrotoxic, but because creatinine-based GFR monitoring becomes unreliable [3]
● Elevated serum creatinine in creatine user misinterpreted as renal failure — educate clinicians that creatine raises creatinine as a normal metabolite [3]
● Adolescent using creatine with inadequate hydration — ensure 2.5+ L water daily during supplementation [5]
● Patient purchasing 'novel' creatine forms (ethyl ester, liquid creatine) at premium prices — monohydrate is superior and cheapest [5]
● Weight gain concern in weight-class athletes — 1–2 kg water retention during loading phase [1]
6 Interactions
Drug interactions
Nephrotoxic medications (NSAIDs, aminoglycosides) Moderate
Mechanism: Creatine supplementation raises serum creatinine by 10–20% as a normal metabolic byproduct (NOT indicating kidney damage). This can falsely lower calculated eGFR using creatinine-based equations [3].
Caffeine Minor
Mechanism: Initial Vandenberghe (1996) study suggested caffeine abolished creatine's benefits on muscle performance. Subsequent larger studies found no clinically significant interference at moderate caffeine doses [4].
Metformin Minor
Mechanism: Both raise serum creatinine through different mechanisms. Combined effect may overestimate renal impairment on lab reports using creatinine-based GFR [3].
7 Regulatory
United States (FDA): Classified as a dietary supplement (OTC). Not banned by any major sports organization. The International Olympic Committee, FIFA, NCAA, and World Anti-Doping Agency all permit creatine use.
European Union (EFSA): Authorized health claim: creatine increases physical performance in successive bursts of short-term, high-intensity exercise (at 3 g/day). This is one of the few performance claims approved by EFSA.
World Anti-Doping Agency: Creatine is NOT on the WADA Prohibited List and is permitted in all sports at all competition levels.
Australia (TGA): Classified as a complementary medicine. Available OTC with no restrictions.
8 US supplement products
547
on-market products containing Creatine (NIH DSLD)
Brands carrying Creatine (144)
Click a brand to see its Creatine products.
9 Frequently paired with
10 References (2)
[1]National Institutes of Health, Office of Dietary Supplements. Dietary supplements for exercise and athletic performance. Updated 2024. ods.od.nih.gov REVIEW Accessed: 2026-05-29
[2]Kreider RB, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. doi:10.1186/s12970-017-0173-z REVIEW Accessed: 2026-05-29
11 Related articles
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12 Cite this page
Vancouver: Pkhakadze G. Creatine — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Jun 01]. Available from: https://supplement.ge/ingredients/creatine/
APA 7th: Pkhakadze, G. (2026). Creatine — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/creatine/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: December 2026
References: 2 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Creatine — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/creatine/ CC BY 4.0.
GP
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG