Creatine monohydrate

Dietary supplements, sports nutraceuticals (local classification)

ATC code: A11JA-CREATINE

Brand names – supplements: Optimum Nutrition Creatine, Creapure, Thorne CreatineSupplements are not tested in clinical trials and are not registered as medications.

Updated 24 Sep 2026 · Methodology

Indications

Athletic endurance

Adjunct

Creatine monohydrate is the most evidence-based sports supplement for strength and short-duration power. Meta-analyses (Lanhers 2017, Branch 2003, Kreider 2017) based on more than 500 RCTs confirm 8–14% increase in 1-RM squat, 5–12% in bench press, and 1–2 kg lean mass gain over 4–12 weeks of training at 3–5 g/day. Predominant effect is on anaerobic work (strength sports, sprint, combat); aerobic and marathon performance gain is minimal. IOC, ISSN, NCAA, and AIS guidelines list creatine as evidence-based and safe (AIS category A).

Sources

Anti-aging and longevity

Adjunct

Creatine monohydrate in older adults is studied as an agent against sarcopenia – age-related loss of muscle mass and strength. The Chilibeck 2017 meta-analysis (22 RCTs, n=721) in older adults showed that creatine at 5 g/day combined with resistance training increases muscle mass by 1.4 kg and strength by 10–20% more than training without creatine. Without training, the effect is markedly smaller or absent. Creatine does not rejuvenate or extend life, but it can genuinely help preserve muscle strength in older adults who train. It is safe at 3–5 g/day, may cause water retention and slight weight gain (1–2 kg in the first weeks), and requires caution in chronic kidney disease. If creatine is being taken without resistance training for anti-aging, no effect should be expected.

Sources

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Memory and concentration enhancement

Not recommended

Creatine monohydrate is an amino acid derivative, a classical sports supplement for muscle strength and performance. In 2023–2024, creatine became popular as a cognitive enhancer among students and in biohacker circles. The Avgerinos 2018 meta-analysis (6 RCTs, n=281) showed significant short-term memory and intellectual performance gains in vegetarians and vegans (whose baseline muscle creatine is lower due to a meat-free diet). In omnivores the effect is not significant. An effect on sleep and reduced fatigue during sleep deprivation has been reported in recent studies (Roschel 2024). Creatine is safe at 3–5 g/day; it can cause water retention and slight weight gain (1–2 kg in the first weeks). With a normal diet, a cognitive effect in omnivores is unlikely.

Sources

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Creatine is a nitrogenous compound synthesized in the liver, kidneys, and pancreas from glycine, arginine, and methionine. In muscle it is phosphorylated to phosphocreatine – a high-energy phosphate depot that resynthesizes ATP during short, powerful efforts (up to 10–15 seconds). Loading phase of 20 g/day for 5–7 days raises muscle creatine stores by 20–40%. Maintenance dose is 3–5 g/day. Creatine monohydrate is the most-studied and most cost-effective form. Creatine HCl, ethyl ester, and buffered forms have not shown clinical superiority.

Safety

Contraindications

Chronic kidney disease stage 3–5
Pregnancy and breastfeeding (insufficient data)
Age under 18 (without specialist recommendation)
Hypersensitivity

Serious adverse effects

Decompensation of pre-existing chronic kidney disease (rare; isolated case reports)

Common adverse effects

1–2 kg weight gain from muscle water retention (first 2–4 weeks)
GI discomfort at high doses (loading phase)
Muscle cramps (rare)

Pregnancy: can you take Creatine monohydrate?

Data are insufficient; supplement is not recommended in pregnancy.

Breastfeeding: can you take Creatine monohydrate?

Data are insufficient; supplement is not recommended during breastfeeding.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Russian practice note

In Russia, creatine is sold as a dietary and sports supplement. Marketing dose is 3–5 g/day continuously or 20 g/day for 5–7 days followed by 3–5 g maintenance. Monthly cost is 300–1500 ₽. Creatine monohydrate labeled Creapure (Alzchem, Germany) is considered the gold standard for purity. Alternative forms (HCl, malate, ethyl ester, buffered) have shown no clinical superiority over monohydrate – paying more is unjustified. Creatine draws water into muscle cells, so a 1–2 kg weight gain in the first 2–4 weeks is expected from water shift. This is not edema or harm to the kidneys in healthy individuals. In baseline chronic kidney disease or a single kidney, consult a physician before starting.

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Frequently asked

What is Creatine monohydrate used for?

Creatine monohydrate is evaluated for the following indications with varying evidence strength: Athletic endurance (evidence tier A), Memory and concentration enhancement (evidence tier C), Anti-aging and longevity (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Creatine monohydrate?

Common side effects of Creatine monohydrate (≥ 1 in 100): 1–2 kg weight gain from muscle water retention (first 2–4 weeks), GI discomfort at high doses (loading phase), Muscle cramps (rare). See the Safety section for uncommon and serious reactions.

Is Creatine monohydrate safe during pregnancy?

Data are insufficient; supplement is not recommended in pregnancy.

Is Creatine monohydrate compatible with breastfeeding?

Data are insufficient; supplement is not recommended during breastfeeding.

Who should not take Creatine monohydrate?

Creatine monohydrate is contraindicated in: Chronic kidney disease stage 3–5; Pregnancy and breastfeeding (insufficient data); Age under 18 (without specialist recommendation); Hypersensitivity. Full list in the Safety section.

Other drugs in this group

D-chiro-inositol, D-ribose, Diindolylmethane (DIM), Epigallocatechin-3-gallate (EGCG, main green tea polyphenol), Maca, Pterostilbene (dimethyl resveratrol analogue), Spermidine, Ascorbic acid