Merck Manual

Please confirm that you are a health care professional

honeypot link

Creatine

By

Laura Shane-McWhorter

, PharmD, University of Utah College of Pharmacy

Reviewed/Revised Jan 2023
View PATIENT EDUCATION

Phosphocreatine is a compound stored in muscle; it donates phosphate to ADP and thereby rapidly replenishes ATP during anaerobic muscle contraction. It is synthesized endogenously in the liver from arginine, glycine, and methionine. Dietary sources are milk, steak, and some fish.

Claims

Creatine is said to improve physical and athletic performance and to reduce muscle fatigue.

Evidence

Some evidence suggests creatine is effective at increasing work done in a short duration with maximal effort (eg, sprinting, rowing, weightlifting). A small 6-week study in 22 physically active adults also showed creatine ingestion during resistance training sessions may improve muscle strength (1 References Phosphocreatine is a compound stored in muscle; it donates phosphate to ADP and thereby rapidly replenishes ATP during anaerobic muscle contraction. It is synthesized endogenously in the liver... read more ). Creatine has proven therapeutic use in muscle phosphorylase deficiency (glycogen storage disease Glycogen Storage Diseases Glycogen storage diseases are carbohydrate metabolism disorders. There are many numbered and named types, all of which are caused by deficiencies of enzymes involved in glycogen synthesis or... read more type V [McArdle disease]) and gyrate atrophy of the choroid and retina; early data also suggest possible effects in Parkinson disease Parkinson Disease Parkinson disease is a slowly progressive, degenerative disorder characterized by resting tremor, stiffness (rigidity), slow and decreased movement (bradykinesia), and eventually gait and/or... read more and amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis (ALS) and Other Motor Neuron Diseases (MNDs) Amyotrophic lateral sclerosis and other motor neuron diseases are characterized by steady, relentless, progressive degeneration of corticospinal tracts, anterior horn cells, bulbar motor nuclei... read more .

Numerous clinical trials have demonstrated that creatine supplementation is well tolerated and may increase muscle mass. The effects can be seen in normal healthy people as well as a means of aiding in the treatment of muscle disorders and improving physical function and quality of life in patients with muscle disorders or osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic arthropathy characterized by disruption and potential loss of joint cartilage along with other joint changes, including bone hypertrophy (osteophyte formation). Symptoms... read more Osteoarthritis (OA) (2-4 References Phosphocreatine is a compound stored in muscle; it donates phosphate to ADP and thereby rapidly replenishes ATP during anaerobic muscle contraction. It is synthesized endogenously in the liver... read more ).

Adverse Effects

Creatine may cause weight gain (possibly because of an increase in muscle mass) and spurious increases in serum creatinine levels. Minor gastrointestinal symptoms, headache, dehydration, irritability and aggression, edema, electrolyte imbalance, and muscle cramps have been reported anecdotally.

Drug Interactions

No drug interactions are well documented, but taking creatine may increase the risk from drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), that affect kidney function. Also, caffeine may decrease the benefit of creatine by decreasing its energy production.

References

  • 1. Mills S, Candow DG, Forbes SC, et al: Effects of creatine supplementation during resistance training sessions in physically active young adults. Nutrients 12(6):1880, 2020. doi:10.3390/nu12061880

  • 2. Kley RA, Tarnopolsky MA, Vorgerd M: Creatine for treating muscle disorders. Cochrane Database Syst Rev (6):CD004760, 2013. doi: 10.1002/14651858.CD004760.pub4

  • 3. Branch JD: Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab 13(2):198-226, 2003. doi:10.1123/ijsnem.13.2.198

  • 4. Neves M Jr, Gualano B, Roschel H, et al: Beneficial effect of creatine supplementation in knee osteoarthritis. Med Sci Sports Exerc 43(8):1538-1543, 2011. doi: 10.1249/MSS.0b013e3182118592

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Drug Name Select Trade
Arginine, Nutricia SHS L-Arginine, R-Gene
No brand name available
Cafcit, NoDoz, Stay Awake, Vivarin
View PATIENT EDUCATION
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz! 
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP