Creatine Monohydrate Supplementation: Dosage and Safety Protocol
Recommended Dosing Protocol
For creatine monohydrate supplementation, use a loading phase of 20 g/day divided into four equal 5 g doses for 5-7 days, followed by a maintenance dose of 3-5 g/day as a single daily dose. 1, 2
Loading Phase
- Administer 20 g/day divided into four separate 5 g doses taken throughout the day for 5-7 days 1, 2
- This rapidly saturates muscle creatine stores 2
- Expect a 1-2 kg body mass increase during this phase due to intracellular water retention 1, 2
Maintenance Phase
- Continue with 3-5 g/day as a single dose for the duration of supplementation 1, 2
- After cessation, approximately 4-6 weeks are required for muscle creatine levels to return to baseline 1, 2
Alternative Low-Dose Approach
- A lower dose approach of 2-5 g/day for 28 days can be used to avoid the associated body mass increase 1
- Loading doses are not strictly necessary to increase intramuscular creatine stores, though they achieve saturation more rapidly 3
Optimization Strategy
Consume creatine concurrently with approximately 50 g of mixed protein and carbohydrate to enhance muscle uptake via insulin stimulation. 1, 2, 4
Special Application for Post-Exercise Recovery
- For enhanced muscle glycogen resynthesis in the first 24 hours post-exercise, use 20 g of creatine divided into four 5 g doses beginning on the same day of fatiguing exercise 1, 2
Safety Considerations and Contraindications
Renal Function Monitoring
- Discontinue creatine immediately if any evidence of renal dysfunction develops 4
- Creatine should not be used in patients with pre-existing renal impairment (creatinine >2.5 mg/dL in men or >2.0 mg/dL in women) 1
- While short-term supplementation up to 8 weeks at high doses has not been associated with major health risks in healthy individuals, and long-term use up to 5 years at low doses appears safe, appropriate medical supervision is warranted 5
Common Pitfalls to Avoid
- Do not exceed 6 g/day for more than 2 weeks without medical supervision, as doses above this threshold should be considered therapeutic intervention requiring physician oversight 6, 7
- The most common adverse effect is transient water retention in early supplementation stages 3
- When combined with other supplements or taken at higher than recommended doses for several months, cases of liver and renal complications have been reported 3
Quality and Contaminant Concerns
- During industrial production from sarcosine and cyanamide, variable amounts of contaminants (dicyandiamide, dihydrotriazines, creatinine, ions) may be generated 6, 7
- Use pharmaceutical-grade creatine monohydrate from reputable sources 8
Clinical Context for Dosing Decisions
For Recreational Athletes
- In healthy subjects with fat-rich, carbohydrate- and protein-poor diets participating in daily recreational sport, oral supplementation should be on the order of daily turnover: less than 2.5-3 g per day 6, 7
For Competitive Athletes
- In athletes undergoing daily high-intensity strength or sprint training, maximal supplementation should be no more than twice the daily turnover: less than 5-6 g per day for less than 2 weeks, taken under medical supervision 6, 7
Therapeutic Use
- Doses exceeding 6 g per day should only be prescribed by physicians in cases of suspected or proven deficiency, or in conditions of severe stress and/or injury 6, 7
Performance Benefits
Creatine supplementation improves high-intensity repeated sprint performance, enhances training capacity and chronic training adaptations (muscle strength and power), increases lean body mass, and may support brain function 1, 2, 4