Creatine Supplementation Dosing
For creatine monohydrate supplementation, use a loading phase of 20 g/day divided into four equal doses (5 g each) for 5-7 days, followed by a maintenance dose of 3-5 g/day as a single dose. 1
Loading Phase Protocol
- Administer 20 g/day divided into four equal doses of 5 g each for 5-7 days to rapidly saturate muscle creatine stores 1
- This loading protocol is supported by the British Journal of Sports Medicine and represents the evidence-based standard 1
- Expect a body mass increase of 1-2 kg during loading due to intracellular water retention 1
- Alternative dosing: 0.3 g/kg/day for 5-7 days can be used for weight-based calculations 2
Maintenance Phase Protocol
- Continue with 3-5 g/day as a single daily dose for the entire supplementation period 1
- Weight-based alternative: 0.03 g/kg/day for maintenance dosing 2
- Muscle creatine levels return to baseline approximately 4-6 weeks after stopping supplementation 1
Important Caveat: Loading Phase is Optional
While the loading phase rapidly saturates muscle stores, loading doses are not strictly necessary to increase intramuscular creatine 2. Starting directly with maintenance dosing (3-5 g/day) will achieve the same muscle saturation, just over a longer timeframe (approximately 3-4 weeks instead of 5-7 days).
Optimization Strategy
- Consume creatine with approximately 50 g of protein and carbohydrate to enhance muscle uptake through insulin-mediated transport 1
- For post-exercise glycogen resynthesis: use 20 g divided into 5 g doses on four occasions within the first 24 hours after fatiguing exercise 1
Safety Considerations
- Creatine monohydrate is the most studied form; other forms like creatine ethyl ester have not demonstrated added benefits 2
- Short-term supplementation (up to 8 weeks with high doses, up to 5 years with maintenance doses) has not been associated with major health risks in healthy adults 3
- Avoid in patients with pre-existing renal disease or those taking nephrotoxic medications, as creatine may increase risk of renal dysfunction 4
- Creatine supplementation increases serum creatinine levels, which can falsely suggest renal dysfunction; use additional renal function markers (GFR, cystatin C) if monitoring kidney function 4
- Most common adverse effect is transient water retention in early supplementation stages 2
Clinical Pitfall to Avoid
Do not confuse elevated creatinine from creatine supplementation with actual renal impairment—creatine increases creatinine production as a normal metabolic byproduct, not necessarily indicating kidney damage 4. Always assess GFR and other renal markers if renal dysfunction is suspected.