Creatine is used in alternative medicine as a possibly effective aid for enhancing athletic performance, and for increasing muscle strength in people with heart failure, muscular dystrophy, and McArdle's disease (a genetic disorder). It may also be possibly effective in treating Parkinson's disease, and gyrate atrophy (a genetic eye disorder that affects the retina and causes vision loss).

Creatine has also been used to treat rheumatoid arthritis, or Lou Gehrig's disease (ALS). However, research has shown that it may not be effective in treating these conditions.

Other uses not proven with research have included treating high cholesterol, depression, bipolar disorder, or certain muscle diseases.

It is not certain whether creatine is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. It should not be used in place of medication prescribed for you by your doctor.

Creatine is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Creatine has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of this medication may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Drink plenty of fluid while taking creatine. Although it has not been proven, dehydration, heat-related illnesses, muscle cramps, reduced blood volume, and electrolyte imbalances are expected to be more likely to occur while taking creatine.

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use creatine, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label. High doses may cause harmful effects on your heart, kidneys, or liver.

Some athletes have used a "loading method" of taking creatine by using large doses for 2 to 5 days, followed by smaller "maintenance" doses. This method has been used by athletes seeking a short-term increase in athletic ability, such as before a sporting competition.

Another method of use involves taking smaller doses over an extended training period. This method has been used by people seeking endurance for long-term training such as body-building.

Creatine may be more effective if you take it with a meal of carbohydrates. Follow all directions on the product label.

Muscle tissues can only hold a certain amount of creatine. Using more of this product will not increase any effects.

Do not use different forms (tablets, liquid, powder, beverages, etc) of creatine at the same time without medical advice. Using different formulations together increases the risk of an overdose.

Drink plenty of fluid to avoid becoming overheated or dehydrated during exercise and in hot weather. You may be more prone to dehydration, heat stroke, or electrolyte imbalances while you are taking creatine.

Store in a sealed container as directed on the label, away from moisture and heat.

You should not use creatine if you have:

• kidney disease; or

• diabetes.

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have:

• heart disease.

Creatine may not be as effective in improving strength or building muscle in people over 60 years old.

It is not known whether creatine will harm an unborn baby. Do not use this product if you are pregnant.

Creatine may pass into breast milk and may harm a nursing baby. Do not use this product if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

Skip the missed dose if it is almost time for your next scheduled dose. Do not use any extra to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Creatine can cause kidney damage when used over a long period or if your daily doses are too high.

Avoid drinking caffeine (coffee, tea, soda) or taking herbal stimulants such as ephedra or Ma Huang while you are taking creatine. Combining this product with these substances may increase your risk of having a stroke or other serious medical problems.

Avoid becoming overheated or dehydrated during exercise and in hot weather.

Get emergency medical help if you have any of these signs of an allergic reaction to creatine: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using creatine and call your healthcare provider at once if you have:

• pounding heartbeats or fluttering in your chest;

• trouble breathing;

• swelling, rapid weight gain;

• dehydration symptoms--feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or

• signs of an electrolyte imbalance--dry mouth, increased thirst, drowsiness, restless feeling, confusion, nausea, vomiting, increased urination, muscle pain or weakness, fast heart rate, feeling light-headed, fainting, or seizure (convulsions).

Common creatine side effects may include:

• nausea, stomach pain;

• diarrhea;

• muscle cramps; or

• weight gain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Creatine can harm your kidneys. This effect is increased when you also use certain other medicines, including:

• antivirals, injected antibiotics;

• chemotherapy;

• medicine for bowel disorders;

• medicine to prevent organ transplant rejection;

• injectable osteoporosis medication; and

• some pain or arthritis medicines (including aspirin, Tylenol, Advil, and Aleve).

This list is not complete. Other drugs may interact with creatine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.