Who should not take creatine?

People with pre-existing kidney disease, those on dialysis, pregnant or breastfeeding women (due to insufficient safety data), and individuals taking nephrotoxic medications should avoid creatine or use it only under medical supervision.

Can I take creatine with kidney stones?

If you have a history of kidney stones, consult your nephrologist before taking creatine. While creatine itself does not cause kidney stones, the increased creatinine from supplementation warrants monitoring in individuals with a history of renal issues.

Is creatine safe during pregnancy?

There is insufficient safety data on creatine supplementation during pregnancy. While creatine is naturally present in the body and some researchers have theorized potential fetal benefits, supplementation during pregnancy is not recommended without explicit medical guidance.

Can teenagers take creatine?

While there is no evidence that creatine is harmful to adolescents, there is less long-term safety data for this age group compared to adults. Parental consent and medical guidance are recommended for anyone under 18.

When Not to Take Creatine: Contraindications & Warnings

When Creatine Is Not the Right Choice

Creatine monohydrate is one of the most thoroughly researched and safest supplements available — for healthy individuals. The ISSN Position Stand confirms its safety at recommended doses in people without pre-existing health conditions (RB et al., 2017) .

However, “safe for healthy individuals” does not mean safe for everyone in every situation. This guide outlines the specific circumstances where creatine should be avoided or used only with medical supervision.

Absolute Contraindications

These are situations where creatine supplementation should be avoided entirely without explicit medical approval:

Pre-Existing Kidney Disease

This is the most important contraindication. While creatine does not damage healthy kidneys (JR & M, 2000) , kidneys that are already impaired may not handle the increased creatinine load efficiently.

Specific conditions requiring avoidance:

Chronic kidney disease (CKD) stages 3-5
Active kidney infection (pyelonephritis)
Glomerulonephritis
Polycystic kidney disease
Dialysis patients
Single kidney (relative contraindication — consult nephrologist)

Why: Creatine supplementation raises creatinine levels. In healthy kidneys, this extra creatinine is filtered efficiently. In impaired kidneys, creatinine clearance is already compromised, and adding more metabolic load is inadvisable.

Stage 3+

CKD is the threshold where creatine supplementation should be avoided without nephrology supervision

Clinical consensus

Active Kidney Injury

If you are currently experiencing acute kidney injury (AKI) from any cause — dehydration, infection, medication toxicity, rhabdomyolysis — do not take creatine until the condition has fully resolved and your kidney function has returned to normal.

Situations Requiring Medical Supervision

Pregnancy and Breastfeeding

Smith-Ryan et al. (2021) reviewed creatine use across the female lifespan and noted theoretical benefits of creatine during pregnancy (supporting fetal brain development and energy metabolism). However, there is currently insufficient clinical trial data to confirm safety during pregnancy and lactation (AE et al., 2021) .

Recommendation: Do not supplement with creatine during pregnancy or breastfeeding unless your obstetrician specifically advises it. Your body naturally produces creatine and you obtain it from dietary sources — supplementation adds an uncertain variable during a critical period.

Medications Affecting Kidney Function

Several common medications are nephrotoxic (potentially harmful to kidneys). Combining these with creatine adds theoretical kidney stress:

NSAIDs (ibuprofen, naproxen) at high doses or prolonged use
Certain antibiotics (aminoglycosides, vancomycin)
ACE inhibitors and ARBs (used for blood pressure)
Some chemotherapy agents (cisplatin, methotrexate)
Lithium (psychiatric medication)
Cyclosporine (immunosuppressant)

If you take any of these medications regularly, consult your prescribing doctor before adding creatine. In many cases, the combination is manageable with proper monitoring, but this is a medical decision.

Type 1 Diabetes with Kidney Involvement

While creatine may benefit type 2 diabetics (see our separate article), type 1 diabetes patients with diabetic nephropathy (kidney damage from diabetes) should avoid creatine or use it only under nephrological supervision.

Liver Disease

The liver is involved in endogenous creatine synthesis. While creatine supplementation has not been shown to harm healthy livers, individuals with active liver disease (hepatitis, cirrhosis, liver failure) should consult their hepatologist before supplementing.

Relative Contraindications

These are situations where creatine is not necessarily harmful but where caution is warranted:

Adolescents Under 18

Creatine has been studied in adolescents with no adverse findings, but the evidence base is smaller than for adults. The concern is not toxicity but rather the lack of long-term data specific to growing individuals. Parental consent and ideally medical guidance are recommended.

Weight-Class Athletes Close to Competition

If you compete in a weight-class sport (boxing, judo, wrestling, MMA, weightlifting) and need to make weight within the next 4 weeks, starting creatine is inadvisable because the 1-3kg water weight gain may push you into a higher weight class.

History of Compartment Syndrome

Compartment syndrome occurs when pressure within a muscle compartment increases to dangerous levels. Since creatine increases intracellular water, there is a theoretical (though unproven) risk of exacerbating this condition in susceptible individuals.

Severe Dehydration Risk Scenarios

While creatine does not cause dehydration, starting creatine during a period when you cannot maintain adequate hydration (extreme fasting, certain medical conditions, severe illness) is not recommended.

Pre-Supplementation Checklist

Before starting creatine, answer these questions:

Do you have any diagnosed kidney condition? If yes, consult your nephrologist first
Are you pregnant or breastfeeding? If yes, avoid supplementation
Do you take any nephrotoxic medications? If yes, consult your prescribing doctor
Are you under 18? If yes, get parental consent and ideally medical guidance
Do you have liver disease? If yes, consult your hepatologist
Can you maintain adequate hydration (2-3L/day)? If no, address this before starting creatine

If you answered “no” to all the above, creatine supplementation at 3-5g/day is considered safe based on the totality of evidence.

Malaysian Context

In Malaysia, where awareness of supplement safety varies, a few practical points:

Government hospital clinics may not be familiar with creatine research. If your doctor is uncertain, provide references to the ISSN Position Stand (Kreider et al., 2017)
NPRA registration — verify that your creatine product is registered with Malaysia’s National Pharmaceutical Regulatory Agency
Kidney disease prevalence — Malaysia has rising CKD rates, partly driven by diabetes and hypertension. Get baseline kidney function tested (simple blood test at any clinic) before starting creatine
Cultural context — some Malaysian families may view any supplement with suspicion. Share evidence-based information from trusted sources rather than anecdotal claims

The Bottom Line

Creatine is safe for the vast majority of healthy adults. The exceptions are specific and medically defined: kidney disease, pregnancy, nephrotoxic medications, and liver disease. If any of these apply to you, seek medical guidance before supplementing. For everyone else, 3-5g/day of quality creatine monohydrate has an excellent safety record supported by decades of research.

Sources & References

This article cites the ISSN Position Stand (Kreider et al., 2017), Poortmans & Francaux (2000) on renal safety, and Smith-Ryan et al. (2021) on women’s health considerations. Full citations are available in our Research Library.