Creatine, Liver, Blood Pressure and Heart Questions
What trials and reviews report about creatine and liver blood tests, blood pressure and heart measures, and where proper evidence has not been found, such as liver disease.
Content last updated . This page has not been medically reviewed.
Urgent first: who should ask a clinician
People with liver disease, high blood pressure, a heart condition, or kidney disease, and people taking medicines for these conditions, should ask a clinician or pharmacist before using creatine. Sudden severe symptoms, such as chest pain, fainting or a racing irregular heartbeat, need emergency care; in the US call 911. Never stop a prescribed medicine because of this page.The short answer
In healthy adults, trials and reviews we read reported no clear signal for liver blood tests or blood pressure. Evidence in people who already have liver disease or high blood pressure is missing, and short pilot studies on heart and blood vessel measures are not proof of a health benefit. Several authors of these reviews report creatine-industry ties. [1] [2]Evidence labels
"Evidence in adequately nourished people" means repeated findings in healthy adults. "Promising but limited" means small or short studies. "Insufficient evidence" means too little to judge. A change in a lab marker is not a health outcome.| Question | What the source found | Evidence label |
|---|---|---|
| Liver blood tests in healthy adults | A review found liver enzymes unchanged in healthy people, even over several months. [3] Football players followed for 21 months showed no clinically significant differences in muscle and liver enzymes. [4] | Evidence in adequately nourished people |
| Liver tests in females | A meta-analysis of 29 studies (951 participants) found no significant difference in renal or hepatic function. [5] | Promising but limited |
| Liver tests in adolescents | A systematic review of five studies found no consistent short-term signals in liver enzymes. [6] | Promising but limited |
| People with liver disease | Creatine in chronic liver disease is described as barely investigated and not studied in human patients. [7] | Insufficient evidence |
| Blood pressure, healthy adults | Short-term 10 to 20 g a day for 5 to 31 days did not affect blood pressure in young healthy adults. [2] | Promising but limited |
| Blood pressure, longer | In a 2-year trial of postmenopausal women, blood pressure measured at one research site showed no difference between groups. [2] | Promising but limited |
| People with heart disease | A systematic review of heart failure, ischemic heart disease and heart attack patients found no impact on blood pressure at 20 g a day for up to six weeks. [2] | Promising but limited |
| Heart and vessel measures | A 7-day trial in men aged 55 to 80 found one arterial stiffness index improved, with no change in stroke volume or ejection fraction. [8] A pilot crossover trial in 12 older adults reported favorable vascular findings. [9] | Promising but limited |
All amounts above are study amounts, not advice.
Liver
No liver injury signal appeared in the healthy-adult reviews we read, but those groups were healthy and the trials mostly short. A 2026 case report described a man with a muscle breakdown after very long training who used creatine and several other supplements; his liver blood tests (AST and ALT) were raised alongside a very high muscle enzyme. [10] The abstract does not say whether the liver tests came from the liver or the muscle injury, and many supplements were involved, so it cannot be blamed on creatine.Proper evidence not found: studies of creatine in people with liver disease, which one review calls barely investigated. [7] We searched PubMed for creatine with liver function, hepatotoxicity and liver enzymes, and did not locate a LiverTox record for creatine. For other liver-safety questions see Liver safety and supplements.
Blood pressure
A 2025 review of misconceptions concluded there is no evidence that short-term or chronic creatine harms blood pressure. [2] It also notes that studies in people who already had high blood pressure are missing. [2] Proper evidence not found for creatine in people with diagnosed hypertension or those taking blood pressure medicines; ask your prescriber.Heart
The two small trials above measured blood vessel function, not heart attacks or survival. Each has an author with creatine-industry ties. [8] [9] A 2005 case report described a healthy 30-year-old man who arrived at an emergency department in atrial fibrillation (an irregular, often fast heartbeat); creatine monohydrate use was found only when he was asked about supplements. [11] The author notes earlier anecdotal reports linking creatine to arrhythmia. [11] A single case cannot show cause. Proper evidence not found: controlled studies of creatine and heart rhythm. We searched PubMed for creatine with atrial fibrillation and arrhythmia.Frequently asked questions
Does creatine harm the liver?
Reviews of healthy adults report no change in liver enzymes, but studies in liver disease are essentially missing. [3] [7]
Does creatine raise blood pressure?
A 2025 review found no evidence that it does in healthy people, but studies in people with high blood pressure are missing. [2]
Is creatine safe for the heart?
Small trials measured blood vessel function, not health outcomes, and a case report links creatine use with atrial fibrillation in one man. [8] [9] [11] Ask a clinician if you have a heart condition.
Can I use creatine with blood pressure medicine?
We found no interaction studies in the sources we read. Ask your prescriber or pharmacist.
Do raised liver tests mean creatine is the cause?
No. A case report with raised liver tests involved muscle injury and several supplements. [10]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Related safety pages
Kidney tests and heart or blood pressure risk often overlap: see Creatine, kidney questions and creatinine testing. Other pages: Creatine and medicines, Creatine with alcohol, caffeine and energy drinks, Supplements before surgery and How interactions work. We found no creatine-specific pre-surgery guidance in the sources we read.
References
- Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr 2021 (narrative review, full text read via PMC7871530; several authors declare creatine-industry advisory roles). Read 2026-10-23.
- Antonio J, Brown AF, Candow DG, et al. Part II. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr 2025 (narrative review, full text read via PMC11703406; several authors declare creatine-industry ties). Read 2026-10-23.
- Kim HJ, Kim CK, Carpentier A, Poortmans JR. Studies on the safety of creatine supplementation. Amino Acids 2011 (narrative review, abstract read). Read 2026-10-23.
- Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr 2017 (full text read via PMC5469049; preparation was supported by the Council for Responsible Nutrition and several authors declare industry ties). Read 2026-10-23.
- de Guingand DL, Palmer KR, Snow RJ, Davies-Tuck ML, Ellery SJ. Risk of adverse outcomes in females taking oral creatine monohydrate: a systematic review and meta-analysis. Nutrients 2020 (abstract read). Read 2026-10-23.
- Rubinchuk A, Dulkoski Z, Persaud NA, Wallen M. Evaluating the safety of creatine monohydrate in adolescents: a systematic review of renal, hepatic, and cardiometabolic outcomes. Cureus 2026 (abstract read). Read 2026-10-23.
- Casciola R, Leoni L, Cuffari B, et al. Creatine supplementation to improve sarcopenia in chronic liver disease: facts and perspectives. Nutrients 2023 (narrative review, abstract read). Read 2026-10-23.
- Aron A, Landrum EJ, Schneider AD, et al. Effects of acute creatine supplementation on cardiac and vascular responses in older men: a randomized controlled trial. Clin Nutr ESPEN 2024 (abstract read; one author reports industry-sponsored creatine research). Read 2026-10-23.
- Clarke HE, Akhavan NS, Behl TA, Ormsbee MJ, Hickner RC. Effect of creatine monohydrate supplementation on macro- and microvascular endothelial function in older adults: a pilot study. Nutrients 2024 (abstract read; one author is an advisory board member for a creatine maker). Read 2026-10-23.
- Chowaniec P, Miedziaszczyk M, Kucia M, et al. Exercise-induced rhabdomyolysis with supplements (creatine, beta-alanine, citrulline malate, and beta-ecdysterone). Cureus 2026 (single case report, abstract read). Read 2026-10-23.
- Kammer RT. Lone atrial fibrillation associated with creatine monohydrate supplementation. Pharmacotherapy 2005 (single case report, abstract read). Read 2026-10-23.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.