Duchenne muscular dystrophy (DMD) – creatine monohydrate

  • Many medications have been tried in the treatment of DMD, and corticosteroids (e.g. prednisolone) are the only proven effective medication. However, recent studies of the dietary supplement creatine monohydrate in children with DMD have shown increased muscle strength, leading to improvement in functions such as walking and climbing stairs.

    There is good evidence for the safe and effective use of creatine monohydrate in children with DMD.

    What is creatine monohydrate?

    Creatine monohydrate (commonly referred to as just creatine) is a naturally occurring compound involved in making energy in cells of the body, particularly in the brain and muscles. Creatine is converted to creatinine in the body. It is made in the liver and kidneys, as well as being found in food. In healthy people, taking creatine monohydrate supplements increases muscle strength. In children with DMD, creatine supplements improve muscle strength and may have other effects, including better energy use within muscle cells and less muscle breakdown.

    Benefits of creatine

    Studies show that children with DMD taking creatine maintain strength longer, and they are able to perform better in activities like walking and climbing stairs. Children taking the supplements and their parents both notice an overall improvement in the child’s strength.

    These benefits occur while the child is taking the supplement, and short to medium-term benefits have been recorded. However, the long-term benefits of this treatment are not yet known.  

    No side effects have been identified in children with DMD who take creatine monohydrate as a dietary supplement.  

    Where to buy creatine

    It is best to purchase creatine monohydrate supplements from Australian suppliers, as they must conform to national medicine standards. 

    Creatine comes in several different forms. The forms used in The Royal Children's Hospital DMD clinic are: 

    • Creatine monohydrate powder: this can be purchased from pharmacists or stores selling dietary supplements. It can also be purchased online.
    • Kre-Alkalyn: this has been produced to have a higher pH, meaning conversion to creatinine is quicker. It comes in a capsule form, which is easier for some children to tolerate compared to a powder. It is not the form of creatine that has been studied in people with muscle disorders, but it has been shown to have the same effect as creatine monohydrate in athletes and body builders. It can be purchased online.

    Don't buy other forms of creatine (e.g. creatine esters) or creatine in pre-mixed powders containing other supplements.

    Giving creatine to your child

    You can mix creatine monohydrate powder into drinks to be given to your child. Follow these steps:

    • Add the required dose of creatine to 50–100 mL of milk or juice.
    • Mix it well – the powder does not dissolve very well, so you must mix it thoroughly to ensure that the white powder is not left at the bottom of the glass. 
    • Give it to your child to drink immediately.

    The best time of day to take creatine is each day in the morning, before school.

    Key points to remember

    • Creatine is a naturally occurring compound that can improve the function of muscles.
    • Studies have shown that creatine can improve strength and performance in children with DMD, although long-term outcomes are unclear.
    • Creatine is safe and is not associated with any known side effects.

    For more information

    Common questions our doctors are asked

    How safe is creatine?

    No side effects have been identified in children with DMD who take creatine monohydrate as a dietary supplement. In addition, healthy people who take creatine monohydrate, and those who take creatine monohydrate for other reasons, have not reported any side effects.

    When should we start creatine?

    The best time to start a creatine monohydrate supplement in children with DMD is not known, but because there are no known side effects, it’s reasonable for you and your doctor to consider it from the time of diagnosis.

    Developed by The Royal Children's Hospital Neurology department. We acknowledge the input of RCH consumers and carers.

    Reviewed June 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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