NAD+ (Nicotinamide Adenine Dinucleotide)
Get a source-linked, educational explanation from this profile.
Complete Research Guide
Open each section for the available evidence. Gaps are stated rather than inferred.
Overview
NAD+ (Nicotinamide Adenine Dinucleotide) is listed as cellular coenzyme (not a peptide).
- •Cellular energy and mitochondrial research
- •Healthy-aging (longevity) research
- •Metabolic health research
- •IV and injection wellness clinics
- •Recovery and fatigue (anecdotal)
- •Often paired with peptides in longevity protocols
Regulatory status: Not FDA-approved as a drug for any condition. Compounded NAD+ is offered by some pharmacies while its status for 503A compounding remains under FDA review; NAD+ precursors (NR, niacin, and in some cases NMN) are sold as dietary supplements, and FDA has questioned NMN's supplement status. Not on the WADA prohibited list..
Structure & Properties
Compound: NAD+ (Nicotinamide Adenine Dinucleotide); also known as NAD+, NAD, NADH, Nicotinamide adenine dinucleotide, NAD IV, NAD injection.
Pharmacologic class: Cellular Coenzyme (not a peptide).
Known delivery routes: IV infusion, Subcutaneous (limited data), Intranasal (no human data), Oral precursors (NMN, NR, niacin).
Sequence, molecular weight, salt form, and excipient details are formulation-specific and are not listed unless verified by a manufacturer or laboratory COA.
How It Works
NAD+ is a coenzyme — a helper molecule, not a peptide — found in every living cell. It carries electrons in the mitochondria to make energy (ATP) and is consumed by enzymes that repair DNA (PARPs), regulate aging-related genes (sirtuins) and signal immune activity (CD38). Tissue NAD+ levels fall with age, partly because CD38 activity rises. NAD+ itself is a large, charged molecule that is mostly broken down outside cells; IV or injected NAD+ is largely converted to smaller precursors (such as nicotinamide) before cells take it up. Oral precursors — NMN, nicotinamide riboside and niacin — reliably raise blood NAD+ levels.
- •Raises blood NAD+ levels (shown mainly with oral precursors)
- •Improved muscle insulin sensitivity in one small trial of prediabetic women (NMN)
- •Supports mitochondrial energy production and DNA repair (lab and animal data)
- •Lowered inflammatory markers in aged muscle in one small trial (NR)
Human Research
Evidence grade: Clinical RCT (Limited)
Clinical RCT (Limited). Strong basic-science evidence that NAD+ falls with age and supports cell energy and repair. Human trials mostly test oral precursors, which raise NAD+ levels safely but show small or inconsistent health effects. Human data on IV or injected NAD+ are limited to small pilot and pharmacokinetic studies..
- Verdin E. NAD+ in aging, metabolism, and neurodegeneration. Science. 2015;350:1208-13.
- Covarrubias AJ et al. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021;22:119-41.
- Rajman L, Chwalek K, Sinclair DA. Therapeutic potential of NAD-boosting molecules: the in vivo evidence. Cell Metab. 2018;27:529-47.
- Massudi H et al. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS One. 2012;7:e42357.
- Camacho-Pereira J et al. CD38 dictates age-related NAD decline and mitochondrial dysfunction through an SIRT3-dependent mechanism. Cell Metab. 2016;23:1127-39.
- Grant R et al. A pilot study investigating changes in the human plasma and urine NAD+ metabolome during a 6 hour intravenous infusion of NAD+. Front Aging Neurosci. 2019;11:257.
- Martens CR et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9:1286.
- Yoshino M et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science. 2021;372:1224-9.
- Elhassan YS et al. Nicotinamide riboside augments the aged human skeletal muscle NAD+ metabolome and induces transcriptomic and anti-inflammatory signatures. Cell Rep. 2019;28:1717-28.
- Dollerup OL et al. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects. Am J Clin Nutr. 2018;108:343-53.
- U.S. FDA. Bulk drug substances used in compounding under section 503A (nominations and evaluation status).
Laboratory Research
Strong basic-science evidence that NAD+ falls with age and supports cell energy and repair. Human trials mostly test oral precursors, which raise NAD+ levels safely but show small or inconsistent health effects. Human data on IV or injected NAD+ are limited to small pilot and pharmacokinetic studies.
Preclinical findings describe biological plausibility, not proven benefit in people. Animal and laboratory doses do not translate directly to human use.
Processing & Interactions
Timing and exposure
No studied schedule. IV sessions are usually given slowly over several hours in the daytime; oral precursors (NMN, NR) are commonly taken in the morning.
Potential interactions and combinations to avoid
- •Fast IV infusion — causes flushing, chest tightness and nausea
- •Active or suspected cancer — discuss with an oncologist first
- •Stacking several NAD+ precursors at high doses — no added benefit shown
Absorption, half-life, metabolism, and clearance can vary by formulation and route. Use prescribing information when an approved product exists.
Safety & Precautions
Known or reported risks
- •IV infusion: flushing, chest tightness, nausea, cramping and anxiety if infused too fast
- •Injection-site pain and burning (subcutaneous)
- •Unclear benefit — human trials show small or mixed effects on health outcomes
- •Theoretical concern that boosting NAD+ could fuel existing cancer cells (animal data)
- •Compounded or research-market products — purity and strength often unverified
Contraindications
- •Active cancer or history of cancer (discuss with oncologist)
- •Pregnancy or breastfeeding
- •Heart rhythm or blood-pressure problems (IV infusion reactions)
- •Under 18 years of age
- •Bleeding disorders or anticoagulant therapy without physician guidance (injection-site haematoma)
- •Active skin infection, cellulitis, or lipohypertrophy at intended injection sites
- •Inability to maintain sterile technique or safe sharps disposal
- •Not FDA-approved for human therapeutic use — no verified purity, sterility, or potency standards
- •Immunocompromised or transplant patients (unverified sterility and immunogenicity risk)
- •Concurrent participation in drug-tested sport (WADA prohibited or non-cleared substance)
- •Known hypersensitivity or prior reaction to this compound or any excipient/diluent
- •Pregnancy, attempting conception, or breastfeeding unless prescribed and monitored by a physician
- •Children and adolescents with open growth plates (unless under specialist endocrine care)
- •Active or recently treated malignancy without oncology clearance
- •Use without a confirmed diagnosis, baseline labs, and licensed clinical supervision
Unknown long-term toxicity should be assumed where controlled human data are limited. Seek urgent care for a severe or unexpected reaction.
Administration & Studied Formulations
Reference range: No established dose for injected or IV NAD+. A published pilot study infused 750 mg over 6 hours; clinic and community protocols vary widely and are not evidence-based.
Frequency: Not established — clinic protocols vary
Cycling: No evidence-based cycle exists. Clinics often use a loading series of IV sessions followed by occasional maintenance; this is not studied.
IV Infusion
Clinic setting — infused slowly over hours.
IV drip under clinical supervision. Clinician-only. Slowing the rate eases flushing and chest tightness.
Most infused NAD+ is broken down to smaller precursors before cells use it.
Oral (precursors)
NMN, nicotinamide riboside or niacin — see the Supplement Library.
Capsule or powder. Best-studied way to raise NAD+ levels in people.
Niacin can cause flushing; nicotinamide and NR usually do not.
Dosing information is educational context, not a personal recommendation. Approved products must follow their label and prescriber instructions.
Applications & Related Therapies
Potentially complementary measures
- •Regular exercise
- •Adequate sleep
- •Clinician-guided metabolic care
Clinical use should account for diagnosis, approved alternatives, nutrition, activity, sleep, rehabilitation, current medicines, and appropriate monitoring.
Educational only. NAD+ is a coenzyme, not a peptide; human evidence for injected forms is limited.
Cases, Considerations & Ethics
Decision framework: establish the clinical goal, confirm evidence quality and legal status, screen contraindications and interactions, compare approved alternatives, define monitoring and stopping criteria, and use shared decision-making with a licensed clinician.
Case evidence: individual reports cannot establish safety or effectiveness and should not outweigh controlled trials.
Ethics: informed consent should distinguish established care from experimental use, disclose uncertainty and cost, avoid overstated claims, and never substitute research products for medically necessary care.
What is NAD+ (Nicotinamide Adenine Dinucleotide)?
In plain words
NAD+ is a helper molecule every cell uses to turn food into energy and to repair damage. The body makes less of it as we age, which is why it is studied for healthy aging. Some clinics give it by IV or injection, but there is little research on those forms. Supplements like NMN and NR reliably raise NAD+ levels, though clear health benefits in people are still unproven.
Technical definition
NAD+ (nicotinamide adenine dinucleotide) is a dinucleotide coenzyme, not a peptide, present in all living cells. It serves as an electron carrier in glycolysis and mitochondrial oxidative phosphorylation and as a consumed substrate for sirtuins, PARPs and CD38/CD157; tissue levels decline with age, partly through increased CD38 activity. Exogenous NAD+ is largely hydrolyzed extracellularly to precursors such as nicotinamide and NMN before cellular uptake. It is not FDA-approved as a drug; precursors (NR, NMN, niacin) are studied orally and raise blood NAD+ levels.
Function
Dosing
Recommended Time of Day
Morning or daytime — many people report it feels energizing; no studied time of day.
See “Timing & Interactions” below for full fasted/fed circumstances, what to avoid combining, and what pairs well.
Administration & Technique
Injection & Application Sites
- IV — clinician only — Antecubital vein or central line. Not for home administration.
Diagram is a general illustration, not a medical instruction. Rotate sites every injection, keep 1 in (2.5 cm) between recent sites, and avoid scars, moles, bruises and the navel area.
Cycling
No evidence-based cycle exists. Clinics often use a loading series of IV sessions followed by occasional maintenance; this is not studied.
Timing & Interactions
- ·Fast IV infusion — causes flushing, chest tightness and nausea
- ·Active or suspected cancer — discuss with an oncologist first
- ·Stacking several NAD+ precursors at high doses — no added benefit shown
- ·Regular exercise
- ·Adequate sleep
- ·Clinician-guided metabolic care
Storage & Reconstitution
Reconstitution Calculator
1 mL = 100 units on a standard U-100 insulin syringe. Draw to the nearest 0.5 unit and confirm dosing with a clinician before injection.
Your Notes
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Benefits
- ·Raises blood NAD+ levels (shown mainly with oral precursors)
- ·Improved muscle insulin sensitivity in one small trial of prediabetic women (NMN)
- ·Supports mitochondrial energy production and DNA repair (lab and animal data)
- ·Lowered inflammatory markers in aged muscle in one small trial (NR)
Risks
- ·IV infusion: flushing, chest tightness, nausea, cramping and anxiety if infused too fast
- ·Injection-site pain and burning (subcutaneous)
- ·Unclear benefit — human trials show small or mixed effects on health outcomes
- ·Theoretical concern that boosting NAD+ could fuel existing cancer cells (animal data)
- ·Compounded or research-market products — purity and strength often unverified
Contraindications
- ·Active cancer or history of cancer (discuss with oncologist)
- ·Pregnancy or breastfeeding
- ·Heart rhythm or blood-pressure problems (IV infusion reactions)
- ·Under 18 years of age
- ·Bleeding disorders or anticoagulant therapy without physician guidance (injection-site haematoma)
- ·Active skin infection, cellulitis, or lipohypertrophy at intended injection sites
- ·Inability to maintain sterile technique or safe sharps disposal
- ·Not FDA-approved for human therapeutic use — no verified purity, sterility, or potency standards
- ·Immunocompromised or transplant patients (unverified sterility and immunogenicity risk)
- ·Concurrent participation in drug-tested sport (WADA prohibited or non-cleared substance)
- ·Known hypersensitivity or prior reaction to this compound or any excipient/diluent
- ·Pregnancy, attempting conception, or breastfeeding unless prescribed and monitored by a physician
- ·Children and adolescents with open growth plates (unless under specialist endocrine care)
- ·Active or recently treated malignancy without oncology clearance
- ·Use without a confirmed diagnosis, baseline labs, and licensed clinical supervision
Regulatory
Not FDA-approved as a drug for any condition. Compounded NAD+ is offered by some pharmacies while its status for 503A compounding remains under FDA review; NAD+ precursors (NR, niacin, and in some cases NMN) are sold as dietary supplements, and FDA has questioned NMN's supplement status. Not on the WADA prohibited list.
Veterinary Use (Pets)
No established veterinary protocol for NAD+ (Nicotinamide Adenine Dinucleotide). Consult a licensed veterinarian before considering off-label use in any species.
Full veterinary reference →Functional Groups
Cited Works
Tap any study to open the published work.
- 1.Verdin E. NAD+ in aging, metabolism, and neurodegeneration. Science. 2015;350:1208-13.Read published work Link not opening? Search Google Scholar
- 2.Covarrubias AJ et al. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021;22:119-41.Read published work Link not opening? Search Google Scholar
- 3.Rajman L, Chwalek K, Sinclair DA. Therapeutic potential of NAD-boosting molecules: the in vivo evidence. Cell Metab. 2018;27:529-47.Read published work Link not opening? Search Google Scholar
- 4.Massudi H et al. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS One. 2012;7:e42357.Read published work Link not opening? Search Google Scholar
- 5.Camacho-Pereira J et al. CD38 dictates age-related NAD decline and mitochondrial dysfunction through an SIRT3-dependent mechanism. Cell Metab. 2016;23:1127-39.Read published work Link not opening? Search Google Scholar
- 6.Grant R et al. A pilot study investigating changes in the human plasma and urine NAD+ metabolome during a 6 hour intravenous infusion of NAD+. Front Aging Neurosci. 2019;11:257.Read published work Link not opening? Search Google Scholar
- 7.Martens CR et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9:1286.Read published work Link not opening? Search Google Scholar
- 8.Yoshino M et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science. 2021;372:1224-9.Read published work Link not opening? Search Google Scholar
- 9.Elhassan YS et al. Nicotinamide riboside augments the aged human skeletal muscle NAD+ metabolome and induces transcriptomic and anti-inflammatory signatures. Cell Rep. 2019;28:1717-28.Read published work Link not opening? Search Google Scholar
- 10.Dollerup OL et al. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects. Am J Clin Nutr. 2018;108:343-53.Read published work Link not opening? Search Google Scholar
- 11.U.S. FDA. Bulk drug substances used in compounding under section 503A (nominations and evaluation status).Read published work Link not opening? Search Google Scholar