NAD+

also known as: Nicotinamide Adenine Dinucleotide, NAD, NAD plus, β-nicotinamide adenine dinucleotide

An essential cellular coenzyme that declines with age; now heavily marketed in IV and injectable longevity protocols despite limited randomized clinical evidence for anti-aging claims.

A coenzyme required for hundreds of redox reactions and for the activity of sirtuins, PARPs, and CD38; its levels decline with age, prompting a wave of IV, injectable, and precursor-based supplementation products aimed at cellular energy, DNA repair, and healthspan extension.

Mechanism of action

Acts as a cofactor in hundreds of enzymatic redox reactions (hydride transfer between NAD+/NADH) central to glycolysis, TCA cycle, and oxidative phosphorylation. Also a substrate for sirtuins (NAD+-dependent deacetylases implicated in longevity signaling), PARP enzymes (DNA repair), and CD38 (immune signaling). Cellular NAD+ declines with age in many tissues, which has motivated investigation of NAD+ restoration as a geroscience intervention. Exogenous NAD+ administration likely works indirectly through precursor metabolites rather than direct cellular uptake of intact NAD+.

Primary uses

IV wellness protocols for energy and cognitive support
Investigational adjunct in addiction recovery (primarily clinic-based, limited RCT evidence)
Anti-aging and longevity protocols (unestablished efficacy)
Investigational in neurodegenerative conditions (early-phase trials)

Typical dosing

100–1000 mg variable; 1–5x weekly IV or daily SC (IV (most common), subcutaneous, or intramuscular)

IV dosing commonly 250–1000 mg per infusion over 1–4 hours. Subcutaneous compounded protocols typically 50–100 mg per injection. Flushing, nausea, and chest tightness are common with faster IV infusion rates. No FDA-established dose.

Regulatory status

NAD+ itself is not FDA-approved for any therapeutic indication. Compounded IV and injectable NAD+ is available via 503A pharmacies. Oral NAD+ precursors (nicotinamide riboside, nicotinamide mononucleotide) are sold as dietary supplements in the US. The FDA has taken enforcement actions against several IV NAD+ clinics for making unsubstantiated disease claims.

References

[review] Braidy N, Berg J, Clement J, et al. "Role of nicotinamide adenine dinucleotide and related precursors as therapeutic targets for age-related degenerative diseases." Antioxid Redox Signal, 2019;30(2):251-294.
[review] Rajman L, Chwalek K, Sinclair DA. "Therapeutic potential of NAD-boosting molecules: the in vivo evidence." Cell Metab, 2018;27(3):529-547.
[clinical-trial] Taylor JP, et al. "Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study." Front Aging, 2026;7:1652582.

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Disclaimer

This entry is for educational purposes only and does not constitute medical advice. Dosing information reflects published regulatory or research data and is not a recommendation. Many compounds described here are not approved for human use in the United States. Consult a licensed medical professional before considering any peptide therapy.