Compounds / NAD+
NAD+
Also known as: Nicotinamide adenine dinucleotide; NAD; NAD+; beta-NAD; coenzyme I; CAS 53-84-9
Primary research focus: Cellular energy metabolism and NAD+ repletion (IV and injectable use is compounded; oral precursors are supplements)
Last updated July 2026 · Reviewed against FDA labeling and published research.
What is NAD+?
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme present in every living cell, essential for converting food into cellular energy (ATP), DNA repair, and the activity of sirtuins and other NAD+-dependent enzymes. It is not a peptide but a dinucleotide. Tissue NAD+ levels decline with age, which drives interest in repletion. Injectable and IV NAD+ are compounded preparations that are not FDA-approved for any therapeutic indication; oral NAD+ precursors occupy a separate and complicated regulatory space.
NAD+ functions as an electron carrier, cycling between oxidized (NAD+) and reduced (NADH) forms to shuttle electrons through glycolysis, the Krebs cycle, and oxidative phosphorylation to produce ATP. It is also consumed as a substrate (not merely a cofactor) by three enzyme families: sirtuins, which regulate DNA repair, metabolism, and stress resistance; PARPs, which mediate DNA damage repair; and CD38, the enzyme most responsible for the age-related decline in NAD+. Importantly, NAD+ itself is not absorbed intact across the intestine or directly taken up by cells; the body synthesizes it de novo from tryptophan or, more commonly, from vitamin B3 precursors (nicotinamide, nicotinic acid, NR, NMN) through the salvage and Preiss-Handler pathways. This is why the oral products sold for NAD+ support are precursors rather than NAD+ itself.
How it’s supplied
Injectable NAD+ is available only as a compounded preparation from 503A and 503B pharmacies with a prescription, typically as a lyophilized powder reconstituted for subcutaneous, intramuscular, or intravenous use (IV infusions commonly dilute 500 mg into normal saline). Oral products marketed for NAD+ support generally contain precursors (nicotinamide riboside or nicotinamide) rather than NAD+ itself. There is no FDA-approved NAD+ drug product.
Dosage Chart
Units shown are for a U-100 insulin syringe (100 units = 1 mL), calculated from the vial size and BAC water you select. Always confirm against your prescription and your syringe markings.
| Phase | Dose | Frequency | Notes |
|---|---|---|---|
| Weeks 1-2 | 50mg | 1x Daily | — |
| Weeks 3-16 | 100mg | 1x Daily | — |
- Rotate injection sites to reduce irritation and lipohypertrophy
- Not for use during pregnancy or breastfeeding
- Do not exceed the recommended dose to try to speed results
Potential Benefits and Side Effects
Effects reported in published research. Not a promise of results, and not medical advice.
- Reported in human research (mostly with oral precursors) and in clinical practice; therapeutic benefits for most marketed uses are not established.
- Raises measurable NAD+ levels (demonstrated most clearly with oral NR).
- Supports mitochondrial ATP production as an essential electron carrier.
- Serves as substrate for sirtuins and PARPs, linking it to DNA repair and metabolic regulation.
- Addresses the well-documented age-related decline in tissue NAD+ (repletion rationale).
- IV infusion: chest tightness or pressure, flushing, nausea, abdominal cramping, and lightheadedness, generally rate-dependent and relieved by slowing the infusion.
- Injection-site reactions with subcutaneous or intramuscular use.
- Oral precursors are generally well tolerated; nausea and flushing (with nicotinic acid forms) can occur.
- Long-term safety of repeated high-dose IV NAD+ is not established.
Warnings and contraindications
Important safety information. This is not exhaustive — read the full prescribing information and consult your prescriber or pharmacist.
- No FDA-approved drug labeling exists for therapeutic NAD+; the following reflect regulatory status and reported experience, not label warnings.
- IV and injectable NAD+ are compounded preparations; the FDA has not evaluated them for safety or effectiveness, and no standardized dosing, monitoring, or quality standards apply.
- IV infusion commonly causes chest tightness, flushing, nausea, and abdominal discomfort if run too fast; infusions are typically slowed or paused for tolerability, and sessions can take hours.
- Evidence for the marketed benefits (energy, addiction recovery, anti-aging, cognition) is limited; major medical societies do not endorse NAD+ IV therapy for these uses.
- Oral NAD+ itself is poorly absorbed; precursor products are not interchangeable with IV NAD+ in pharmacology or evidence.
- NMN specifically is excluded by the FDA from the dietary supplement definition because of an active investigational new drug application; products still sold face enforcement risk.
- Safety in pregnancy and breastfeeding has not been established for therapeutic use.
- Not established; no FDA-approved drug labeling. Precautionary considerations include known hypersensitivity and clinician judgment in significant cardiovascular, hepatic, or renal disease given the infusion burden.
Reconstitution Steps
How to prepare the lyophilized vial. Confirm specifics with your pharmacist or prescriber.
- Confirm the amount of peptide in the vial and the volume of diluent you intend to use before starting.
- Wash your hands and gather supplies: the lyophilized vial, the diluent (typically bacteriostatic water), an alcohol swab, and a sterile syringe.
- Let the vial and diluent reach room temperature if they were refrigerated or frozen.
- Wipe the rubber stopper of both the peptide vial and the diluent vial with a fresh alcohol swab and let them air dry.
- Draw the intended diluent volume into the syringe.
- Insert the needle into the vial and slowly release the diluent down the inside wall rather than directly onto the powder, to avoid foaming.
- Do not shake. Gently swirl or roll the vial until fully dissolved.
- Inspect the solution: it should be clear and colorless with no visible particles. Do not use if cloudy or containing particles.
- Note the resulting concentration (amount divided by diluent volume) so it matches the reconstitution calculator on this page.
- Label the vial with the reconstitution date and store as directed under reconstituted storage.
US regulatory status
Classifications are public record but can change. For reference only, not legal advice.
Development: NAD+ biology is foundational biochemistry with a very large research base, but therapeutic NAD+ repletion is a much newer and less settled area. Human trials have concentrated on oral precursors rather than NAD+ itself: nicotinamide riboside at 1,000 mg/day has been shown to raise NAD+ in peripheral blood mononuclear cells. Direct IV NAD+ evidence is thinner; a 2026 retrospective tolerability pilot published in Frontiers in Aging compared four consecutive days of 500 mg IV NAD+ versus IV NR in a commercial setting, and noted that commercial clinical and wellness settings increasingly provide these infusions despite limited evaluation of safety and effectiveness. There is no FDA-approved NAD+ drug and no active approval program; the compound is unpatentable, which limits commercial development incentive.
Notes: There is no FDA-approved NAD+ drug product, and no FDA drug label exists for IV NAD+. Injectable and IV NAD+ are compounded preparations lawfully prepared by 503A and 503B pharmacies under prescription, but they are not FDA-evaluated for safety or efficacy. The oral space is separate and more complicated: nicotinamide riboside (NR) remains a lawful dietary supplement, while the FDA has excluded nicotinamide mononucleotide (NMN) from the dietary supplement definition since November 2022 because an investigational new drug application was filed for it, meaning NMN products sold as supplements face enforcement risk. NAD+ is not a controlled substance and is not on the WADA Prohibited List. (Status current as of mid-2026.)
International status
Pharmacokinetics
Storage and handling
Important Notes
Practical considerations for consistency and safety.
- NAD+ is a coenzyme (a dinucleotide), not a peptide.
- Routes are not interchangeable: NAD+ itself is not absorbed orally, so oral products are precursors (NR, nicotinamide) with a different evidence base than IV NAD+.
- Injectable and IV NAD+ are compounded, not FDA-approved; no FDA drug label exists.
- NMN is excluded from the dietary supplement definition by the FDA due to IND preclusion; NR remains a lawful supplement.
- IV infusion tolerability is dose- and rate-dependent; chest tightness and flushing during infusion are common and rate-related.
Lifestyle Factors
- Endogenous NAD+ is supported by dietary B3 (niacin, nicotinamide) and tryptophan; levels are influenced by age, alcohol intake, and metabolic health.
- Exercise and caloric restriction are associated with better NAD+ status in the research literature.
References
Related compounds
Important disclaimer
This page is an educational reference, not medical advice, a diagnosis, or a treatment recommendation, and not a substitute for your prescriber or pharmacist. Approval and regulatory status varies by compound and can change. Always confirm against current prescribing information and consult a qualified healthcare professional before making any decision about a medication.