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Mitochondrial & longevity

NAD+ (injectable)

Also known as Nicotinamide adenine dinucleotide, NAD, Beta-NAD, Coenzyme I, Diphosphopyridine nucleotide

Limited human dataHuman data come from IV infusion studies; none for subcutaneous or intramuscular use.

Endogenous pyridine nucleotide coenzyme (compounded injectable; not an FDA-approved drug)

Not FDA-approved. On FDA's 503A list (May 14, 2026): Category 1, bulk substance under evaluation. Source, May 14, 2026

Identity. NAD+ here means oxidized nicotinamide adenine dinucleotide itself. It does not cover the precursors nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), which are different molecules with different uptake and tolerability. FDA's 503A nomination list names NAD and NADH as separate entries and lists a disodium salt trihydrate form separately. Check that the label expresses mg as NAD+ and not as the salt. The IV literature used lyophilized NAD+ powder reconstituted with bacteriostatic water and diluted in 500 mL normal saline. Do not use the SC/IM vial for IV infusion unless the partner pharmacy confirms in writing that it is suitable for IV use.

At a glance

These dosages are a helpful guide, not a prescription. Every clinician is expected to do their own due diligence before prescribing.

  1. Start

    750 mg intravenous infusion over 6 h (healthy men, pilot)1

    Human study
Frequency
single infusion1
Route
intravenous1
Course
6 h1
Both human studies were IV only; do not apply to SC or IM use. A 500 mg daily IV series was poorly tolerated.
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Dosing detail

Human studies

Human study

  • Healthy men aged 30-55 y; pharmacokinetic pilot of a single 6-h IV NAD+ infusion vs saline

    750 mg1

    Route
    intravenous
    Frequency
    single infusion
    Duration
    6 h
    n
    11 (8 NAD+, 3 saline)
    Design
    Randomized, saline-controlled pilot; plasma/urine NAD+ metabolome; no clinical outcomes; healthy men only (diabetes, liver and renal disease excluded)
    Source quote
    Participants in the Test group were intravenously administered 750 mg NAD+ in normal saline (Archway Apothecary, Covington, LA, USA) over a 6 h period (infusion rate = ~2 mg/min ≡ 3 μmoles/min).

    Finding. Plasma NAD+ rose 398% vs baseline only at 6 h. No adverse events were observed, and no clinical efficacy outcomes were assessed. The ~2 mg/min rate is the only rate in the available sources with no observed adverse events.

  • Adults at a commercial IV clinic; NAD+ vs nicotinamide riboside (NR) tolerability, retrospective record review; lyophilized powder reconstituted with bacteriostatic water

    500 mg2

    Route
    intravenous
    Frequency
    once daily for four consecutive days ('loading dose'); patient-controlled infusion rate
    Duration
    4 days; 30-day follow-up
    n
    6 NAD+ (8 NR)
    Design
    Retrospective chart review, no placebo, by a commercial clinic's employees; 500 mg diluted in 500 mL normal saline
    Source quote
    Participants received four consecutive days of 500 mg NADIV or NR IV, with 30 days follow-up.

    Finding. All 6 NAD+ clients reported moderate-to-severe abdominal cramping, diarrhea, nausea, vomiting, raised heart rate, throat pain, congestion and chest pressure during infusion. No significant ALT/AST change.

Clinical practice

Clinical practice

Practice dosing rests on one medically reviewed consumer education page (updated Sept 1, 2026) and one prescriber-facing page. No controlled trial supports any SC or IM regimen. The two sources differ on titration detail, and neither is a label or guideline.

Start
About 20 mg NAD+ per subcutaneous injection.
Titration
Increase gradually over subsequent injections up to about 100 mg per injection. One prescriber page gives steps of 20 mg every one to two weeks. This is a single-source figure and prescriber judgment applies.
Typical
Maintenance of about 50-100 mg weekly (SC).
Ceiling
SC only: some prescribers recommend not going above about 300 mg PER WEEK subcutaneously 'without further evaluation'. This is described as clinical practice, not a validated or regulatory limit. It is a weekly SC figure only.
Frequency
1 to 3 times weekly during the initial phase (SC). One prescriber page gives 'one to three times per week' for 20 to 100 mg.
Route
Subcutaneous (practice dosing sources describe SC injection only; no IM dose is stated); IV under clinical supervision (separate product and rate considerations).
Timing
No timing-of-day guidance found in the sources
Cycle
No defined cycle length found; IV 'loading' of 500 mg daily x4 days is described in one clinic series.

Sources

  • Clinical practicePeer-reviewed study2
    Identical infusions were repeated for four continuous days at the same time each day, which is the typical commercial “loading dose” recommended by the compounding pharmacy

What clinics and vendors publish

These ranges come from clinic and vendor publications, not studies.

Clinic-reported
  • Clinic-reportedProfessional education3
    Subcutaneous protocols usually start at about 20 mg per injection and titrate up gradually to about 100 mg.
  • Clinic-reportedPharmacy or clinic protocol4
    Titration up by 20mg every one to two weeks
  • Clinic-reportedPharmacy or clinic protocol4
    The common range is 20 to 100mg injected subcutaneously, one to three times per week.
  • Clinic-reportedProfessional education3
    Maintenance often settles at 50–100 mg weekly.
  • Clinic-reportedProfessional education3
    Most prescribers schedule injections one to three times weekly during the initial phase.
  • Clinic-reportedProfessional education3
    Some prescribers recommend not going above about 300 mg/week subcutaneously without further evaluation.
  • Clinic-reportedProfessional education3
    For intensive addiction detox protocols, IV doses of 500–1,000 mg/day over four to ten days are used under direct medical supervision.

Safety

Serious warnings

  • Not an FDA-approved drug: 'NAD+ is not FDA-approved for any specific medical indication.' Compounded preparations are not FDA-reviewed for safety or quality.3
  • A 2026 systematic review found that 'No eligible outcomes trials evaluated intravenous or intramuscular NAD⁺ itself for anti-aging or wellness indications.'5
  • A 2026 critical review of IV longevity therapy in general (many agents, not NAD+ alone) concluded it 'should be regarded as an experimental intervention rather than an evidence-based dermatological or anti-aging practice.'6
  • IV rate is the dose variable that drives tolerability. A rate of ~2 mg/min (750 mg over 6 h) produced no observed adverse events in 8 healthy men. Self-paced 500 mg infusions (about 5 mg/min or faster on either reading) produced moderate-to-severe symptoms in 6 of 6 patients. One education source states 'a fast IV drip can cause immediate headache or shortness of breath, while a slower drip usually doesn't.'2

Contraindications

  • Pregnancy and breastfeeding: one education source lists 'if you're pregnant or breastfeeding (no safety data exists)' as a reason to avoid NAD+ injections.3
  • Cancer: the same source states 'anyone with active cancer or any cancer history should avoid it, not just monitor it closely.' The rationale (that boosting NAD+ might fuel malignancy growth) is theoretical and has not been shown in humans.3
  • In the IV clinic series, records required that the client was 'not pregnant, and did not have a family or recent history of cancer, which were all contraindications of IV therapy at the commercial clinic.'2
  • Hypersensitivity: 'Don't use NAD+ if you have a known allergy to NAD+ or any formulation component.'3
  • Severe liver or kidney impairment and unstable cardiovascular disease are listed as contraindications by the education source ('if you have severe liver or kidney impairment'; 'if you have unstable cardiovascular disease'). No approved label exists, so these come from practice sources and are not labeled contraindications.3

Adverse effects

  • IV 500 mg daily x4: 'All clients (n = 6) in the NADgroup reported moderate to severe abdominal cramping, diarrhea, nausea, vomiting, increased heart rates, pain in throat, congestion, and chest pressure during infusion.' Symptoms ceased on completing the infusion; patients controlled the rate, giving longer infusion times.2
  • IV 750 mg over 6 h (n=8 healthy men): 'No adverse events were observed during the 6 h infusion'. Total bilirubin rose 2.75 μmoles/L at 8 h, and GGT, LD and AST fell. None was judged clinically significant.1
  • The education source lists 'headache, nausea, dizziness, lightheadedness, or flushing' as the mild reactions most people notice.3
  • 'The side effects most people notice (headache, nausea, dizziness) are dose- and rate-dependent'; 'Slowing the drip usually settles these symptoms, but they're real cardiovascular responses, not just minor nuisances.'3

Monitoring

  • The IV clinic series tracked symptoms, infusion time, blood pressure, resting heart rate and ALT, AST, hsCRP, BUN/creatinine and TSH. These were study measures, not a guideline-endorsed monitoring schedule.2
  • The IV pilot followed liver function tests (bilirubin, ALP, ALT, GGT, LD, AST) for safety.1
  • No SC or IM monitoring standard exists. As a precaution, consider baseline and follow-up hepatic and renal function, heart rate and blood pressure at each IV infusion, and glucose or HbA1c. The glycemic item rests on indirect evidence: the IV series authors cite meta-analyses where oral NAD precursors 'resulted in hyperglycemia', which is not NAD+ injection data.2

Interactions

  • One education source states: 'No significant drug interactions with NAD+ injection have been identified in the medical literature to date.' The source notes this partly reflects limited formal study. The absence of identified interactions does not demonstrate safety.3

Handling

Reconstitution

The lyophilized IV powder in the clinic series was reconstituted with bacteriostatic water as directed by the supplier and diluted in 500 mL normal saline. One education source also describes compounded NAD+ powder as reconstituted with bacteriostatic water before use. No source states whether SC/IM products are supplied as ready-to-use solution or powder, or at what concentration. Ask the dispensing pharmacy before relying on any mL guidance.

Storage before mixing

Refrigerated at 36 to 46 degrees Fahrenheit (about 2 to 8°C). Beyond-use date: approximately one month after the patient receives it. This is pharmacy-specific, so follow the actual label.

Storage after mixing

After the first vial puncture, use the product within 28 days. Discard at 28 days regardless of remaining volume. At 50-100 mg weekly a 500 mg vial outlasts that window, so plan vial size against dose frequency.24

Evidence

All human data are intravenous. One study is a pharmacokinetic pilot in healthy men (n=11; 8 NAD+, 3 saline) given 750 mg over 6 h at ~2 mg/min. No adverse events were observed, and no clinical outcomes were measured. Patients with diabetes, liver disease or renal disease were excluded. The other is a retrospective, uncontrolled clinic series (500 mg daily x4 days, n=6, patient-controlled rate). All 6 patients reported moderate-to-severe abdominal, cardiovascular and chest symptoms during infusion. A 2026 systematic review found no outcome trials of IV or IM NAD+ for anti-aging or wellness. No SC or IM human study of NAD+ was found. SC and IM regimens come from educational and prescriber-facing sources only. Clinical efficacy is not established.

Mechanism

NAD+ is a coenzyme for redox reactions and a substrate for sirtuins, PARPs and CD38. Extracellular NAD+ is poorly cell-permeant. Ectoenzymes (CD38, pyrophosphatases, CD73) cleave it to nicotinamide, NMN and NR, which cells take up and resynthesize to NAD+. Direct uptake of intact NAD+ has been proposed but is not well characterized.12

Availability

Amounts offered

  • 500 mg
  • 1,000 mg

Custom strengths on request.

References

According to PubMed

  1. 1A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD+Frontiers in Aging Neuroscience, 2019
  2. 2Intravenous infusion of nicotinamide adenine dinucleotide (NAD) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world settingFrontiers in Aging, 2026
  3. 3NAD+ Injections: Benefits, Safety, and What to Know (medically reviewed by Soma Mandal, MD; updated September 1, 2026)Testing.com, 2026
  4. 4NAD+ Dosage and Subcutaneous Protocols for PrescribersMediveraRx
  5. 5NAD⁺ supplementation for anti-aging and wellness: A PRISMA-guided systematic review of preclinical and clinical evidenceAgeing Research Reviews, 2026
  6. 6Intravenous longevity therapy: a critical review of evidence, mechanisms, and clinical utilityActa Dermatovenerologica Alpina, Pannonica, et Adriatica, 2026
  7. 7NAD⁺ biology and supplementation: From mechanisms to clinical perspectivesMolecular Biology Reports, 2026
  8. 8Bulk Drug Substances Nominated for Use in Compounding Under Section 503A of the FD&C Act (Categories 1-3), updated May 14, 2026U.S. FDA, 2026
  9. 9Bulk Drug Substances Used in Compounding Under Section 503A of the FD&C Act (page last updated 05/14/2026)U.S. FDA, 2026

Last reviewed 2026-10-14. 27 figures checked against their sources. How this works