The Basics

What is NAD+?

NAD+ (nicotinamide adenine dinucleotide) is a coenzyme found in every cell of your body. It plays essential roles in energy production, DNA repair, cellular signaling, and metabolic function. Think of it as a crucial helper molecule that your cells need to function optimally.

What does "NAD+" stand for?

NAD+ stands for Nicotinamide Adenine Dinucleotide (the + indicates its oxidized form). It's sometimes called "NAD plus" in conversation.

Why do NAD+ levels decline with age?

Multiple factors contribute to age-related NAD+ decline:

  • Increased consumption by enzymes (CD38, PARPs) activated by inflammation and oxidative stress
  • Decreased production as the enzyme NAMPT becomes less active
  • Mitochondrial dysfunction requiring more NAD+ for cellular repair
  • Accumulated DNA damage demanding NAD+ for repair processes

Research shows NAD+ levels can drop 10-80% from youth to old age.

Who should consider NAD+ injections?

NAD+ may be appropriate for adults experiencing:

  • Age-related fatigue or declining energy
  • Reduced mental clarity or cognitive performance
  • Slower recovery from exercise
  • Interest in longevity and healthy aging strategies
  • Metabolic concerns (with medical supervision)

Always consult a healthcare provider to determine if NAD+ is right for your individual situation.

What's the difference between NAD+, NADH, NMN, and NR?

  • NAD+: The oxidized, active form of the molecule
  • NADH: The reduced form of NAD+
  • NMN (Nicotinamide Mononucleotide): A precursor that converts to NAD+ in the body
  • NR (Nicotinamide Riboside): Another precursor that converts to NAD+

NAD+ injections deliver the molecule directly, while NMN and NR are precursors typically taken orally that your body converts to NAD+.

Safety & Side Effects

Is NAD+ safe?

Clinical studies show NAD+ supplementation has a favorable safety profile with low incidence of side effects. A 2024 pilot study found that IV infusions of NAD+ precursors were safe with only minor temporary side effects and no serious adverse events up to 14 days post-infusion.

However, long-term safety data in healthy adults is still limited. Always use NAD+ under medical supervision from a licensed provider.

What are the side effects?

Common (generally mild):

  • Injection site reactions (redness, tenderness)
  • Mild flushing or warmth
  • Occasional nausea (usually with higher doses)
  • Temporary headache

Rare:

  • Allergic reactions
  • Prolonged injection site irritation

Most side effects are mild and resolve quickly, especially when starting with lower doses.

Are there any serious risks?

Serious adverse events are rare in clinical studies. Theoretical concerns include:

  • Cancer considerations: NAD+ fuels cellular metabolism—both healthy cells and potentially cancer cells. Those with history of cancer should discuss thoroughly with their oncologist.
  • Allergic reactions: While rare, severe allergic reactions are possible with any injectable medication.
  • Unknown long-term effects: Large-scale, multi-year human studies are still ongoing.

Who should NOT use NAD+?

Avoid or use with extreme caution if you have:

  • Active cancer or history of cancer (discuss with oncologist)
  • Severe liver or kidney disease
  • Are pregnant or breastfeeding (insufficient safety data)
  • Known allergies to NAD+ or formulation ingredients

Can I overdose on NAD+?

Your body regulates NAD+ levels, and excess is typically metabolized. However, extremely high doses (>1,000mg daily) may overwhelm your liver's processing capacity and cause complications. Never exceed recommended dosing without medical supervision. Most protocols use 50-200mg per injection.

Does NAD+ interact with medications?

NAD+ has relatively few known drug interactions, but you should always inform your healthcare provider of all medications and supplements you're taking. Potential considerations include:

  • Blood pressure medications (NAD+ may affect blood pressure)
  • Diabetes medications (may affect blood sugar regulation)
  • Cancer treatments (consult oncologist)

Effectiveness

Does NAD+ really work?

The evidence is mixed and still emerging:

What we know for certain:

  • NAD+ levels DO decline significantly with age
  • NAD+ IS essential for hundreds of cellular processes
  • Supplementation DOES successfully raise NAD+ levels in blood and tissues

What's less certain:

  • How much the subjective benefits (energy, cognition) translate from animal studies to humans
  • Optimal dosing and delivery methods for specific outcomes
  • Long-term impact on healthspan and lifespan in humans

A 2023 systematic review found that while many studies show improved clinical features with NAD+ supplementation, other studies showed no measurable benefits. More research is needed.

How long does it take to work?

Timeline varies by individual:

  • Days 1-3: Some users notice subtle energy improvements
  • Week 1-2: Many report more consistent energy and mental clarity
  • Week 4-8: Full benefits typically emerge with consistent use
  • Month 3+: Effects plateau at maintenance levels

Blood NAD+ levels rise within 24 hours of injection, but subjective improvements take longer.

Will I feel a difference immediately?

Most users don't feel dramatic immediate effects. NAD+ works at the cellular level—benefits accumulate over time. Some people report subtle energy improvements within days, while others take 4-6 weeks to notice changes. This is a long-term optimization strategy, not a quick fix.

How long do the effects last?

NAD+ has a relatively short half-life in the body. Benefits are sustained with regular dosing (typically 1-3x weekly). If you stop injections, NAD+ levels will gradually return to baseline over weeks to months, and benefits will diminish.

What results can I realistically expect?

Common reported benefits include:

  • More sustained energy throughout the day
  • Improved mental clarity and focus
  • Better sleep quality
  • Faster recovery from exercise
  • General sense of vitality

NAD+ is NOT a miracle cure. Don't expect dramatic weight loss, complete reversal of aging, or cure of chronic diseases. Think of it as one tool in a comprehensive health optimization strategy.

Are the anti-aging claims backed by science?

Partially. Animal studies show compelling evidence that NAD+ boosting can extend lifespan and healthspan in mice, worms, and other organisms. It activates sirtuins and other longevity pathways.

However, we don't yet have long-term human studies proving NAD+ extends human lifespan. The research is promising but preliminary. Current use is based on mechanistic understanding and emerging clinical evidence.

Usage & Dosing

How do I take NAD+ injections?

NAD+ injections are administered subcutaneously (into fatty tissue under the skin). Most people inject into the abdomen, thigh, or back of the arm. The process is similar to insulin injections—simple enough to do at home after brief instruction.

View our complete injection guide →

How often do I need to inject?

Typical protocols range from 1-3 times per week. Common schedules:

  • Once weekly: Simple maintenance for busy schedules
  • Twice weekly: Balance of convenience and optimization
  • Three times weekly: More aggressive protocol for optimal levels

Your provider will recommend a specific protocol based on your goals and response.

What dose should I start with?

Most providers recommend starting with 50-100mg per injection to assess tolerance. You can gradually increase to 100-200mg as needed. Never exceed 300mg per week without medical evaluation.

Do injections hurt?

Most people describe subcutaneous NAD+ injections as virtually painless when done correctly with a small needle (29-31 gauge). You may feel a brief pinch, and occasional mild stinging during injection. Injecting slowly helps minimize discomfort.

How do I store NAD+?

NAD+ vials must be refrigerated at 36-46°F (2-8°C). Do not freeze. Keep away from light. Once opened, use within 28-30 days or as directed. Properly stored unopened vials typically remain stable for 6-12 months.

Can I travel with NAD+ injections?

Yes, but you'll need to maintain refrigeration. Use an insulated cooler with ice packs. Bring your prescription documentation. NAD+ can tolerate brief temperature variations but should be kept cool as much as possible.

What time of day should I inject?

There's no definitive "best time," but considerations include:

  • Morning: May support daytime energy
  • Pre-workout: Some users inject before training for enhanced performance
  • Evening: Others prefer evening if they notice improved sleep quality

Experiment to find what works best for you. Consistency matters more than specific timing.

Cost & Access

How much do NAD+ injections cost?

Prices vary significantly by provider and protocol:

  • Initial consultation: $0-150 (many telehealth providers offer free consultations)
  • Monthly medication cost: $100-300+ depending on dose and frequency
  • Shipping: Often included, or $10-20
  • Supplies (syringes, alcohol pads): Usually included

Weekly injection at 100mg typically costs $150-250/month.

Does insurance cover NAD+?

Most insurance companies do NOT cover NAD+ injections as they're typically considered preventive/wellness rather than treatment for a specific disease. Some providers offer insurance reimbursement support, but coverage is rare. Consider this an out-of-pocket expense.

Do I need a prescription?

Yes. NAD+ injections are prescription-only. You'll need to consult with a licensed healthcare provider (physician, nurse practitioner, or physician assistant) who can evaluate your health and write a prescription if appropriate.

How do I get a prescription?

Two main options:

  • Telehealth (easiest): Complete an online health assessment, consult with a licensed provider via video or messaging, receive prescription if approved. See top telehealth providers →
  • In-person: Visit an integrative medicine clinic, anti-aging specialist, or wellness provider who offers peptide therapy.

Telehealth is typically faster, more convenient, and more affordable.

Can I buy NAD+ without a prescription?

No. Injectable NAD+ requires a prescription in the United States. Beware of websites selling injectable NAD+ without prescriptions—these are illegal and potentially dangerous (quality not guaranteed).

Oral NAD+ precursors (NMN, NR) are available over-the-counter as supplements, but injectable forms are regulated.

How long will a vial last?

Depends on concentration and dosing. Common example:

  • A 10mL vial at 100mg/mL = 1,000mg total
  • If you inject 100mg twice weekly, that's ~5 weeks per vial

Your provider will calculate supply based on your specific protocol.

Comparisons

NAD+ injections vs. oral supplements (NMN, NR)?

NAD+ Injections

Pros:

  • Bypasses digestive system
  • Potentially higher bioavailability
  • Lower doses needed
  • Direct delivery to bloodstream

Cons:

  • Requires prescription
  • More expensive
  • Requires injection
  • Less clinical research vs oral

Oral NMN/NR

Pros:

  • Over-the-counter (no prescription)
  • Convenient (just swallow)
  • More clinical studies
  • Often less expensive

Cons:

  • Subject to digestive breakdown
  • Variable absorption
  • Requires higher doses
  • Quality varies by brand

Bottom line: Both can be effective. Injections may offer superior bioavailability, while oral is more convenient. Some people use both.

NAD+ injections vs. IV infusions?

  • IV infusions: Administered at a clinic, takes 1-4 hours, doses of 250-1000mg, most expensive ($250-1000+ per session), highest bioavailability
  • Subcutaneous injections: Self-administered at home, takes seconds, doses of 50-200mg, moderate cost ($30-75 per injection), good bioavailability

SubQ injections offer a middle ground: more convenient and affordable than IV, more bioavailable than oral.

Is NAD+ better than other longevity supplements?

NAD+ addresses a specific, well-documented age-related decline. It's not necessarily "better" than other interventions—think of it as complementary. Common longevity strategies that may work synergistically:

  • NAD+ (cellular energy, DNA repair)
  • Resveratrol/Pterostilbene (sirtuin activation)
  • Metformin (metabolic health, some evidence for longevity)
  • Rapamycin (mTOR inhibition, research ongoing)
  • Exercise, sleep, nutrition (foundational)

No single supplement is a longevity panacea. NAD+ is one tool in a comprehensive approach.

Can I combine NAD+ with other peptides?

Yes, many people combine NAD+ with other peptides for synergistic effects. Common combinations (always under medical supervision):

  • NAD+ + BPC-157 (recovery and healing)
  • NAD+ + Thymosin Beta-4 (tissue repair)
  • NAD+ + CJC-1295/Ipamorelin (growth hormone optimization)

Always discuss combinations with your provider to ensure safety and compatibility.

Still Have Questions?

The best way to get personalized answers is to consult with a licensed healthcare provider who specializes in NAD+ therapy.