NAD+ injections and IV therapy

What are NAD+ injections?

NAD+ is a coenzyme found in every cell that declines with age; it is not a peptide but is marketed alongside peptides as injections and infusions. Randomized trials show that oral precursors such as nicotinamide riboside and nicotinamide mononucleotide reliably raise blood NAD+ and that NMN modestly improved muscle insulin sensitivity in 25 prediabetic women, but hard clinical outcomes have not been demonstrated and intravenous NAD+ has only an 11 person pharmacokinetic pilot. NAD+ was nominated for the FDA 503A bulks list and has no final FDA determination, so compounded injections sit in a gray area, while oral precursors are sold as dietary supplements.

What is NAD+?

NAD+ is a coenzyme (a dinucleotide, not a peptide) central to redox metabolism and sirtuin and PARP signaling; sold as intravenous or subcutaneous NAD+ and as oral precursors. It is also known as Nicotinamide adenine dinucleotide, NAD, IV NAD+, NAD+ injection, Precursors: nicotinamide riboside (NR), nicotinamide mononucleotide (NMN), NAD injections, NAD+ IV therapy, NAD IV drip.

How does it work?

NAD+ shuttles electrons in glycolysis, the citric acid cycle, and oxidative phosphorylation, and is consumed as a substrate by sirtuins, PARP DNA repair enzymes, and CD38. Tissue NAD+ falls with age, partly because CD38 activity rises. Oral precursors (NR, NMN, niacin) enter the salvage pathway and raise cellular NAD+. Intravenous NAD+ is largely broken down in blood to nicotinamide and other metabolites before reaching cells, which is why the pharmacology of infusions differs from oral precursors.

NAD+ IV therapy: what the evidence shows

Human randomized trials exist mainly for precursors. Martens et al. 2018 (24 healthy middle aged and older adults, crossover, 6 weeks of NR 1,000 mg per day) found NR raised blood NAD+ by about 60% and was well tolerated, with a nonsignificant trend to lower blood pressure. Yoshino et al. 2021 (25 postmenopausal prediabetic women, 10 weeks of NMN 250 mg per day) found improved muscle insulin sensitivity by about 25% without changes in body composition or other metabolic markers. A 2025 meta-analysis found no meaningful effect of NR or NMN on muscle mass or function. For intravenous NAD+ itself, the only published human study is an 11 person pilot describing plasma and urine metabolites during a 6 hour infusion. A 2018 review summarizes the in vivo evidence for NAD boosting molecules, which is mostly rodent.

Human evidence

Martens 2018: 24 adults aged 55 to 79, randomized crossover, NR 500 mg twice daily for 6 weeks raised blood NAD+ metabolome and was well tolerated; secondary blood pressure and arterial stiffness changes were not significant. Yoshino 2021: 25 overweight or obese postmenopausal women with prediabetes, NMN 250 mg per day for 10 weeks, muscle insulin stimulated glucose disposal improved about 25% versus no change on placebo, with no change in body weight, fat, or fasting glucose. Grant 2019: 11 healthy men received a 6 hour intravenous infusion of NAD+ at 3 umol per minute; plasma NAD+ did not rise until the second hour and metabolites accumulated in urine, with no clinical endpoints. Prokopidis 2025 meta-analysis: NR and NMN did not improve muscle mass or physical function across pooled trials.

Animal evidence

In mice, NR, NMN, and other NAD boosting strategies improve mitochondrial function, insulin sensitivity, and exercise capacity, and in some models extend life span or healthspan; sirtuin activation is the proposed pathway. Rajman, Chwalek, and Sinclair 2018 review the in vivo rodent evidence and note that human data lag well behind.

Key studies

Conditions studied

Is NAD+ legal in the United States?

FDA and compounding status

NAD+ (nicotinamide adenine dinucleotide) is not an FDA approved drug. It was nominated for the FDA 503A bulks list and appears on the nominated substances lists pending FDA evaluation; no final rule placing it on or excluding it from the bulks list had been published as of the last verification date, so compounded NAD+ injections and infusions are dispensed under FDA's interim enforcement policy where state boards permit. Oral NR and NMN are sold as dietary supplements, and FDA has questioned whether NMN qualifies as a dietary ingredient because of prior drug investigation.

WADA status

Not WADA prohibited. Not named on the current prohibited list. Athletes should still confirm against the list in force for their season.

Regulatory timeline

No regulatory events recorded.

Full tracker for NAD+ or the category-wide tracker.

What published studies of NAD+ used

Ranges below are reported from published studies and labeling only. PeptideAgent does not recommend doses or protocols.

Oral nicotinamide riboside 1,000 mg per day (500 mg twice daily) for 6 weeks (Martens 2018) and nicotinamide mononucleotide 250 mg per day for 10 weeks (Yoshino 2021) were the regimens used in randomized trials. The only intravenous NAD+ study infused 750 mg over 6 hours in 11 healthy men (Grant 2019). No clinical outcome based dose has been established for NAD+ infusions or injections.

Routes reported

NAD+ side effects and interactions

Side effects

Interactions

Contraindications

How do people access NAD+ legally?

Typical cost: IV NAD+ at a published clinic menu costs about 450 to 900 USD per session for 500 to 1,000 mg (member prices from 400 USD); compounded subcutaneous NAD+ through telehealth is about 79 to 199 USD per month. Oral NR or NMN supplements are sold over the counter. Prices checked 2026-09-22 on published provider and pharmacy price pages.

• NAD+ cost by channel
• Rules by state
• Verified provider directory

Compare NAD+

• Glutathione vs NAD+
• NAD+ vs MOTS-c

What's actually offered, and what that means for you

Licensed compounding pharmacies, clinics, and telehealth prescribers openly offer many unapproved peptides, and prescribers write prescriptions for them. NAD+ is not FDA approved. It is a nominated bulk substance FDA has not finished evaluating, and pharmacies compound it under FDA's interim policy where state boards permit, without any FDA finding on its safety or quality. [6] [9]

Enforcement is uneven. FDA mostly acts through warning letters to compounders and online sellers, Category 2 safety listings, and import alerts that let it detain shipments, rather than stopping every pharmacy. State pharmacy boards oversee pharmacies day to day, and their rules differ. [10] [11] [12] [13] [14]

What changes for you

• No FDA review of the product: FDA does not check a compounded drug's safety, effectiveness, or quality before it is sold. [14]
• Identity, purity, sterility, and dose accuracy can vary from batch to batch. [12]
• Insurance rarely covers it, so you usually pay cash.

What to check

Before you accept a compounded product, check for:

• A 503A pharmacy licensed in your state (your state board of pharmacy publishes license lookups). [14]
• A real evaluation by a licensed prescriber, not just an online form.
• A certificate of analysis for the specific batch.

Frequently asked questions

Decisions about starting, stopping, or combining any treatment belong with a licensed clinician who knows your history.

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Sources

Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.