NAD+ — Research, Dosing & Price Guide

NAD+ (nicotinamide adenine dinucleotide) is a critical coenzyme found in every living cell that plays essential roles in energy metabolism, DNA repair, gene expression regulation, and cellular signaling. NAD+ levels decline significantly with age — by age 60, levels are roughly half of what they were at age 20 — and this decline is implicated in numerous age-related diseases. Supplementation via IV infusion, subcutaneous injection, or precursors aims to restore youthful NAD+ levels and support cellular function.

NAD+ serves as the primary electron carrier in mitochondrial oxidative phosphorylation, shuttling electrons through Complexes I–IV of the electron transport chain to drive ATP synthesis. Beyond energy production, NAD+ is the essential substrate for three families of enzymes critical to aging and health: sirtuins (SIRT1-7), which deacetylate proteins to regulate gene expression, mitochondrial function, and stress responses; PARPs (poly-ADP-ribose polymerases), which consume NAD+ to repair DNA damage; and CD38/CD157, ectoenzymes involved in immune cell signaling. As NAD+ declines with age, competition between these enzyme families intensifies — PARP activity increases due to accumulated DNA damage, depleting the NAD+ pool and reducing sirtuin activity. This creates a vicious cycle of declining mitochondrial function, impaired DNA repair, and accelerated aging. Exogenous NAD+ supplementation aims to break this cycle by restoring the available pool.

• Yoshino et al. (2011) in Cell Metabolism demonstrated NMN (NAD+ precursor) restored NAD+ levels and improved glucose tolerance in aged mice
• A 2013 study by Gomes et al. in Cell showed restoring NAD+ levels in aged mice reversed mitochondrial dysfunction to youthful parameters within one week
• Rajman et al. (2018) published a comprehensive review in Cell Metabolism summarizing NAD+ decline as a hallmark of aging with therapeutic potential
• The NIAD trial (2023) showed IV NAD+ infusion improved cognitive performance and reduced fatigue in a small cohort of healthy adults
• Camacho-Pereira et al. (2016) in Cell Metabolism identified CD38 as the primary NAD+-consuming enzyme driving age-related NAD+ decline
• Preclinical studies show NAD+ restoration improves stem cell function, muscle regeneration, and neuronal health in aged animals

• IV infusion: 250–500 mg over 2–4 hours, 1–2 times per week (clinical setting)
• Subcutaneous injection: 50–200 mg daily or every other day
• Intramuscular injection: 100–200 mg 2–3 times per week
• NAD+ precursors (oral): NMN 250–1000 mg/day or NR 300–600 mg/day as alternatives
• Loading protocol: daily injections or IV infusions for 1–2 weeks, then transition to maintenance
• IV infusions should be administered slowly — rapid infusion can cause chest pressure, nausea, and flushing
• Cycle: continuous use is common for anti-aging protocols, with periodic bloodwork to monitor NAD+ levels

Known Side Effects

• Nausea and abdominal discomfort — common during IV infusion, mitigated by slower infusion rates
• Chest tightness or pressure — reported during rapid IV infusion; resolves by slowing the rate
• Injection site pain — subcutaneous NAD+ injections can cause a burning sensation due to the compound's acidity
• Flushing and warmth — transient vasodilation during or after administration
• Headache — occasionally reported, usually mild and self-resolving
• Insomnia — if administered late in the day due to increased cellular energy production

Safety Profile

NAD+ is an endogenous molecule essential for life, and supplementation has a strong theoretical safety basis. IV NAD+ infusion has been used clinically for decades, particularly in addiction medicine and chronic fatigue treatment, with a favorable safety record. The primary risks relate to administration route — rapid IV infusion can cause uncomfortable but non-dangerous symptoms (nausea, chest pressure, flushing). Subcutaneous injections are generally better tolerated but may cause local irritation. There are no known dangerous drug interactions, though individuals on chemotherapy should consult their oncologist, as NAD+ could theoretically support DNA repair in cancer cells. Long-term high-dose safety data is limited but no serious adverse events have been reported in published literature. Quality and purity of injectable NAD+ products vary significantly between suppliers.

Day 1 (IV): Immediate energy boost reported by many users within hours of infusion. Improved mental clarity and reduced brain fog. Some users describe a 'switched on' feeling. Week 1: Consistent improvements in energy, focus, and exercise recovery. Sleep quality often improves. Mood elevation is commonly reported. Weeks 2–4: Cumulative benefits become more pronounced — improved exercise endurance, faster recovery, clearer skin, and sustained mental clarity. Some users notice improvements in chronic fatigue or age-related sluggishness. Months 1–3: Long-term users report sustained vitality improvements. Bloodwork may show improved metabolic markers. The anti-aging benefits are best understood as cumulative and preventive rather than dramatic or acute.

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