What NAD+ is
Nicotinamide adenine dinucleotide (NAD+) is a coenzyme every cell uses for energy metabolism and for enzymes involved in DNA repair and cell signaling. Animal studies link falling NAD+ to aging, which drove interest in raising it, either directly with NAD+ or with oral precursors such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) (Rajman et al., Cell Metab 2018, PMID: 29514064).
Most of that evidence comes from animals. In people, studies mostly measure whether NAD+ levels go up, not whether health outcomes improve.
This article is general information, not medical advice or a dosing recommendation. Decisions about starting, changing or stopping a prescription belong with a licensed clinician who knows your history.
Routes compared
| Route | Regulatory status | What human studies show |
|---|---|---|
| IV infusion | Compounded; no FDA-approved NAD+ drug | Small pilot: plasma NAD+ did not rise for the first 2 hours of a 6-hour infusion |
| Injection (subcutaneous or intramuscular) | Compounded; no FDA-approved NAD+ drug | No randomized outcome trials found |
| Nasal spray | Compounded | No randomized outcome trials found |
| Oral NR or NMN | Sold as dietary supplements | Randomized trials show raised NAD+ levels; outcome effects limited |
IV. In a pilot study of a 6-hour NAD+ infusion, NAD+ was rapidly and completely removed from the blood for at least the first 2 hours; breakdown products appeared later and NAD+ itself showed up in urine (Grant et al., Front Aging Neurosci 2019, PMID: 31572171).
Injections and nasal sprays. We found no randomized controlled trials showing that NAD+ injections or sprays improve energy, cognition or aging outcomes.
Oral precursors. In a 6-week crossover trial in healthy middle-aged and older adults, NR was well tolerated and raised NAD+ metabolism (Martens et al., Nat Commun 2018, PMID: 29599478). In a 10-week trial in women with prediabetes and overweight or obesity, NMN increased muscle insulin sensitivity (Yoshino et al., Science 2021, PMID: 33888596). These are small, short studies, and supplements are not intended to diagnose, treat, cure or prevent any disease. Our NMN vs NR vs NAD+ guide compares them in detail.
FDA status of compounded NAD+
No FDA-approved drug contains NAD+ as an injection or infusion. Pharmacies compound it under section 503A, where NAD appears in Category 1 (“under evaluation”) of the FDA’s list of nominated bulk substances, updated May 14, 2026. In Category 1, the FDA does not intend to take action against compounders who meet the conditions of its interim policy; that is not an approval (FDA).
The FDA has also warned compounders that food-grade NAD+ sold by repackagers has been used to make IV products, that food-grade ingredients carry a high risk of microbial and endotoxin contamination, and that it has received adverse event reports after NAD+ injectables, including severe chills, shaking, vomiting and fatigue, some needing medical treatment (FDA).
Safety: questions to ask before NAD+ therapy
• Which licensed pharmacy compounds it, and can the provider name it?
• Is the NAD+ pharmaceutical grade (not food or supplement grade)?
• Who reviews your history before prescribing, and what should you do if you have a reaction?
Report fever, chills, shaking, vomiting or injection-site problems to the prescriber, and report adverse events to FDA MedWatch. People who are pregnant, breastfeeding or being treated for cancer should discuss NAD+ products with their own clinician, since they have not been studied in those groups.
This article is general information, not medical advice or a dosing recommendation. Decisions about starting, changing or stopping a prescription belong with a licensed clinician who knows your history.
Cost and online options
Current prices for prescription NAD+ injections and sprays are on NAD+ injections online. Approved partners that list NAD+ include HealthRX and Luvo Health; see our HealthRX review, Luvo Health review and the telehealth comparison hub.
Disclosure
CalcMyPeptide may earn commissions from some telehealth providers on our comparison and review pages, which list only vetted providers whose affiliate programs have approved us or are reviewing our application. This article contains no paid links. How we rank providers and get paid: telehealth disclosure and methodology.