NAD+

Definition

Nicotinamide adenine dinucleotide is a coenzyme central to cellular energy metabolism and a substrate for enzymes implicated in aging biology; it is not a peptide, and it appears in this index because it is prescribed and marketed alongside peptide therapy by the same providers.

Levels decline with age in many tissues, which is the observation the injectable market is built on; whether raising circulating NAD+ changes any clinical outcome is a separate question.

Evidence

The interventional evidence comes almost entirely from oral precursors rather than NAD+ itself: a 2026 systematic review of nicotinamide mononucleotide trials reports consistent safety and modest metabolic effects ^[1], and reviews of NAD+ biology note that direct intravenous or injectable NAD+ has little published human trial data behind it ^[2].

The gap matters when reading marketing: trial results for oral precursors are routinely cited in support of injections and infusions that those trials did not study.

Counted separately in August 2026, the three literatures are of very different sizes. Nicotinamide riboside returns 952 indexed papers and 42 clinical trials, of which 32 carry the randomized-controlled-trial type; nicotinamide mononucleotide returns 1,713 papers and 22 clinical trials, of which 16 are randomized; the phrase set that names an infused or intravenous NAD+ preparation returns 22 papers in total, of which 4 carry the clinical-trial type and 1 the randomized type ^[5].

Those four were read individually rather than counted, and three of them concern something else — a chemotherapy sequence in esophageal cancer, a topical preparation for psoriasis, and a 1972 review of nicotinic acid in schizophrenia ^[5]. The fourth is a genuine randomized placebo-controlled trial, and its subject is neither aging nor wellness: 180 adults with heart failure from ischemic cardiomyopathy and an ejection fraction at or below 45 percent received intravenous NAD+ at 10 mg daily or placebo for seven days alongside guideline-directed therapy, with the change in ejection fraction at one month as the primary endpoint ^[4].

The one published human study of the infusion itself is a pilot pharmacokinetic investigation rather than an outcome trial, and its result is worth stating plainly: during a six-hour intravenous infusion of NAD+ at 3 micromoles per minute, plasma NAD+ and its measured metabolites did not change until after the second hour, which the authors read as complete removal of the infused compound from plasma over that period ^[3].

Side effects

No randomized trial has published a safety profile for the NAD+ injections and infusions sold for energy, recovery or longevity. The only randomized trial of intravenous NAD+ studied 180 adults with heart failure over seven days and reported heart function and cardiovascular events as its outcomes ^[4], and the one pharmacokinetic study of an NAD+ infusion measured blood and urine levels in a small cohort ^[3].

The tolerability data that exist come from oral precursors. A 2026 review of 15 randomized trials of oral nicotinamide mononucleotide, lasting 14 days to 24 weeks, found no increase in adverse events, serious adverse events or liver enzymes ^[1]. That result describes a supplement taken by mouth; it does not transfer to NAD+ given by injection or infusion, which is a different compound delivered by a different route.

Educational summary of the cited sources, not medical advice; a prescriber weighs these risks against a person’s own history.

Lawful access

NAD+ is listed in Category 1 of the FDA's interim 503A bulks list; licensed pharmacies may compound it with a valid prescription while the agency's review continues.

Category 1 is a permission to compound during review, not an approval, and the index records it as such.

Related molecules

NAD+ sits in the mitochondrial group beside MOTS-c, whose regulatory position is far more restrictive; glutathione shares its Category 1 posture, and the compoundable page lists both. A third substance joined that category in 2026: vasoactive intestinal peptide, which is lawful to compound and has no approved product behind it at all.

Elsewhere in this index