Reader’s guide · First edition · September 2026 · Revised September 23, 2026
NAD+
A guide to the drip and the shot: a molecule every cell makes, sold by the milligram at med spas, with real chemistry, small trials, and no outcome anyone has measured
NAD+ is not a peptide. It is a coenzyme, nicotinamide adenine dinucleotide, that every cell uses hundreds of times a second to move energy and to run the repair enzymes that longevity research is built around. Blood and tissue levels fall with age, which is the observation behind an industry: intravenous drips of 250 to 1,000 mg over a few hours, subcutaneous shots of 50 to 100 mg a week, and vials of powder for home use. This guide covers what the molecule does, what the small human studies have and have not shown, how the drip and the shot are dosed, why a fast infusion makes people feel terrible, and where the FDA stands on a compounded injection with no approved product behind it.
Who this is for
Written for adults who are using, or being offered, NAD+ by infusion, injection, or vial for energy, recovery, or aging, and for the clinics that sell it. It summarizes the published record and the regulatory position as of the edition date. It is not medical advice.
Every living cell carries a pool of NAD+ and its charged partner NADH, passing electrons between them to turn food into usable energy. The same molecule is consumed by three families of enzymes that longevity science cares about: the sirtuins, which regulate stress responses and metabolism; PARPs, which repair damaged DNA; and CD38, which rises with inflammation and burns NAD+ as it goes. As people age, CD38 climbs and NAD+ falls, in some tissues by half. Raising it back is the whole idea.
- Class
- A coenzyme built from vitamin B3; not a peptide, not a hormone, not a drug approved for anything
- Ways to raise it
- Oral precursors (nicotinamide riboside, NR, and nicotinamide mononucleotide, NMN), sold as supplements and studied in dozens of small trials; NAD+ itself by intravenous drip, intramuscular or subcutaneous injection, nasal spray, or patch
- Forms in use
- Compounded injection from 503A pharmacies at 100 to 200 mg/mL; med-spa IV bags of 250 to 1,000 mg; research-chemical vials of 100, 500, and 1,000 mg
- Price as sold
- IV drips $250 to $600 for 500 mg in most clinics and up to $1,500 in major cities; subcutaneous injections about $199 to $350 a month by telehealth; research vials $50 to $100 for 500 mg
- Status
- No approved injectable product. Nominated for the 503A compounding list in 2016 and still under FDA evaluation; not on the 503B list, so outsourcing facilities may not make it, as a January 2026 warning letter states
- Anti-doping
- Not prohibited
The one title in this series where the pill has the better evidence
Most of what is known about raising NAD+ in people comes from oral precursor trials, not from infusions. NR at 1 g a day roughly doubles blood NAD+ in a week and has a safety record across many small trials. The drip does the same thing faster, at fifty times the price, with side effects the pill does not have, and with less data.
The animal literature is large and encouraging: NAD+ precursors extend healthspan in mice and improve muscle, liver, and brain measures in old animals. The human literature is small, mostly with oral precursors, and mostly measures blood levels and lab markers rather than how people feel or function. For the drip and the shot, the human evidence is a few tolerability studies.
| Route | What has been done | What it showed | Grade |
|---|---|---|---|
| Oral NR | Dozens of small placebo-controlled trials, 2016 onward, up to 12 weeks | Blood NAD+ rises reliably; small changes in blood pressure and some inflammatory markers in some trials; no consistent effect on strength, endurance, or cognition | B for raising the level; C for anything downstream |
| Oral NMN | Several small trials, mostly in Japan and China | Blood NAD+ rises; a modest gain in walking distance in one 60-day trial of older adults | C |
| IV NAD+ | One placebo-controlled pilot (2024) comparing NAD+ and NR infusions; one 2026 retrospective tolerability review of clinic infusions | Blood NAD+ and its metabolites rise; the NAD+ infusion caused flushing, nausea, and chest tightness that the NR infusion did not; no functional outcome measured | C for tolerability; nothing for benefit |
| Subcutaneous or IM NAD+ | Trials of a subcutaneous NR product registered 2025; no published controlled trial of NAD+ shots | Nothing yet | D |
No trial of any route has measured what the clinics sell: energy, recovery, mental clarity, addiction, or aging. The claims are extrapolated from the mouse work and from the fact that the level goes up.
Randomized trials of NAD+ infusion or injection with a functional or clinical outcome
Rise in blood NAD+ from 1 g of oral NR daily, the best-documented way to raise it
Placebo-controlled study of the drip, a pilot, in healthy adults; it measured tolerability and blood levels
What would count as evidence
A randomized trial of NAD+ by injection against placebo in the people it is sold to, measuring something a buyer would notice, such as fatigue scores, exercise capacity, or cognitive testing, over months. None exists. The nearest are oral precursor trials, which have mostly measured the level and mostly found little beyond it.
| Form | Instruction | What is known |
|---|---|---|
| IV drip, wellness | 250 to 500 mg in saline over 2 to 4 hours, every few weeks, or a series of 3 to 6 | Raises blood NAD+; the slow rate is to limit flushing and chest tightness; no outcome data |
| IV drip, addiction protocols | 500 to 1,000 mg daily for 4 to 10 days | Sold for withdrawal and cravings on case series and clinic testimonials; no controlled trial |
| Subcutaneous injection | 20 to 50 mg to start, rising to 100 mg, once or twice a week; some clinics daily | Fewer whole-body effects than the drip because absorption is slow; no published trial |
| Intramuscular injection | 50 to 100 mg, weekly | As above |
| Nasal spray, patches | Various | Absorption unmeasured; the molecule is large and charged |
What the next table is, and is not
It expresses the common clinic injection protocol for a 500 mg vial, so the arithmetic can be checked against a pharmacy label. NAD+ has no label. A pharmacy vial states its concentration and governs; a research-chemical vial's identity, strength, and sterility are unverified.
- Vial
- 500 mg lyophilized NAD+, as sold; pharmacies more often dispense a ready solution at 100 or 200 mg/mL
- Water added
- 2.5 mL bacteriostatic water, which a 3 mL vial holds
- Concentration
- 200 mg/mL. One concentration for the whole vial; check it against the pharmacy label if there is one.
- Syringe
- 0.5 mL or 1 mL insulin syringe; the doses are in milligrams and the draws are large
| Weeks | Dose | Draw | Units | Used per 4 weeks |
|---|---|---|---|---|
| 1–2 | 25 mg, twice a week | 0.125 mL | 12.5 | 100 mg |
| 3–4 | 50 mg, twice a week | 0.25 mL | 25 | 200 mg |
| 5 on | 100 mg, once or twice a week | 0.5 mL | 50 | 400 to 800 mg (1 to 2 vials) |
Doses are in milligrams, hundreds of times the microgram doses of most peptides in this series. Injection stings; clinics advise slow injection and rotating sites. Nausea, flushing, and cramping become common above about 250 mg by injection.
What each draw looks like · 0.5 mL (50-unit) U-100 insulin syringe
The plunger tip sits on the line for the dose. Units are marks on a U-100 syringe: 100 units is 1 mL. The picture assumes the concentration in the table above; a different amount of water changes every line.
- The drip's side effects are rate effects. NAD+ pushed in quickly dilates blood vessels: flushing, a pounding heart, chest tightness, and nausea that ease when the drip is slowed. A four-hour bag is four hours because of this.
- Oral NR does the same job on the blood level for about a dollar a day and without the chair. The precursor trials are the reason anyone thinks raising NAD+ matters; the drip has borrowed them.
- There is no cycling logic: the level returns to baseline within days of stopping any route.
NAD+ occupies an unusual position: it is neither an approved drug nor a banned one, and its injectable form exists only through compounding. Pharmacies have compounded it for years under FDA's interim policy, while the agency evaluates a nomination filed in 2016. That evaluation is still open. Outsourcing facilities, the larger 503B compounders, are in a different place: NAD+ is not on their list, and FDA said so in a warning letter this year.
| Route | Legal position | What the buyer gets |
|---|---|---|
| Oral precursors (NR, NMN) | Dietary supplements. FDA has disputed NMN's supplement status since 2022 because it was studied as a drug first; NR is unaffected | Studied products with a safety record; no drug claims allowed |
| Compounded injection from a 503A pharmacy | Permitted under FDA's interim policy while the 2016 nomination is evaluated; a prescription is required | A pharmacy vial with a stated concentration and beyond-use date |
| Compounded in bulk by a 503B facility | Not permitted: NAD+ is not on the 503B list. FDA's January 2026 warning letter to a compounder says so directly | Office-stock vials that should not exist |
| Research-chemical vial | An unapproved new drug | Unverified identity, strength, and sterility; NAD+ is unstable in solution and the powder's purity is rarely certified |
| IV drip at a med spa | A prescription drug administered by a clinician; lawful when a licensed prescriber orders it from a 503A pharmacy | The most expensive route to a blood level a pill reaches |
Legal, and unfinished
NAD+ is the rare injectable in this series that a pharmacy may lawfully make on a prescription today. That is a statement about FDA's interim policy, not about evidence: the agency has neither approved the substance nor finished deciding whether compounding it is appropriate, ten years after it was asked.
Reading a vial: milligrams and concentration9
The arithmetic is easy and the pitfall is the pharmacy's concentration. Compounded NAD+ comes at 100 mg/mL from some pharmacies and 200 mg/mL from others, so a 100 mg dose is a full milliliter from one vial and half from the next. The IV bag has its own arithmetic: milligrams in the bag and hours on the pump.
units = (dose mg ÷ concentration mg/mL) × 100
A 500 mg vial with 2.5 mL of water is 200 mg/mL. A 50 mg dose is 0.25 mL, or 25 units on a U-100 insulin syringe; 100 mg is 0.5 mL, or 50 units. At a pharmacy's 100 mg/mL, the same 100 mg is 1 mL, a full 100 units.
| Concentration | 25 mg | 50 mg | 100 mg |
|---|---|---|---|
| 200 mg/mL (500 mg + 2.5 mL) | 12.5 units | 25 units | 50 units |
| 100 mg/mL (pharmacy solution) | 25 units | 50 units | 100 units |
| Drip: 500 mg in 250 mL over 3 hours | About 2.8 mL a minute on the pump |
NAD+ in solution degrades with warmth and light; pharmacies ship it cold and date it in weeks. A research powder reconstituted at home has no tested shelf life at all.
- During a drip
- Flushing, warmth, a pounding or racing heart, chest tightness, nausea, abdominal cramping, and light-headedness from a fall in blood pressure. Rate-dependent; the standard remedy is to slow the pump. The 2026 clinic review found these in a substantial share of infusions and rarely serious.
- Injections
- Stinging or burning at the site, brief nausea, headache, fatigue; fewer whole-body effects than the drip. Cramping and flushing appear above about 250 mg.
- Who should be careful
- Anyone with heart rhythm problems, low blood pressure, or on blood-pressure drugs, because of the vasodilation; the studies excluded them.
- Theoretical
- NAD+ feeds every cell, including tumor cells, and the enzymes it supports include those cancers use for repair. No study has examined NAD+ therapy in people with cancer or a cancer history, and the precursor trials exclude them.
- Product
- NAD+ is unstable in solution. A compounded vial is dated; a research vial is not, and a degraded solution delivers nicotinamide and adenine breakdown products rather than NAD+.
- Unknown
- Long-term use by any injected route, pregnancy, and interactions. The precursor literature runs to twelve weeks; the injection literature to a few visits.
- What am I trying to change, and how will we know if it changed? (A blood NAD+ level is not a symptom.)
- Has anyone suggested oral NR first, and if not, why not?
- Is this compounded by a 503A pharmacy on a prescription, drawn from a 503B office stock, or a research vial? Only the first is on solid ground.
- What is the concentration on this vial, and what is my dose in units?
- For a drip: how many milligrams, over how long, and what happens if I get chest tightness?
- Do I have a heart rhythm problem, low blood pressure, a cancer history, or am I pregnant?
- What does a month of this cost, against a month of the pill?
What does have evidence for energy and aging
Sleep, aerobic and resistance exercise, and not smoking, each with outcome data that no NAD+ product has. Among NAD+ approaches, oral NR for raising the level, with the caveat that raising the level has not yet been shown to do anything a person would notice. The drip is the same molecule with more cost, more side effects, and less data.
Latest
Developments since this edition, newest first. Items here are dated and sourced; they update the guide without re-editing it.
Bronx NAD+ infusion death ruled a homicide; manslaughter charge filed
New York City's medical examiner ruled the July 19 death of a 27-year-old woman after an NAD+ drip at an unlicensed Bronx wellness center a homicide, attributed in press reports to air in the IV line rather than to NAD+ itself. The unlicensed practitioner who placed the line now faces second-degree manslaughter.
Clinic pricing guide puts an NAD+ drip at $250 to $1,500
A telehealth pricing survey lists IV NAD+ at $250 to $600 in standard wellness clinics and up to $1,500 in major metros, with home subcutaneous injections from about $199 a month. The guide's price line has been updated to match.
Bronx death raised at FDA compounding committee as a warning
The Partnership for Safe Medicines cited the death in testimony against expanding the 503A compounding list at the July 23 and 24 advisory meeting, noting FDA has never evaluated NAD+ for efficacy, safety, or quality.
Woman dies after NAD+ injection at unlicensed Bronx center
A 27-year-old woman died about an hour after an NAD+ infusion at a Bronx lifestyle business; the man who injected her told police he was not licensed in New York. New York's med-spa inspections had by then visited 337 sites and shut 24.
References
- 1.Covarrubias AJ, et al. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021;22(2):119-141.
- 2.Trammell SAJ, et al. Nicotinamide riboside is uniquely and orally bioavailable in mice and humans. Nat Commun. 2016;7:12948; and Martens CR, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9:1286.
- 3.Yi L, et al. The efficacy and safety of beta-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicentre, double-blind, placebo-controlled trial. GeroScience. 2023;45(1):29-43.
- 4.Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting. Front Aging. 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC12907335/
- 5.Randomized, placebo-controlled, pilot clinical study evaluating acute Niagen+ IV and NAD+ IV in healthy adults. medRxiv preprint, 2024. https://www.medrxiv.org/content/10.1101/2024.06.06.24308565.full.pdf
- 6.NPR. Marketers say NAD+ pills and infusions can boost longevity. What's the evidence? May 11, 2026. https://www.npr.org/2026/05/11/nx-s1-5813664/nad-infusions-supplements-longevity-science
- 7.U.S. Food and Drug Administration. Warning letter to GenoGenix LLC, January 20, 2026 (NAD+ not on the 503B bulks list). https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/genogenix-llc-718739-01202026
- 8.U.S. Food and Drug Administration. Bulk drug substances nominated for use in compounding under section 503A (nicotinamide adenine dinucleotide, nominated 2016; interim policy). https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding-under-section-503a-fdc-act
- 9.Representative compounded NAD+ injection listings (100 and 200 mg/mL), med-spa infusion menus, and research-chemical vial listings, as sold September 2026.