NAD+ and precursors

What NAD+ and precursors does

NAD+ is a coenzyme, not a peptide. Oral NR and NMN often raise blood NAD markers, but that does not prove longer life or better health. A large NR trial in Parkinson disease found no benefit and worse clinical scores than placebo. NAD+ infusions have much thinner evidence and can cause marked discomfort. Compounded injections also carry contamination risks.

• In studies, oral NR and NMN raise NAD levels in the blood, but no trial has shown that this means longer life. (Studied in a trial)
• In one trial in people with poor leg circulation, NR modestly improved how far they could walk in six minutes. (Studied in a trial)
• In a small study, NAD+ shots added to usual care were linked to more hearing recovery. (Studied in a trial)
• People report using NAD+ drips for energy and tiredness, though a real benefit has not been shown in studies. (Reported by users)

Uses in the sources

• NR and NMN raise NAD-related blood markers. No human trial has shown longer lifespan or reliable reversal of aging. (Studied in a trial) (source)
• NAD+ IV use for energy and fatigue is reported online. Controlled wellness benefit has not been established. (Reported by users) (source)
• NR modestly improved six-minute walking distance in one peripheral-artery-disease trial; confirmation is needed. (Studied in a trial) (source)
• NR, NMN and NAD+ have separate disease trials. The 410-person NR Parkinson trial favored placebo on clinical scores. (Studied in a trial) (source)
• Several NR trials raised NAD without improving cognition. Blood-marker changes are not proof of brain benefit. (Studied in a trial) (source)
• NR or NMN did not consistently improve muscle recovery or function. One NMN exercise study found less mitochondrial replenishment. (Studied in a trial) (source)

NAD+ and precursors dosage

Typical reported dose: 25 mg three times a week, building up to 100 mg

• NR: 500 mg: NR 500 mg twice daily. twice daily, by mouth. Studied in a trial. Studied in: Adults with early Parkinson disease. (source)
• NAD+: 750 mg: NAD+ 750 mg once over 6 hours. 750 mg total in saline over 6 hours. once over 6 hours, into a vein. Studied in a trial. Studied in: Healthy men aged 30–55. (source)
• NAD+: 750 mg: NAD+ 750 mg once over 6 hours. once over 6 hours, into a vein. Clinician-published. Studied in: Healthy men aged 30–55. (source)
• NAD+: 10 mg: NAD+ 10 mg IV daily for 7 days, in 100 mL glucose or saline. once daily, into a vein. Studied in a trial. Studied in: Adults with ischemic heart failure; LVEF ≤45%; usual therapy continued. (source)
• NAD+: 5 mg: NAD+ 5 mg once daily during hospitalization. once daily during hospitalization, into muscle. Studied in a trial. Studied in: Adults with sudden sensorineural hearing loss; several standard treatments continued. (source)
• Observed NAD+ IV 500 mg course: NAD+ 500 mg once daily. once daily, into a vein. Clinician-published. Studied in: 14 adults attending a commercial wellness service. (source)

Highest studied: One 14-person crossover trial tested a single 250 mg sublingual NMN tablet..

These are doses reported in labels, trials or user reports, not a personal plan. Check the source behind each one.

Work out syringe units with the dosing calculator

How to mix NAD+ and precursors

Comes as: Compounded NAD+ injection solution, Lyophilized NAD+ vials reported online, Oral NR capsules and NMN powder/tablets, Sublingual NMN tablets, NAD+ iontophoresis patches in a study.

Mixed with: Forum reports use bacteriostatic water. Clinical studies used controlled preparations; the correct diluent is product-specific..

Common vial sizes: 100, 500, 1000 mg. Common water amounts: 1, 3, 5 mL.

• These vial sizes and water volumes are community reports, not an approved label.
• A forum example used 100 mg with 1 mL, 500 mg with 3 mL, or 1000 mg with 5 mL.
• Syringe units are volume, not milligrams. Never transfer a unit count between different concentrations.
• No validated universal expiry after mixing was found; do not infer 28-day chemical stability from the diluent.

Before mixing: No universal validated storage rule was found. Use the exact product instructions; oral and injectable products differ.

After mixing: No universal post-mixing stability or beyond-use time was verified. Refrigeration does not make a contaminated vial safe.

NAD+ and precursors side effects and risks

Reported side effects

• Stomach upset with oral NR: In an 8 week trial: 20.0%, 14.3%, 11.4% at 100, 300, 1000 mg/day vs 14.3% placebo., mild. Review persistent symptoms and other supplements; rates vary widely across populations. (source)
• Diarrhea with NR or an NR combination: PAD trial: NR 39.3%; NR plus resveratrol 54.6%; placebo 27.6%., moderate. Assess ongoing diarrhea and hydration. The combination may be less tolerable. (source)
• NAD+ infusion cramps, nausea and chest pressure: All 6 NAD+ clients in a small retrospective series reported symptoms; this is not a general incidence estimate., moderate. Pause the infusion and alert clinical staff. Chest pain, breathlessness or fainting needs urgent assessment. (source)
• Severe chills, shaking, vomiting or fatigue after injections: unknown, serious. Get urgent assessment; FDA reports were consistent with excessive endotoxin contamination. (source)
• Injection pain and local irritation: NR shot preprint: pain >2 minutes 45.9%; soreness/tightness 43.2%. NAD+ route specific rates were not published there., moderate. Persistent redness, warmth, swelling or fever needs assessment. (source)
• Headache or nausea with high-dose NR: NR 3000 mg/day: 3 headache events and 2 nausea events vs 0 and 0 placebo, in 10 people per arm., mild. These are small-study event counts, not a reliable population frequency. (source)
• Poor sleep, jitteriness or anxiety: unknown, moderate. Reported online with NR/NMN or NAD+ shots; causal links and rates are unproven. (source)
• Iontophoresis patch skin irritation: 25% in the uncontrolled NAD+ plus naltrexone study., mild. Stop applying to irritated skin and have the reaction assessed. (source)

Stop and get help if

• Severe chills, shaking, repeated vomiting or sudden illness after an injection: Stop administration and get urgent medical assessment; contamination or endotoxin is possible.
• Chest pain, breathlessness, fainting or a sustained racing heart during an infusion: Stop the infusion and seek urgent assessment; do not assume it is a normal NAD+ sensation.
• Spreading redness, marked warmth, swelling or fever after an injection: Get prompt medical assessment for infection or a serious reaction.
• Face or tongue swelling, wheezing or trouble breathing after administration: Stop administration and seek emergency care for a possible severe reaction.
• Sudden severe vomiting, diarrhea, agitation or confusion after starting naltrexone in the NAD+ combination: Seek urgent medical care for possible opioid withdrawal triggered by naltrexone.

Who should avoid it

• pregnant: This is an editorial screen, not an FDA NAD+ label.
• breastfeeding: This is an editorial screen, not an FDA NAD+ label.
• tryingToConceive: This is an editorial screen, not an FDA NAD+ label.
• under18: Some rare-disease studies enrolled children; they do not establish routine wellness use under 18.
• activeCancer: Animal NR data show a tumor-growth/spread signal. Human risk is unknown; review any NAD booster with the oncology team.
• cancerHistory: Cancer recurrence risk has not been tested adequately; animal findings cannot quantify human risk.
• kidneyDisease: Small kidney-disease trials do not establish safe self-dosing, particularly during acute illness.
• liverDisease: Liver safety needs individual review. A negative liver-fat trial of an NR combination is not proof of liver treatment.
• heartCondition: NAD+ infusions can cause chest pressure and faster heart rate. Heart-failure trials used monitored care.
• diabetes: NMN may change insulin responses. Review glucose monitoring and medicines; a hypoglycemia interaction is not established.
• testedAthlete: IV fluid volume can breach WADA M2.2 even when the infused substance is not prohibited.
• other: The large NR Parkinson trial found worse clinical scores than placebo; discuss supplementation with the treating neurologist.
• other: Do not repeat exposure after a serious reaction until the ingredient, excipients and possible contamination are assessed.
• other: For the naltrexone combination only: opioid analgesics, current opioid dependence or acute withdrawal contraindicate naltrexone. It can trigger severe withdrawal.

Interactions

• Other NAD+ boosters or high-dose vitamin B3: Duplicate exposure has no proven extra benefit. NR, NMN, NAD+ and niacin are not interchangeable milligram for milligram.
• Insulin and sulfonylureas: A direct interaction is unproven. Because NMN changed insulin sensitivity in one trial, discuss extra glucose checks when medicines lower blood sugar.
• Levodopa and Parkinson medicines: NR-SAFE had changes in movement symptoms and levodopa use. NOPARK found worse scores; a direct drug interaction remains unproven.
• Cancer treatment and NAD-pathway drugs: NAD supports DNA-repair pathways used in cancer biology. Clinical interaction effects are unknown; review with the oncology team.
• Opioids, only when naltrexone is included: NAD+–naltrexone combination only: opioid use or dependence contraindicates naltrexone and can cause severe withdrawal. Assess recent use before starting.

Product quality risks

• FDA reports of severe reactions to NAD+ injections were consistent with endotoxin contamination.
• A study tested 18 NMN products. NMN deviations from adjusted label claims ranged from −100% to +11.2%.
• An oral purity result cannot establish injectable sterility, endotoxin safety or correct dose.
• A 2026 FDA warning identified NAD+ bulk compounding outside 503B eligibility and major sterile-manufacturing failures.

What to expect

A small NAD+ study used one six-hour IV infusion and measured blood and urine changes, rather than health benefits.

Evidence is separated by administered compound. NOPARK tested oral nicotinamide riboside, not injected NAD+. NAD+, NR and NMN have distinct route-specific evidence.

Key studies

• NOPARK: NR in early Parkinson disease: NR did not improve Parkinson outcomes; the main outcome favored placebo. (source)
• NAD+ infusion: six-hour pilot: A slow infusion changed blood and urine metabolites; it did not test health benefits. (source)
• NAD+ in ischemic heart failure: A small improvement in pumping function needs replication. (source)
• NAD+ added to hearing-loss care: One small add-on study reported more hearing recovery. (source)
• NAD+ versus NR infusions: NAD+ caused substantially more infusion discomfort than NR. (source)
• Single IV dose: 2024 preprint: Preliminary data suggest different infusion tolerability for NAD+ and NR. (source)

NAD+ and precursors FAQ

• Is NAD+ and precursors FDA-approved? No FDA-approved systemic NAD+, NR or NMN medicine found. Oral NR is a supplement; FDA reversed NMN drug-exclusion in September 2025. Injectable rules are separate.
• How do people take it? Under the skin, three times weekly. Source: reported by users, not an established dose.
• What's the difference between NAD+ and precursors and SS-31 (elamipretide)? NAD+ and precursors: nAD+ helps cells use energy; wellness injection benefits remain unproven. SS-31 (elamipretide): a peptide approved for Barth syndrome muscle strength; benefit needs confirmation and broader energy benefits remain unproven. Why people pair them: a forum plan pairs it with NAD+ for mitochondrial energy; this combination has no established clinical benefit.
• Can I take it with SS-31 / elamipretide? A forum plan pairs it with NAD+ for mitochondrial energy; this combination has no established clinical benefit. The cited post proposed a plan; use and benefit were not independently verified. Source: reported by users. Ask a doctor before combining anything.
• Is it banned in sport? It is unclear (WADA 2026). NAD+, NR and NMN are not named. IV >100 mL per 12 hours is prohibited except specified medical settings; exact product/S0 status needs checking. M2.2 separately addresses total IV infusions or injections over 100 mL per 12 hours, except legitimate hospital treatment, surgical procedures or clinical diagnostic investigations.
• How long does a mixed vial last? No universal post-mixing stability or beyond-use time was verified. Refrigeration does not make a contaminated vial safe.