A coenzyme every cell uses for energy and DNA repair, not a peptide. Given as IV drips and injections with very little human outcome data.
Also called Nicotinamide adenine dinucleotide, NAD, beta-NAD, Coenzyme I, NAD+ IV, NAD+ injection
NAD+ is not a peptide. It is a coenzyme built from vitamin B3 and adenosine that every cell uses to turn food into ATP, and that enzymes called sirtuins and PARPs burn through to repair DNA and regulate genes. Levels fall with age in mice and in some human tissues, which is why it is sold as an anti-aging and energy treatment. It appears here because clinics usually offer it on the same menu as peptides.
There are two separate questions, and the evidence for each is very different. The first is whether taking precursors by mouth, nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), raises NAD+ and does anything useful. The answer to the first half is yes: dozens of randomized trials show blood NAD+ goes up. The second half is mostly disappointing. A 2025 meta-analysis found no effect on muscle mass, grip strength or walking speed in older adults, NR did not improve insulin sensitivity in obese men, and in October 2026 a 410-patient Parkinson trial found NR did slightly worse than placebo. One small trial in 25 prediabetic women found NMN raised muscle insulin sensitivity by 25%.
The second question is about NAD+ itself given by IV drip or injection, which is what most clinics sell. That has almost no data. The only published pharmacokinetic study gave 750 mg over 6 hours to 8 men: plasma NAD+ did not rise at all for the first 2 hours because the body broke it down as fast as it went in. A 2026 review found no outcome trials of IV or injected NAD+ for aging or wellness. A retrospective clinic review found NAD+ drips caused stomach upset, faster heart rate and chest pressure, forcing slower infusions that averaged 97 minutes.
Not technically a peptide. NAD+ is listed here because it is discussed and used alongside peptides, but it is not built from amino acids joined by peptide bonds.
What it binds to, and what happens inside the body after that, step by step.
NAD+ accepts electrons in glycolysis and the Krebs cycle, becoming NADH, which feeds the mitochondrial electron transport chain to make ATP. It is also consumed as a substrate by sirtuins (gene regulation, metabolism), PARPs (DNA repair) and CD38 (immune signaling). Cells mainly rebuild it from nicotinamide through the salvage pathway; NAD+ in the blood is largely broken down outside cells before it can enter them.
Human results and animal results are kept apart below. A result in rats tells you a mechanism is plausible. It does not tell you what happens in a person.
For oral precursors (NR, NMN) there are many small RCTs: they reliably raise blood NAD+ and are well tolerated, but effects on muscle, metabolism and disease are mostly null, with one negative 410-patient Parkinson trial. For IV or injected NAD+, the form clinics sell, there is one 8-person pharmacokinetic pilot and one retrospective clinic review, and no controlled outcome trial.
410 patients with early Parkinson disease, 11 centers in Norway, 52 weeks
NR 500 mg twice daily worsened the MDS-UPDRS score by 2.72 points more than placebo (P = .02) and worsened non-motor symptoms; it did not slow the disease.
Read the studyRCTs in adults with mean age 60.9 to 83 years
NMN had no effect on muscle mass index, grip strength, gait speed or chair-stand time; the authors conclude the evidence does not support NR or NMN for preserving muscle.
Read the study25 postmenopausal women with prediabetes and overweight, 10 weeks
NMN 250 mg/day raised insulin-stimulated glucose disposal in muscle by 25% with no change on placebo; body composition did not change, and muscle NAD+ content did not rise.
Read the study40 sedentary men with BMI over 30, aged 40 to 70, 12 weeks
NR 1000 mg twice daily was safe but did not improve insulin sensitivity, glucose metabolism, energy expenditure or body composition.
Read the study80 healthy middle-aged adults, 300, 600 or 900 mg/day NMN or placebo for 60 days
Blood NAD+ rose in all NMN groups, highest at 600 and 900 mg; six-minute walk distance improved versus placebo and HOMA-IR did not change. The trial was fully funded by the NMN manufacturers, and three authors were their employees.
Read the study11 healthy men, 8 given 750 mg NAD+ IV over 6 hours, 3 given saline
Plasma NAD+ and its metabolites did not change for the first 2 hours because infused NAD+ was cleared as fast as it was given; NAD+ and methylnicotinamide appeared in urine by 6 hours. No adverse events.
Read the studyClinic clients given 500 mg IV NAD+ or IV NR daily for 4 days
NAD+ drips caused moderate to severe stomach symptoms, faster heart rate and chest pressure, and took 97 minutes on average versus 37 for NR; liver and kidney markers did not change. Authors employed by the clinic chain.
Read the studyNo preclinical studies are listed as key studies here. The human data above carries the evidence.
These are questions the published research has not answered.
No product containing NAD+ is approved as a medicine by the FDA.
No FDA-approved NAD+ drug exists for any indication. Oral NAD+, NR and NMN are sold as dietary supplements; FDA said in 2022 that NMN could not be sold as a supplement because it was being studied as a drug, then reversed that position on September 29, 2025. NAD+ itself is not on the WADA Prohibited List, but any IV infusion or injection over 100 mL in a 12-hour period is a prohibited method (M2) without a therapeutic use exemption, which covers many NAD+ drips.
No human half-life has been published for NAD+, so we do not draw a clearance curve. Half-lives quoted online for it are usually estimates from animal data.
This table records the doses that trials and approved labels used, with the source for each row. It is a record of research, not a recommendation, and it is open to free members.
Which symptoms are expected and which mean stop and get help: side effects and red flags.
Tap a claim to see what the studies found.
In the only human pharmacokinetic study, plasma NAD+ did not rise for 2 hours because it was broken down in the blood; cells mostly rebuild NAD+ from the breakdown products.
Raising NAD+ improves aging markers in mice. In humans, trials show higher blood NAD+ but no consistent effect on muscle, metabolism or function, and no IV NAD+ outcome trials exist.
Repeated RCTs show blood NAD+ rises within weeks of daily NR or NMN.
This is a common clinic claim, but no randomized controlled trial of IV NAD+ for addiction has been published.
The 410-patient NOPARK trial found NR slightly worse than placebo over 52 weeks.
These pairings come up often. Almost none have been tested together in a trial, and the evidence note on each says so plainly.
Blocking NNMT keeps nicotinamide in the NAD+ recycling loop, so the two are promoted as complementary.
EvidenceNo study of the combination exists; 5-Amino-1MQ has no human data at all.
Clinic 'mitochondrial' protocols pair a coenzyme for energy metabolism with an AMPK-activating mitochondrial peptide.
EvidenceNever studied together; MOTS-c has no published human efficacy data.
Both are marketed for mitochondrial function: SS-31 binds the inner mitochondrial membrane, NAD+ supplies the electron carrier.
EvidenceNo combination study. SS-31 (elamipretide) has its own human trials; NAD+ infusions do not.
NAD+ powder is sensitive to moisture and light; manufacturers list refrigerated or frozen storage in a sealed container.
NAD+ in solution is unstable, especially at room temperature and in alkaline solutions; compounded vials are usually refrigerated with short beyond-use dates set by the pharmacy.
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