NAD+ Injections: What They Are, How They're Studied, and Side Effects

NAD+ injections get a lot of attention online, but most human research on NAD+ used precursors taken by mouth, not injections. Keep that gap in mind when you read claims about energy or aging.

What is NAD+?

NAD+ stands for nicotinamide adenine dinucleotide. It is a coenzyme found in every living cell. Your cells use it to move electrons during the reactions that turn food into usable energy. It is also consumed by enzyme families called sirtuins and PARPs, which are involved in DNA maintenance and other cell housekeeping.

A 2021 review in Nature Reviews Molecular Cell Biology (Covarrubias et al.) summarizes evidence that NAD+ levels decline in several tissues with age, mostly from animal studies and a smaller number of human studies. The review describes this decline as an active research area, not a settled cause of aging.

How NAD+ is studied

Researchers have looked at three broad ways to raise NAD+ in the body.

Precursors taken by mouth. Most human data comes from NAD+ precursors such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). A 2018 review in Cell Metabolism (Yoshino, Baur, and Imai) covers how these molecules are converted to NAD+ and what animal studies have found. In a 2018 randomized, placebo-controlled crossover trial in healthy middle-aged and older adults (Martens et al.), six weeks of NR was well tolerated and raised NAD+ levels in blood. The authors called the effects on blood pressure and arterial stiffness preliminary. Individual results vary.

Direct NAD+ by IV infusion. Far less is known here. A 2019 pilot study (Grant et al.) gave a slow six-hour IV infusion of NAD+ to a small group of adults and tracked blood and urine. NAD+ was cleared from the blood quickly for at least the first two hours, and its breakdown products showed up in urine. The study measured what happens to NAD+ in the body. It did not measure energy, focus, or any health outcome.

Animal and lab research. A separate 2018 review in Cell Metabolism (Rajman, Chwalek, and Sinclair) collects the in vivo evidence for NAD-boosting molecules. Much of it comes from mice. Results in animals do not always carry over to people.

What the research has not shown

There are no large, long-term human trials of NAD+ given as a subcutaneous or intramuscular injection, or as a nasal spray. That means there is no solid human evidence yet on whether these forms improve energy, focus, recovery, or how you age. If you see claims that NAD+ injections "work" for those goals, ask for the study.

NAD+ is being studied for many purposes. That is different from being shown to help with them.

NAD+ options at NUVARA

A NUVARA physician may consider three forms, depending on your intake:

• NAD+ Injection. Compounded medication. Not FDA-approved.
• NAD+ Nasal Spray. Compounded medication. Not FDA-approved.
• NAD+ Topical cream. Compounded medication. Not FDA-approved.

Compounded medications are prepared for an individual patient from a prescription. The FDA does not review them for safety, effectiveness, or quality before they are dispensed. Your physician decides which form, if any, fits your health history. Your physician also sets how it is used.

Common side effects

People who use injectable NAD+ commonly mention:

• Nausea or stomach discomfort
• Flushing or a warm feeling
• Headache
• Lightheadedness
• Muscle cramping or a feeling of chest tightness
• Soreness, redness, or swelling where the injection was given

Nasal sprays may cause nasal irritation or a runny nose. Creams may cause skin redness or itching.

Stop and get medical care right away for signs of an allergic reaction, such as swelling of the face or throat, hives, or trouble breathing. Tell your physician about any side effect that does not go away.

Who NAD+ is not for

NAD+ may not be appropriate if you:

• Are pregnant, trying to become pregnant, or breastfeeding. Safety data is lacking.
• Have active cancer or are in cancer care. Talk with your oncologist first.
• Have had an allergic reaction to NAD+ or any ingredient in the preparation.
• Are under 18.

Tell your physician about every medication and supplement you take, including NR or NMN, so nothing is doubled up.

How ordering works at NUVARA

Start online from home. A U.S.-licensed physician reviews your intake, usually within 24 hours. Your first visit includes a brief live telehealth call to establish care, and refills are usually reviewed online.

If your physician prescribes NAD+, the prescription is prepared by one of our US-based partner pharmacies, a state-licensed 503A compounding pharmacy, and shipped to you. NUVARA is not a pharmacy and does not prepare medications. A prescription is required and approval is not guaranteed. Your card is authorized when you order and charged only if the physician approves. If not, the hold is released.

Ready to see if it fits? Start with the NAD+ Injection page. Compounded medication. Not FDA-approved.

Frequently asked questions

What is the FDA status of NAD+ injection?

NAD+ Injection at NUVARA is a compounded medication. Not FDA-approved. It is prepared by a licensed partner pharmacy from your physician's prescription.

What are NAD+ injection benefits?

NAD+ is being studied for its role in cell energy and DNA maintenance. Large human trials of NAD+ injections have not been done, so specific benefits have not been established. Individual results vary.

What are the side effects of NAD+ injections?

Commonly mentioned side effects include nausea, flushing, headache, lightheadedness, cramping or chest tightness, and soreness at the injection spot. Get medical care right away for any sign of an allergic reaction.

How is NAD+ different from NR or NMN?

NR and NMN are precursors your body converts into NAD+. Most human research has used these precursors taken by mouth, not injected NAD+.

How do the NAD+ injection and nasal spray differ?

They are different ways of delivering NAD+. No human trials have compared them directly. Your physician considers your history and preferences when deciding whether either form fits.

Do I need a prescription?

Yes. Every NAD+ product at NUVARA requires a prescription from a U.S.-licensed physician after an intake review. Consult with your MyNuvara Health physician about your own situation.

References

1. Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021;22:119-141. PubMed 33353981 · doi:10.1038/s41580-020-00313-x
2. Yoshino J, Baur JA, Imai SI. NAD+ intermediates: the biology and therapeutic potential of NMN and NR. Cell Metab. 2018;27(3):513-528. PubMed 29249689 · doi:10.1016/j.cmet.2017.11.002
3. 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. PubMed 29599478 · doi:10.1038/s41467-018-03421-7
4. Grant R, et al. A pilot study investigating changes in the human plasma and urine NAD+ metabolome during a 6 hour intravenous infusion of NAD+. Front Aging Neurosci. 2019;11:257. PubMed 31572171 · doi:10.3389/fnagi.2019.00257
5. Rajman L, Chwalek K, Sinclair DA. Therapeutic potential of NAD-boosting molecules: the in vivo evidence. Cell Metab. 2018;27(3):529-547. PubMed 29514064 · doi:10.1016/j.cmet.2018.02.011

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Medical disclaimer: This article is for general education only and is not medical advice. It does not replace an evaluation by a licensed clinician. Talk with your MyNuvara Health physician before starting, stopping, or changing any medication or supplement. If you think you are having a medical emergency, call 911.