Compound
NAD+ (Nicotinamide Adenine Dinucleotide)
Updated February 2026
NAD+ Injection Dosing Protocol
Complete NAD+ injection research protocol with SubQ titration schedule (50-100 mg), reconstitution math, safety context, and clinical references for NR/NMN precursor evidence.
Half-life
~30-45 min plasma (IV)
Dose range
50-100 mg SubQ
Status
Compounded / investigational
Developer
N/A
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Quick Reference Card
Aliases
NAD, Coenzyme NAD
Category / Class
Coenzyme / Longevity Compound
Half-Life
Short systemic half-life (~30-45 minutes IV); SubQ absorption extends release over several hours. Intracellular turnover is about 1-2 hours.
Dosing Frequency
Once daily to 3x weekly (SubQ); weekly to monthly (IV)
Dose Range
50-100 mg per injection (SubQ); 250-1,000 mg per session (IV)
Common Vial Sizes
500 mg, 1,000 mg
Route of Administration
Subcutaneous (SubQ), Intravenous (IV), Intramuscular (IM)
Regulatory Status
Not FDA-approved as an injectable therapeutic. Available as compounded preparation (503A/503B). NR is available as a dietary supplement with GRAS status.
Developer
N/A
Key Stat
NAD+ levels may decline roughly 50% between ages 20 and 60. Oral NR at 1,000 mg/day increased blood NAD+ by approximately 2.7-fold in human trials.
What Is NAD+?
NAD+ (Nicotinamide Adenine Dinucleotide) injection is direct administration of the oxidized form of the essential coenzyme NAD, which is present in all living cells and contributes to hundreds of enzymatic reactions related to energy production, DNA repair, gene expression, and aging biology. While not a peptide, it is widely used in peptide and longevity protocols because of its injectable format and overlap with peptide-therapy workflows.
Structurally, NAD+ is a dinucleotide formed by two nucleotides linked through phosphate groups, one containing adenine and one containing nicotinamide. It cycles between oxidized (NAD+) and reduced (NADH) forms to support glycolysis, the TCA cycle, and oxidative phosphorylation.
The therapeutic rationale is based on age-associated NAD+ decline across tissues including skin, blood, liver, muscle, and brain. Lower NAD+ is associated with mitochondrial dysfunction, weaker DNA repair capacity, and cellular aging hallmarks. Injectable NAD+ bypasses digestive metabolism that affects oral precursor delivery and can produce rapid systemic availability.
Most human clinical trials target oral NAD+ precursors (NR and NMN), which generally show favorable safety and dose-dependent blood NAD+ increases. Direct injectable NAD+ has a smaller published trial base.
NAD+ injection is not FDA-approved for any therapeutic indication. It is available as a compounded preparation. All information on this page is educational and research-reference only.
How NAD+ Works: Multi-Pathway Cellular Support
NAD+ acts as a multi-pathway coenzyme involved in energy metabolism, DNA repair signaling, sirtuin activity, and immune regulation.
Mitochondrial Energy Production (ATP)
NAD+ is a required electron carrier across glycolysis, TCA cycle, and oxidative phosphorylation. By accepting and donating electrons through NAD+/NADH cycling, it supports mitochondrial ATP generation and cellular energy throughput.
DNA Repair (PARP Enzymes)
NAD+ is consumed by PARP enzymes during DNA damage signaling and repair. In aging contexts, high DNA damage load plus low NAD+ availability can impair repair dynamics. Sustained NAD+ availability may support genomic maintenance.
Sirtuin Activation (Gene Regulation)
NAD+ is the obligate co-substrate for sirtuins (SIRT1-7), which regulate gene expression linked to stress responses, inflammation, mitochondrial function, and metabolic homeostasis.
Immune Regulation and Inflammation
NAD+ availability interacts with immune pathways, including CD38-related NAD+ consumption and macrophage signaling balance. This has made NAD+ metabolism a target in aging and inflammaging research.
Together these pathways position NAD+ as a systems-level cellular support compound rather than a single-receptor agonist.
NAD+ Injection Dosing Protocol & Titration Schedule
Assessment
Week 1
50 mg SubQ
Once daily or 3x weekly. Start low and inject slowly to assess tolerance.
Titration
Week 2
75 mg SubQ
Increase by about 25 mg if tolerated. Monitor nausea, flushing, and sleep effects.
Standard Protocol
Weeks 3-8
100 mg SubQ
Once daily or 3x weekly. Morning administration is commonly preferred.
Maintenance
Weeks 9-16
50-100 mg SubQ
Commonly 2-3x weekly after loading phase.
Loading Protocol (Intensive)
Days 1-10
100-200 mg SubQ daily
Higher side-effect potential; typically requires closer supervision.
Important Titration Notes
Evidence level: Large RCTs defining optimal SubQ NAD+ injection dosing for anti-aging or wellness endpoints are not yet available.
Why start low: Initial higher doses can increase nausea, flushing, headache, chest tightness, or anxiety. Gradual titration improves tolerability.
Injection speed matters: Inject slowly (often at least 5-10 seconds; sometimes slower for sensitive users) to reduce rate-dependent discomfort.
Morning vs evening: NAD+ can feel stimulatory through ATP-related pathways. Morning dosing is commonly preferred to avoid sleep disruption.
Maximum dose guidance: Some protocols avoid exceeding about 300 mg weekly SubQ without further evaluation; larger single doses may be split across sites.
Missed dose guidance: Skip missed doses and resume next scheduled dose. Do not double-dose.
NAD+ Reconstitution Guide
Vial Size: 500mg
BAC Water: 5.0 mL
Concentration: 100 mg/mL
25 mg: 0.25 mL (25 units)
50 mg: 0.50 mL (50 units)
75 mg: 0.75 mL (75 units)
100 mg: 1.00 mL (100 units)
Vial Size: 1,000mg
BAC Water: 10.0 mL
Concentration: 100 mg/mL
25 mg: 0.25 mL (25 units)
50 mg: 0.50 mL (50 units)
75 mg: 0.75 mL (75 units)
100 mg: 1.00 mL (100 units)
Vial Size: 500mg
BAC Water: 3.0 mL
Concentration: 166.7 mg/mL
25 mg: 0.15 mL (15 units)
50 mg: 0.30 mL (30 units)
75 mg: 0.45 mL (45 units)
100 mg: 0.60 mL (60 units)
Step-by-Step Reconstitution Instructions
- Allow lyophilized NAD+ vial to reach room temperature for 5-10 minutes.
- Clean NAD+ vial stopper and BAC water stopper with separate alcohol swabs.
- Draw planned BAC water volume with a sterile syringe.
- Inject slowly down vial wall, not directly onto powder.
- Gently swirl or roll until dissolved; do not shake aggressively.
- Inspect for clear, colorless solution and discard if discolored or particulate.
- Label concentration/date and refrigerate at 2-8C. Use within manufacturer or pharmacy guidance window.
NAD+ Injection Side Effects - What Research Shows
NAD+ injection side effects are often dose- and rate-dependent, and many are manageable through conservative titration and slower administration.
Common SubQ effects: Nausea, headache, flushing or warmth, and temporary fatigue are frequently reported during early titration, especially with higher starting doses.
Injection site reactions: Localized stinging, burning, redness, or small temporary nodules can occur. Slower injection and site rotation can reduce irritation.
IV-specific effects: Rapid IV administration has historically been associated with headache or shortness of breath, while slower infusion rates are generally better tolerated.
Sleep disruption: Because NAD+ can feel stimulatory for some users, late-day dosing may worsen insomnia.
Metabolic and hepatic considerations: Very high-dose protocols may increase processing burden. Periodic monitoring of liver and metabolic markers may be considered in extended protocols.
Contraindications: Avoid during pregnancy or breastfeeding, severe hepatic or renal impairment, active malignancy (theoretical concern), and known hypersensitivity to formulation components.
NAD+ Clinical Trial Results
O'Holleran 1961 (case series)
Case series (IV NAD+) • 4-day loading plus maintenance
Addiction medicine patients
500-1,000 mg/day IV NAD+ reported as tolerable at slower infusion rates; rapid rates increased acute discomfort.
Martens et al. 2018 (Nature Communications)
RCT (oral NR) • 6 weeks
30 healthy older adults
500 mg NR twice daily raised NAD+ and showed favorable tolerability with vascular trend improvements.
Conze et al. 2019 (Scientific Reports)
Safety trial (oral NR) • 8 weeks
Healthy overweight adults
NR up to 1,000 mg/day was safe and well tolerated, with strong dose-dependent blood NAD+ increases.
Dollerup et al. 2018 (Am J Clin Nutr)
RCT (oral NR) • 12 weeks
Obese men
NR regimen was safe and increased NAD+ markers, with limited endpoint changes in insulin sensitivity and body composition.
Elhassan et al. 2019 (Cell Reports)
Open-label (oral NR) • 21 days
Older men
NR increased muscle NAD+ metabolome signatures and reduced inflammatory signals.
Brakedal et al. 2022 (Cell Metabolism)
RCT (oral NR) • 30 days
Parkinson's disease patients
NR increased cerebral NAD+ signal on spectroscopy with mild clinical improvement in subsets.
Yoshino et al. 2021 (Science)
RCT (oral NMN) • 10 weeks
Postmenopausal women with prediabetes
250 mg/day NMN improved muscle insulin sensitivity.
ChromaDex pilot 2024 (medRxiv)
Pilot RCT (IV NR vs IV NAD+ vs oral NR) • Acute single-dose
Healthy adults
All arms increased blood NAD+; IV delivery produced faster peak responses in pilot data.
Braidy et al. 2020 (systematic review)
Systematic review • N/A
147 studies
NAD+ precursor literature showed favorable age-related outcome signals with limited acute toxicity but incomplete long-term human data.
Clinical evidence for NAD+ boosting is strongest for oral precursors (NR and NMN), with repeated findings of dose-dependent NAD+ increases and generally favorable safety. Direct injectable NAD+ has comparatively limited published human outcome data, so many SubQ protocols remain practitioner- and community-derived while larger clinical datasets continue to evolve.
Storage & Handling
Lyophilized (powder)
20-25C (68-77F) room temperature
Long-term storage per manufacturer guidance
Lyophilized (powder)
2-8C (36-46F)
Alternative refrigerated storage
Pre-mixed liquid (100 mg/mL)
2-8C (36-46F)
Use per pharmacy beyond-use dating
Reconstituted (from powder)
2-8C (36-46F)
14-30 days depending on compounder guidance
Do not freeze lyophilized NAD+ when manufacturer guidance advises against it. Protect reconstituted solution from light, use bacteriostatic water for multi-dose handling, and discard solution if yellowing, browning, or particulates are observed.
NAD+ Injection vs. NMN vs. NR (Oral Precursors)
Compound Type
NAD+ Injection (SubQ): Direct coenzyme (NAD+)
NMN (Oral): NAD+ precursor (NMN)
NR / Niagen (Oral): NAD+ precursor (NR)
Route
NAD+ Injection (SubQ): Subcutaneous injection
NMN (Oral): Oral capsule or powder
NR / Niagen (Oral): Oral capsule
Bioavailability
NAD+ Injection (SubQ): High (bypasses digestive metabolism)
NMN (Oral): Moderate
NR / Niagen (Oral): Moderate (well-characterized oral absorption)
Typical Dose
NAD+ Injection (SubQ): 50-100 mg/injection, 3-7x/week
NMN (Oral): 250-500 mg/day
NR / Niagen (Oral): 300-1,000 mg/day
Speed of NAD+ Elevation
NAD+ Injection (SubQ): Rapid (hours)
NMN (Oral): Gradual (days to weeks)
NR / Niagen (Oral): Gradual (days to weeks)
Clinical Trial Evidence
NAD+ Injection (SubQ): Limited for direct injection
NMN (Oral): Growing
NR / Niagen (Oral): Strongest human RCT base
FDA Status
NAD+ Injection (SubQ): Not approved; compounded preparation
NMN (Oral): Dietary supplement
NR / Niagen (Oral): Dietary supplement with GRAS status
Convenience
NAD+ Injection (SubQ): Requires injection technique and refrigeration
NMN (Oral): Oral daily dosing
NR / Niagen (Oral): Oral daily dosing
Cost
NAD+ Injection (SubQ): Higher
NMN (Oral): Moderate
NR / Niagen (Oral): Moderate
Unique Advantage
NAD+ Injection (SubQ): Fastest direct repletion path
NMN (Oral): Emerging insulin-sensitivity evidence
NR / Niagen (Oral): Best human safety and efficacy depth
NAD+ injection, NMN, and NR target the same NAD+ repletion goal through different delivery and conversion pathways.
NAD+ injection offers the most direct delivery but has less clinical-trial depth. NR currently has the strongest human data, while NMN evidence is expanding.
Many practitioner models use oral precursor baseline support plus periodic injectable NAD+ for acute repletion windows.
See the NMN protocol, NR protocol, Ipamorelin protocol, CJC-1295 protocol and BPC-157 protocol for compound-specific guides.
NAD+ Stacking Protocols
Stack 1
NAD+ + Glutathione Longevity Stack
Combines NAD+ cellular-energy and repair support with glutathione antioxidant support in multi-pathway longevity protocols.
See the compound-specific See glutathione protocol for additional context.
View stack protocolStack 2
NAD+ + Ipamorelin/CJC-1295 Anti-Aging Stack
Pairs NAD+ energy-pathway support with GH-secretagogue protocols that target endocrine aging pathways.
These compounds are typically administered as separate injections and are combined as a multi-pathway protocol strategy.
See the compound-specific See ipamorelin protocol for additional context.
View stack protocolStack 3
NAD+ + BPC-157 Recovery Stack
Combines systemic cellular-energy support with localized tissue-repair pathway targeting in recovery-focused research contexts.
See the compound-specific See BPC-157 protocol for additional context.
View stack protocolFrequently Asked Questions - NAD+ Injection
Q1: What is the starting dose of NAD+ injections?
A common starting SubQ dose is 50 mg (about 0.50 mL at 100 mg/mL), once daily or three times weekly, with conservative protocols beginning lower. Titrate gradually and inject slowly. Use https://www.peppal.app/calculator for exact syringe math.
Q2: What is NAD+'s half-life?
Plasma half-life is often cited around 30-45 minutes for IV context, but intracellular turnover and downstream pathway effects extend beyond that window. SubQ delivery typically provides slower absorption over several hours.
Q3: What results can be expected from NAD+ injections?
Commonly reported early effects include energy and mental-clarity changes, with longer-term recovery and vitality effects reported anecdotally. Large RCT outcome evidence for injectable NAD+ remains limited compared with NR/NMN precursor literature.
Q4: How do you reconstitute NAD+?
For lyophilized NAD+, common mixes are 500 mg plus 5 mL (100 mg/mL), 1,000 mg plus 10 mL (100 mg/mL), or 500 mg plus 3 mL (166.7 mg/mL). Pre-mixed vials do not require reconstitution. Use https://www.peppal.app/calculator for custom math.
Q5: Is NAD+ FDA-approved?
No. Injectable NAD+ is not FDA-approved for therapeutic indications and is generally obtained as a compounded preparation. Oral NR has GRAS and NDI positioning in supplement contexts.
Q6: What are the most common side effects of NAD+ injections?
Nausea, headache, flushing, injection-site stinging, and temporary fatigue are common during titration. Many effects are dose- and rate-dependent and improve with slower administration and conservative escalation.
Q7: How does NAD+ compare to NMN and NR supplements?
NAD+ injection is direct and faster for systemic availability, while NMN and NR are oral precursors requiring conversion. NR currently has the strongest human trial depth; NMN evidence is growing.
Q8: What vial sizes is NAD+ available in?
Common formats are 500 mg and 1,000 mg vials as lyophilized powder or pharmacy-prepared liquid concentrations such as 100 mg/mL multi-dose vials.
Q9: How much bacteriostatic water should be added to NAD+?
Common mixes are 5 mL for a 500 mg vial, 10 mL for a 1,000 mg vial, or 3 mL for a 500 mg higher-concentration option. Concentration choice changes injection volume and measurement precision.
Q10: What is the maximum dose of NAD+ studied?
Historical IV protocols used 500-1,000 mg/day for short monitored periods, while common SubQ wellness protocols usually stay around 50-100 mg per injection and often below roughly 300 mg weekly without further evaluation.
Q11: How should reconstituted NAD+ be stored?
Store reconstituted NAD+ at 2-8C, protected from light, and use within pharmacy or manufacturer guidance windows (often 14-30 days). Follow product-specific instructions for dry-powder storage and freezing cautions.
Q12: What clinical trials have been conducted on NAD+?
Most clinical data evaluates oral NR and NMN. Direct injectable NAD+ human evidence is more limited, with historical IV case reports and newer pilot comparisons, while ongoing trials continue to expand the evidence base.
Sources & Research
- Martens CR, Denman BA, Mazzo MR, et al. "Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults." Nature Communications, 2018 DOI: 10.1038/s41467-018-03421-7.
- Conze D, Brenner C, Kruger CL. "Safety and Metabolism of Long-term Administration of NIAGEN in Healthy Overweight Adults." Scientific Reports, 2019 PubMed DOI: 10.1038/s41598-019-46120-z.
- Yoshino M, Yoshino J, Kayser BD, et al. "Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women." Science, 2021 DOI: 10.1126/science.abe9985.
- Braidy N, Liu Y. "NAD+ therapy in age-related degenerative disorders: A benefit/risk analysis." Experimental Gerontology, 2020 PubMed DOI: 10.1016/j.exger.2020.110831.
- Elhassan YS, Kluckova K, Fletcher RS, et al. "Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome and Induces Transcriptomic and Anti-inflammatory Signatures." Cell Reports, 2019 PubMed.
- Brakedal B, Dolle C, Riber F, et al. "The NADPARK study: A randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease." Cell Metabolism, 2022 PubMed.
- Dollerup OL, Christensen B, Svart M, et al. "A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men." American Journal of Clinical Nutrition, 2018 PubMed.
- Campagnoli C, Yoo E, Liu Y, et al. "Clinical Evidence for Targeting NAD Therapeutically." Pharmaceuticals, 2020 PMC DOI: 10.3390/ph13090247.
- Hong W, Mo F, Zhang Z, et al. "The Safety and Antiaging Effects of Nicotinamide Mononucleotide in Human Clinical Trials: an Update." Advances in Nutrition, 2023 PubMed DOI: 10.1016/j.advnut.2023.08.008.
- Trends in Molecular Medicine editorial contributors. "NAD+ in Aging: Molecular Mechanisms and Translational Implications." Trends in Molecular Medicine, 2020 PMC.
- Empower Pharmacy - NAD+ Injection product information. Link.
- Wikipedia - Nicotinamide adenine dinucleotide. Link.
Related Protocols
Oral supplement (daily)
NMN (Nicotinamide Mononucleotide)
NAD+ Precursor
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NR (Nicotinamide Riboside)
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Glutathione
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Ipamorelin
GH Secretagogue
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CJC-1295
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View protocolDisclaimer
The information on this page is for educational and research reference purposes only. NAD+ (Nicotinamide Adenine Dinucleotide) is not FDA-approved as an injectable therapeutic and is available as a compounded preparation. No compounds discussed on this site are intended for human consumption. This is not medical advice.
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