Can Nicotinamide adenine dinucleotide (NAD) supplements cause liver injury?

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Last updated: May 5, 2025View editorial policy

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From the Research

NAD+ supplements are generally considered safe for most people when taken at recommended doses, but they can potentially cause liver injury in some cases, as evidenced by a systematic review published in 2024 1. When considering NAD+ supplementation, it is essential to weigh the potential benefits against the risks, particularly for individuals with pre-existing liver conditions or those taking certain medications.

  • The risk of liver injury appears to be low for healthy individuals taking moderate doses of NAD+ supplements.
  • However, high doses of NAD+ supplements may stress the liver, particularly in individuals with specific genetic variations that affect NAD+ metabolism.
  • A study published in 2022 in The Journal of Physiology found that NAD+ precursors, such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), can increase hepatic NAD+ levels and prevent hepatic lipid accumulation in pre-clinical models of non-alcoholic fatty liver disease (NAFLD) 2.
  • Another study published in 2024 in the American Journal of Physiology-Endocrinology and Metabolism found that NADH supplementation is safe and has a low incidence of side effects, with some studies showing improvements in quality of life and health parameters 1.
  • To minimize the risk of liver injury, it is recommended to start with lower doses of NAD+ supplements (typically 250-500 mg daily) and gradually increase if needed, while monitoring for any adverse effects like nausea, fatigue, or abdominal discomfort.
  • Consulting with a healthcare provider before taking NAD+ supplements is especially important for individuals with liver disease, those taking medications processed by the liver, or those with a history of liver problems.
  • The liver plays a crucial role in metabolizing supplements, and while NAD+ is naturally present in the body and involved in many cellular processes, excessive supplementation can potentially disrupt normal liver function by altering metabolic pathways or creating oxidative stress, as discussed in a review published in 2024 in Cellular and Molecular Life Sciences 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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