Are NAD+ (Nicotinamide adenine dinucleotide) injections safe to use with Adderall (amphetamine and dextroamphetamine)?

Safety of NAD+ Injections with Adderall

NAD+ injections should be avoided when taking Adderall due to lack of safety data and potential risk for drug interactions affecting cardiovascular function.

Understanding the Medications

Adderall

• Combination of amphetamine and dextroamphetamine
• DEA Schedule II controlled substance with high potential for abuse 1
• Stimulates release of norepinephrine affecting both α- and β-adrenergic receptor sites
• α-Adrenergic stimulation causes vasoconstriction and increases total peripheral resistance
• β-Adrenergic stimulation increases heart rate, stroke volume, and skeletal muscle blood flow 1

NAD+ (Nicotinamide Adenine Dinucleotide)

• Essential pyridine nucleotide cofactor involved in:
  • Oxidative phosphorylation
  • ATP production
  • DNA repair
  • Calcium-dependent secondary messaging
  • Gene expression 2

Safety Concerns

Lack of Drug Interaction Data

• No published studies or guidelines specifically address interactions between NAD+ injections and Adderall
• The practice parameter for stimulant medications does not mention NAD+ as a safe combination therapy 3
• Current clinical guidelines focus on established medication combinations with known safety profiles

Cardiovascular Risks

• Adderall causes significant cardiovascular effects including:
  • Tachycardia
  • Increased blood pressure
  • Vasoconstriction 1
• NAD+ supplementation has been shown to affect:
  • Maximum heart rate
  • Cardiovascular parameters 2
• The combined cardiovascular effects of both substances are unknown and potentially dangerous

Reported Side Effects

Adderall Side Effects

• Hyperactivity
• Hyperthermia
• Tachycardia
• Tachypnea
• Mydriasis
• Tremors
• Seizures 1

NAD+ Side Effects

• Muscle pain
• Nervous disorders
• Fatigue
• Sleep disturbance
• Headaches 2

Clinical Decision Making

Risk Assessment

1. High-risk combination: Both substances affect cardiovascular function through different mechanisms
2. Unknown interaction profile: No established safety data for this specific combination
3. Potential for additive adverse effects: Both can cause nervous system effects and fatigue

Alternative Approaches

If considering NAD+ supplementation while on Adderall:

• Oral NAD+ precursors may be safer than injections, as they have been more extensively studied 4
• Timing separation between medications may reduce potential interactions (though this is theoretical without evidence)
• Monitoring of cardiovascular parameters would be essential if attempting this combination

Recommendations for Specific Populations

Patients with Pre-existing Conditions

• Cardiovascular disease: Absolutely contraindicated due to additive cardiovascular risks
• Seizure disorders: High risk due to potential lowering of seizure threshold with stimulants 3
• Hypertension: Increased risk of hypertensive crisis

Medication Combinations to Avoid

• MAO inhibitors: Absolutely contraindicated with Adderall - can cause severe hypertension and cerebrovascular accidents 3
• Adding NAD+ injections to this already risky landscape introduces unnecessary uncertainty

Conclusion

Given the lack of safety data and the potential for serious cardiovascular effects, NAD+ injections should be avoided in patients taking Adderall until proper clinical studies establish their safety profile together. The risk of unknown drug interactions outweighs the potential benefits of this combination.