Are NAD (Nicotinamide adenine dinucleotide) patches safe and effective for medical use?

NAD Patches: Safety and Effectiveness for Medical Use

NAD patches are not supported by sufficient clinical evidence for safety and effectiveness in medical use, and there are no established guidelines recommending their use for any medical condition.

What is NAD?

• NAD (Nicotinamide adenine dinucleotide) is a fundamental molecule that participates in energy metabolism, cell signaling, mitochondrial homeostasis, and dictates cell survival or death 1
• NAD+ is a coenzyme required by more than 400 enzymes to catalyze reactions in the body, helping to convert nutrients into energy, create cholesterol and fats, create and repair DNA, and exert antioxidant effects 2

Current Evidence on NAD Patches

• There are no established clinical guidelines that recommend the use of NAD patches for any medical condition 2
• While preclinical studies have shown promising results for NAD+ precursors in various conditions, clinical evidence specifically for transdermal delivery via patches is lacking 3, 4
• The safety and efficacy of NAD patches have not been evaluated by regulatory bodies such as the FDA 3, 1

NAD Precursors in Clinical Research

• Most clinical research has focused on oral supplementation with NAD+ precursors such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), not transdermal patches 5, 6
• A randomized, double-blind, placebo-controlled study of oral nicotinamide riboside with pterostilbene (NRPT) showed increased NAD+ levels in healthy adults aged 60-80 years with no serious adverse events reported 6
• However, the efficacy of NAD+ precursors in humans has generally been lower than expected based on preclinical studies 1

Safety Considerations

• The safety profile of transdermal NAD administration via patches has not been well-established in clinical trials 3, 1
• For comparison, other transdermal delivery systems like the lidoderm patch have been studied for conditions such as painful diabetic neuropathy and found to be possibly effective (Level C evidence) 2
• Patch delivery systems in general may cause local skin reactions at the application site, as seen with other medical patches 2

Potential Applications Being Studied (Oral NAD+ Precursors)

• Preclinical and limited clinical studies have explored NAD+ precursors for:
  • Age-related conditions 3, 5
  • Metabolic disorders 1, 5
  • Neurodegenerative diseases 4
  • Muscle function 3
• However, these studies primarily used oral supplementation rather than patches 1, 5

Recommended Daily Intake of Niacin (Vitamin B3, a NAD+ Precursor)

• For enteral nutrition: 18-40 mg per day of niacin in 1500 kcal 2
• For parenteral nutrition: at least 40 mg of niacin per day 2
• These are established guidelines for nutritional requirements, not therapeutic interventions 2

Conclusion for Clinical Practice

• Currently, there is insufficient evidence to recommend NAD patches for any medical condition 3, 1
• Healthcare providers should advise patients that NAD patches lack regulatory approval and clinical validation 4, 5
• Patients interested in NAD+ enhancement should be directed toward evidence-based interventions such as:
  • Dietary sources of niacin (meat, poultry, fish, nuts, legumes) 2
  • Established nutritional supplementation when indicated 2
  • Lifestyle modifications like exercise, which naturally increase NAD+ levels 5

Cautions and Contraindications

• High doses of nicotinic acid (a form of niacin) can cause flushing, nausea, vomiting, liver toxicity, blurred vision, and impaired glucose tolerance 2
• The upper intake level for nicotinic acid is set at 10 mg/day due to potential flushing effects 2
• The upper intake level for nicotinamide is approximately 900 mg/day for adults 2
• Patients should be cautioned against using unregulated NAD patches as a substitute for evidence-based medical care 1, 5