What are the benefits and side effects of NAD+ (Nicotinamide adenine dinucleotide) drips?

NAD+ Drips: Benefits and Side Effects

NAD+ infusions are not recommended for therapeutic use outside of research protocols, as there are no FDA-approved injectable NAD+ products, no clinical practice guidelines supporting their use for any medical condition, and insufficient evidence of clinical benefit. 1, 2

Current Regulatory and Clinical Status

Injectable NAD+ lacks any guideline support or regulatory approval:

• No FDA-approved injectable NAD+ products exist for clinical use in the United States 2
• Injectable NAD+ is not found in any current clinical practice guidelines for treatment of any condition 2
• The American Academy of Physical Medicine and Rehabilitation does not recommend NAD patches due to lack of clinical evidence 1
• FDA labeling for intravenous NAD lists only cosmetic uses, not therapeutic medical indications 1

Claimed Benefits (Lacking Clinical Evidence)

While NAD+ plays essential roles in cellular function, the evidence for benefits from IV administration is absent:

• NAD+ is involved in over 400 enzymatic reactions including energy metabolism, DNA repair, gene expression, and stress responses 2, 3
• Oral NAD+ precursors (nicotinamide riboside) have shown some promise in raising NAD+ levels and potentially reducing blood pressure and arterial stiffness in middle-aged and older adults 4
• Oral NADH supplementation has been associated with improvements in quality of life, decreased anxiety, and reduced maximum heart rate in some studies 5
• However, these benefits are from oral precursors, not IV NAD+, and the pharmacokinetics of IV administration remain unknown 2

Side Effects and Safety Concerns

Injectable NAD+ carries significant risks without proven benefit:

Immediate Risks of IV Administration

• Infection risk from improper sterile technique 2
• Potential for hypersensitivity reactions 2
• Unknown pharmacokinetics when administered parenterally 2
• No standardized dosing protocols exist 2

Known Side Effects from NAD+ Precursors

• High doses of nicotinic acid can cause flushing, nausea, vomiting, liver toxicity, blurred vision, and impaired glucose tolerance 1
• Common side effects associated with NAD supplementation include muscle pain, nervous disorders, fatigue, sleep disturbance, and headaches 5
• Patch delivery systems may cause local skin reactions 1

Theoretical Long-Term Risks

• Accumulation of potentially toxic metabolites 6
• Possible tumorigenesis concerns 6
• Potential promotion of cellular senescence 6
• NAD(P)H oxidase activity has been implicated in anthracycline-induced cardiotoxicity, raising concerns about NAD supplementation in certain contexts 7

Evidence-Based Alternative Approach

For patients seeking NAD+ benefits, recommend the following algorithm:

First-Line: Dietary Sources

• Recommend dietary sources of niacin including meat, poultry, fish (especially red fish like tuna and salmon), nuts, legumes, and fortified packaged foods 1, 3
• Adult males require 16 mg/day and adult females 14 mg/day of niacin 3

Second-Line: Oral Supplementation (If Deficiency Suspected)

• Measure blood or tissue NAD+ levels if pellagra symptoms present (diarrhea, dermatitis, dementia) 1
• If deficiency confirmed, use oral nicotinic acid (15-20 mg/day) or nicotinamide (300 mg/day) 1
• The upper limit for nicotinamide is approximately 900 mg/day for adults 2, 3
• The upper limit for free nicotinic acid is only 10 mg/day due to flushing effects 1, 3

For Parenteral Nutrition (Only When GI Tract Non-Functional)

• Parenteral nutrition should provide at least 40 mg of niacin per day 1, 3
• The oral/enteral route should be used whenever the gastrointestinal tract is functional 1

Critical Clinical Pitfall

The most important caveat is that injectable NAD+ administration falls outside standard medical practice and bypasses normal protective barriers. 2 Despite marketing claims, there is no high-quality evidence supporting therapeutic benefits of IV NAD+, and the practice carries unnecessary risks. Oral NAD+ precursors (nicotinamide riboside, nicotinamide mononucleotide) are better studied, safer, and represent the only evidence-based approach to augmenting NAD+ levels. 4, 5, 8