NAD+ Intramuscular Dosing Recommendations
No Established IM Dosing Guidelines Exist
There are currently no established clinical guidelines or FDA-approved protocols for intramuscular administration of NAD+ (Nicotinamide Adenine Dinucleotide). The available evidence only addresses oral supplementation of NAD+ precursors (niacin, nicotinamide, NMN), not direct NAD+ injection 1.
Available Evidence for NAD+ Precursors (Oral Route Only)
The existing guidelines focus exclusively on oral intake of NAD+ precursors:
- Niacin (NAD+ precursor) oral dosing: Adult males require 16 mg/day, adult females 14 mg/day, with parenteral nutrition protocols using 40 mg/day 1
- Nicotinamide upper limits: Maximum safe dose is 12.5 mg/kg body weight/day (approximately 900 mg/day for adults) 1
- Clinical therapeutic doses: For hypercholesterolemia treatment, much higher doses of nicotinic acid (3 g/day) are used, though this is oral administration 1
Critical Gaps in Evidence
Why IM NAD+ Dosing Is Not Standardized
The literature review reveals several important limitations:
- No clinical trials: None of the guideline documents 2, 1 address direct NAD+ intramuscular administration
- Biochemical considerations: NAD+ is a large, charged molecule that may have poor bioavailability and stability when injected intramuscularly 1
- Lack of pharmacokinetic data: No established absorption rates, peak concentrations, or duration of action for IM NAD+ 3
General IM Injection Principles (If Attempting Off-Label Use)
If clinicians are considering off-label IM NAD+ administration despite the lack of evidence, they should follow established IM injection safety protocols:
- Site selection: Ventrogluteal or deltoid sites are preferred for adult IM injections 4, 5, 6
- Needle selection: Appropriate needle length based on patient body mass index and injection site 5, 7
- Volume limitations: IM injections should generally not exceed 3-5 mL per site in adults 4, 5
- Monitoring requirements: No standardized monitoring protocols exist for NAD+ supplementation 1
Important Clinical Caveats
Safety Concerns
- Flushing risk: While NMN does not typically cause flushing, nicotinic acid forms can cause significant vasodilation at doses as low as 30 mg/day 1
- Gastrointestinal effects: NAD+ precursors may cause nausea, vomiting, and diarrhea 1
- Tissue irritation: Without established formulations, IM injection of NAD+ could cause local tissue damage or poor absorption 3
Alternative Approaches
Oral NAD+ precursor supplementation is the only evidence-based approach, with established safety profiles and dosing guidelines 1. The lack of IM dosing protocols suggests this route is not clinically validated or necessary for NAD+ supplementation.