What is the recommended approach to using a Myers cocktail with Nicotinamide adenine dinucleotide (NAD) for energy boosting or recovery?

Myers Cocktail with NAD: Evidence-Based Assessment

Direct Recommendation

There is no high-quality evidence supporting the use of Myers cocktail with or without NAD for energy boosting or recovery in healthy individuals or those without documented vitamin deficiencies, and this practice should not be recommended outside of specific medical conditions requiring intravenous micronutrient replacement.

Evidence Analysis

Lack of Supporting Guidelines and Quality Evidence

• No established medical guidelines exist for Myers cocktail or NAD infusions for wellness, energy enhancement, or recovery purposes 1
• The available evidence consists primarily of low-quality observational studies and case series from alternative medicine literature, not rigorous randomized controlled trials 2, 3
• Licensed injectable vitamins are prescription-only medicines that should not be advertised to the public and should only be supplied by qualified healthcare professionals for legitimate medical indications 1

What the Myers Cocktail Actually Contains

• The modified Myers cocktail typically includes magnesium, calcium, B vitamins (including niacin/NAD precursors), and vitamin C administered intravenously 2
• NAD (nicotinamide adenine dinucleotide) is mentioned in metabolic contexts as a cofactor for electron transport and energy metabolism, not as a therapeutic infusion agent 4

Limited Clinical Data

• One small pilot study (n=7) in therapy-resistant fibromyalgia patients showed subjective symptom improvement, but this was an uncontrolled trial with no placebo group and relied entirely on patient-reported outcomes 5
• Another study examining ATP/ADP ratios after infusion showed biochemical changes but no clinical outcomes or patient benefit was demonstrated 3
• These studies represent the lowest tier of medical evidence and cannot support routine clinical use 1

Legitimate Medical Indications for IV Micronutrients

The evidence supports intravenous vitamin therapy only for specific medical conditions:

• Malabsorption syndromes with severe vitamin depletion requiring parenteral replacement 1
• Wernicke's encephalopathy requiring urgent thiamine administration 1
• Critical illness in ICU settings with documented deficiencies 4
• Pellagra (severe niacin deficiency) requiring 15-20 mg/day nicotinic acid or 300 mg/day nicotinamide 4
• Patients on long-term parenteral nutrition with established dosing guidelines for each micronutrient 4

Physiologic Concerns

• Oral absorption of vitamins is generally adequate in individuals with functioning gastrointestinal tracts, making IV administration unnecessary 1
• Claims that IV administration allows "faster absorption" are irrelevant for non-emergency situations where rapid correction is not medically indicated 1
• High-dose (non-physiological) vitamin administration may cause harm: niacin can cause flushing at doses as low as 30 mg and hepatotoxicity at ~3 g/day 4

Safety Considerations

• Potential adverse effects exist even with "natural" vitamin infusions, including allergic reactions, electrolyte disturbances, and organ toxicity at supraphysiological doses 4, 1
• There is no evidence that healthy individuals or those without deficiencies benefit from supplementation beyond normal dietary intake 1
• The practice diverts patients from evidence-based interventions for fatigue and recovery, such as sleep optimization, exercise, and treatment of underlying medical conditions

Clinical Bottom Line

Myers cocktail with NAD should be reserved exclusively for patients with documented vitamin deficiencies or specific medical conditions requiring parenteral micronutrient replacement. For individuals seeking energy enhancement or recovery without documented deficiencies, this intervention lacks scientific support and may expose patients to unnecessary risks and costs 1. Healthcare providers should focus on identifying and treating underlying causes of fatigue through evidence-based approaches rather than offering unproven IV vitamin therapies 1.