NAD⁺ Reconstitution and Dosing for Weekly Injections
Critical Safety Notice
There are no FDA-approved guidelines, established medical protocols, or peer-reviewed clinical evidence for reconstituting or administering NAD⁺ via subcutaneous or intramuscular injection for any indication. The evidence base consists entirely of preclinical animal studies and theoretical pharmacokinetic data 1, 2, 3.
Reconstitution Protocol (Based on Sterile Compounding Guidelines)
If you proceed despite the absence of clinical evidence, follow strict aseptic technique as outlined for allergen immunotherapy extract preparation:
Preparation Area and Personnel
- Sanitize the work surface with 70% isopropanol without added dyes or glycerin 4
- Wash hands thoroughly to wrists with detergent and potable water, or substitute with 70% isopropanol-based sanitizer 4
- Sanitize the vial stopper with isopropanol before needle puncture 4
Standard Reconstitution Volume
- Add 5 mL of sterile water (preservative-free) to a 500 mg vial of NAD⁺ 4
- This creates a concentration of 100 mg/mL (basic pharmaceutical calculation)
- Inject an equal volume of air into the vial before withdrawing solution to avoid creating a vacuum 4
- Gently roll the vial between palms to dissolve; do not shake vigorously 4
- Inspect visually for complete dissolution and absence of particulate matter 4
Storage After Reconstitution
- Store reconstituted solution at 4°C (refrigerated) to minimize degradation 4
- Use within 30 days if stored refrigerated in a sterile vial 4
- Discard if cloudiness, discoloration, or particulate matter develops 4
Dosing Considerations (No Established Clinical Protocol Exists)
Theoretical Dose Extrapolation from Animal Data
There is no validated human dosing regimen for injectable NAD⁺. Animal studies provide only speculative guidance:
- Mouse studies used 100-500 mg/kg intraperitoneally, achieving peak plasma concentrations of 1,000-4,800 nmol/mL 2
- For a 70 kg human, direct extrapolation would suggest 7,000-35,000 mg per dose—this is not clinically validated and likely unsafe 2
- Human oral nicotinamide riboside (an NAD⁺ precursor) studies typically use 250-1,000 mg daily, but oral bioavailability differs drastically from injection 3
Hypothetical Weekly Injection Volume (If 50-100 mg Dose Assumed)
If reconstituted to 100 mg/mL:
- A 50 mg dose = 0.5 mL (50 units on an insulin syringe)
- A 100 mg dose = 1.0 mL (100 units on an insulin syringe)
These doses are entirely speculative and not based on clinical trials.
Injection Technique (If Proceeding)
Subcutaneous Administration
- Use a 90° angle for most individuals; thin individuals may require a 45° angle to avoid intramuscular injection 4
- Lightly grasp a skin fold, release the pinch, then inject 4
- Embed the needle for 5 seconds after complete delivery to prevent leakage 4
- Rotate injection sites to avoid lipodystrophy 4
Syringe Selection
- Use a new, sterile insulin syringe (typically 0.5-1.0 mL capacity with 28-31 gauge needle) for each injection 4
- Never reuse syringes due to risk of needle deformation, infection, and tissue damage 4
Critical Warnings and Contraindications
Lack of Clinical Evidence
- No human clinical trials establish safety, efficacy, or appropriate dosing for injectable NAD⁺ 1, 3
- Preclinical studies show NAD⁺ precursors (nicotinamide, nicotinamide riboside) may have benefits in animal models, but these do not translate to validated human injection protocols 1, 3
Potential Risks
- Tumorigenesis: NAD⁺ elevation may promote cellular proliferation in existing malignancies 1
- Accumulation of toxic metabolites: Nicotinamide N-oxide and other metabolites may accumulate with repeated dosing 2
- Promotion of cellular senescence: Chronic NAD⁺ elevation may paradoxically accelerate aging pathways 1
- Injection site reactions: Pain, erythema, abscess formation from non-sterile technique 4
- Anaphylaxis: Any injectable substance carries risk of severe allergic reaction 4
Absolute Contraindications (Theoretical)
- Active malignancy or history of cancer (due to potential tumor promotion) 1
- Pregnancy or breastfeeding (no safety data) 1
- Known hypersensitivity to nicotinamide compounds 1
Monitoring and Follow-Up (If Proceeding)
- Monitor injection sites for redness, swelling, or signs of infection 4
- No validated laboratory monitoring exists for injectable NAD⁺ therapy
- Consider baseline and periodic liver function tests, given hepatic metabolism of nicotinamide compounds 2
Recommendation
I cannot recommend a specific weekly injection dose or protocol because no such protocol exists in evidence-based medicine. The reconstitution method described (5 mL sterile water for 500 mg NAD⁺) follows standard pharmaceutical compounding principles, but the clinical application lacks any regulatory approval or peer-reviewed validation 4, 1, 3.
If you are considering this intervention, consult a physician experienced in investigational therapies and consider enrollment in a formal clinical trial rather than self-administration.