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Longevity & wellness · Evidence tier B · #14 in test requests

NAD+

Nicotinamide adenine dinucleotide · NAD · Nadide · beta-NAD · Coenzyme I · Diphosphopyridine nucleotide (DPN)

NAD+ is a helper molecule cells use to make energy, not a peptide. Clinics sell it as IV drips and shots for energy and anti-aging; 2026 reviews found no good evidence for those uses, and contaminated products have sickened people1269.

Last reviewed · First published · 38 sources · 24 min read · By the Pinc Peptide editors

Illustration: a glass vial with a pink label reading NAD+
Illustration, not a real product: an empty glass vial (photo: Missouri Historical Society, public domain) with our label. See every vial.

Quick answers

What is it?
A helper molecule that cells need to turn food into energy4. It is not a peptide3. Wellness clinics sell it as IV drips and shots for energy and anti-aging16. Websites also sell ‘research use only’ vials2930.
Does it work?
Not shown for energy or anti-aging. Two 2026 reviews found no good evidence that drips or shots work for those uses16. In one trial of 180 heart-failure patients, heart pumping improved a little versus placebo, but hospital stays did not clearly drop5.
Is it safe?
Unknown over the long term16. Drips often cause nausea, cramps and chest discomfort614. Contaminated NAD+ caused chills, shaking and low blood pressure29. In July 2026 a woman died after an NAD+ injection; prosecutors say the medical examiner blamed air let into her IV line2737.
Is it legal?
Not approved by FDA, though China has approved an NAD+ injection538. US pharmacies may make it for now under an interim FDA policy, which is not approval78. Sport does not ban NAD+ itself. Drips over 100 mL in 12 hours are banned for tested athletes1124.
What is in the vials?
Most tested samples failed. 41 of 61 online samples tested by Finnrick in 2026 failed its purity-and-dose standard10. A corner-shop vial tested for WIRED held no NAD+26. FDA lists 16 recall records for NAD products from 2016 to 2025, the worst for bacterial toxins21.

What it is

NAD+ (nicotinamide adenine dinucleotide) is a coenzyme: a small helper molecule that enzymes need to move electrons while cells turn food into energy4. It is built from two nucleotides joined by phosphate groups and has a molecular weight of about 6633. It contains no amino acids, so it is not a peptide3. NAD+ also takes part in DNA repair and gene control12, and enzymes such as sirtuins and PARPs break it down as they work13. Given by IV drip, it leaves the blood fast. In a 2019 pilot, blood NAD+ did not rise at all during the first 2 hours of a slow infusion, which the authors read as rapid uptake or breakdown by tissues13. Reviews often say NAD+ declines with age4, but a 2026 review notes that large human studies found whole-blood NAD+ does not fall with healthy aging itself6.

Arthur Harden and William John Young discovered NAD in 1906 as a factor in yeast extract that sped up alcohol fermentation4. IV NAD+ for alcohol withdrawal was reported as early as 196113, and IV NAD+ is now increasingly sold in wellness settings6. In China, an NAD+ injection with a national drug approval number was the study product in a 2026 heart-failure trial5.

Benefits: what the research shows

The largest human trial of NAD+ itself is a single-center randomized trial from China. It gave 180 people with heart failure caused by poor blood supply to the heart muscle either 10 mg of NAD+ or a placebo by IV drip once a day for 7 days, on top of standard drugs. The analysis counted all 180 people, carrying missing values forward. At 1 month, left ventricular ejection fraction (LVEF, the share of blood the heart pumps out with each beat) was 45.4% vs 42.4% (p=0.024). Over 6 months, major cardiac and stroke events (14.6% vs 24.7%) and heart-failure hospital stays (13.5% vs 23.6%) were lower, but neither difference was statistically significant5. Two smaller randomized trials from China also exist, one from 2024 and one from 2026. In 58 hospital patients over 60 with heart failure, 50 mg into a vein daily for 7 days improved heart measures more than saline at every follow-up visit, but no difference was statistically significant; one test of the trend in NT-proBNP, a blood marker of heart strain, did favor NAD+ (p=0.035)533. In 45 people with sudden hearing loss in one ear, a daily 5 mg shot into a muscle on top of standard treatment, which included a steroid, was followed by more hearing recovery than standard treatment alone among the 38 who finished (40.2 vs 23.1 decibels, p=0.010); the comparison group got no placebo shot35. Everything else in people is small: a 2019 pilot that randomized 11 healthy men to 750 mg over 6 hours or saline and measured only blood chemistry13, two industry-sponsored preprint pilots (not peer reviewed) that compared NAD+ drips or shots with a precursor, mainly for comfort and safety3436, a 2026 retrospective series of 6 clinic clients given 500 mg IV on 4 days14, an uncontrolled pilot of 1,000 mg a day for 6 days in 8 adults aged 70 to 80, described in a 2026 review6, and case reports615. A 2026 systematic review of 113 studies found no outcome trial of IV or intramuscular NAD+ for anti-aging or wellness1, and another 2026 review called the IV evidence sparse, mostly small uncontrolled studies and case reports6. Most human ‘NAD+’ research actually tests oral precursors such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), or oral NADH. These are different molecules, so they do not count toward this entry’s rating. They reliably raise NAD-related molecules in blood, but effects on health outcomes are mixed and often null1. NMN improved muscle insulin sensitivity in a 10-week trial in women with prediabetes16, while NR at 1,000 mg twice a day for 12 weeks did not improve insulin sensitivity in 40 obese men17. In mice, injected NAD+ reduced brain damage after an induced stroke and eased an autoimmune model of multiple sclerosis1819.

Key human studies

StudyDesignPeopleDose and routeResult
Yu et al., Am J Cardiovasc Drugs 20265PubMed · DOI Randomized, placebo-controlled, single-center trial in China (ChiCTR2200059169); adults with heart failure from ischemic cardiomyopathy and LVEF of 45% or less 180 10 mg IV in 100 mL once daily for 7 days, run over about 40 to 60 minutes, plus standard care In an intention-to-treat analysis of all 180, with missing values carried forward, LVEF at 1 month was 45.44% vs 42.44% (p=0.024). At 6 months, major cardiac and stroke events 14.6% vs 24.7% (p=0.089) and first heart-failure hospitalization 13.5% vs 23.6% (p=0.078), both not significant5.
Pei et al., Rev Cardiovasc Med 202433PubMed · DOI Single-center randomized double-blind trial in China with a saline control; hospital patients over 60 with heart failure 60 50 mg IV with 50 mL saline once daily for 7 days, plus standard care Of 60, 58 were analyzed. NT-proBNP and LVEF improved more with NAD+ than saline at 2, 4 and 12 weeks, but no difference at a visit was statistically significant; a test of the NT-proBNP trend favored NAD+ (p=0.035)33.
Gao et al., Laryngoscope 202635PubMed · DOI · NCT05849519 Single-center randomized trial in China that the authors call double-blind; the comparison group got standard treatment alone, with no placebo shot; sudden hearing loss in one ear 45 5 mg into a muscle once daily during the hospital stay (median 7 days, range 4 to 13), plus standard treatment that included a steroid Among the 38 who finished, hearing improved by 40.21 vs 23.06 decibels (p=0.010). No adverse events were reported in the NAD+ group35.
Grant et al., Front Aging Neurosci 201913PubMed · DOI Randomized pilot with a saline control; healthy men aged 30 to 55; blood and urine chemistry only 11 750 mg IV over 6 hours (about 2 mg per minute) in 8 men; saline in 3 No adverse events were observed. Plasma NAD+ did not rise for the first 2 hours and was up 398% only at the end of the infusion. No clinical outcomes were measured13.
Reyna et al., Front Aging 202614PubMed · DOI Retrospective tolerability series at a commercial clinic, IV NAD+ vs IV nicotinamide riboside; the researchers were employed by the company 14 500 mg IV on 4 consecutive days (6 NAD+, 8 NR) All 6 NAD+ clients reported moderate to severe cramping, diarrhea, nausea, vomiting, faster heart rate, throat pain, congestion and chest pressure during infusions, which stopped when infusions ended. Average infusion time was 97 minutes vs 37 minutes for NR14.
Itani et al., ACR Open Rheumatol 202615PubMed · DOI Case report; one woman with rheumatoid arthritis 1 250 mg IV in 500 mL saline over about 1 hour every 2 weeks, 4 infusions, given for aesthetic and anti-aging reasons Joint pain and swelling improved, and ultrasound 9 months later showed no joint inflammation. The authors say the uncontrolled design and other changes in her life rule out conclusions about cause15.

Doses studied

Doses below are what studies used or what a label says. They are not advice, and gray-market products may not contain what their label says.

In human studies

Most human data are for IV use. The largest trial gave 10 mg once daily for 7 days in 100 mL, run over about 40 to 60 minutes5, and a smaller trial gave 50 mg into a vein once daily for 7 days533. A healthy-volunteer pilot gave 750 mg over 6 hours, a regimen the authors said reflects common clinic practice13. A preprint pilot gave 500 mg once34, a clinic series gave 500 mg on 4 days in a row14, and a case report describes 250 mg in 500 mL over about an hour every 2 weeks15. Two small 2026 reports gave shots instead: 5 mg into a muscle once a day for a median of 7 days alongside standard treatment for sudden hearing loss35, and 100 mg into a muscle, a vein or under the skin once a day for 3 days in a preprint pilot36. Neither has reported blood NAD+ levels, and we found no other study that shows what a shot does to NAD+ in the body3536.

In animal studies

Mice: 50 mg/kg injected into the abdominal cavity (intraperitoneal) right after an induced stroke, which reduced brain damage at 48 hours18; 250 mg/kg intraperitoneal once daily in an autoimmune model of multiple sclerosis, which lessened disease severity19.

What users report Anecdotal · not validated · not a recommendation

A dosing-calculator site lists community-reported amounts of 50 to 100 mg per injection, once a day. The same page says published human work used supervised IV doses of 500 mg and 750 mg, not this schedule25.

Routes
  • Intravenous drip (human studies, including randomized trials)
  • Subcutaneous injection (common gray-market use; one 3-day preprint pilot only)
  • Intramuscular injection (two small 2026 studies, one a preprint; one of them cites a 1966 study)
  • Oral NADH and the precursors NR and NMN (different molecules; many small trials)

Every dose studied for NAD+, with sources →

Quality and the gray market

What testing finds

Finnrick, an independent testing service, reported 61 tests of gray-market NAD+ from 19 vendors between 19 February 2026 and 24 September 2026: 15 passed, 41 failed and 5 were incomplete under its default standard (purity of at least 99.5% and content within 35% of the label)10. On 15 September 2026 WIRED reported that an ‘NAD+’ vial bought at a Brooklyn bodega contained none of its labeled ingredient in Finnrick testing26. Compounded products have their own problems. openFDA lists 16 recall records for products described as NAD+ or nicotinamide adenine dinucleotide, started from 2016 to 2025. By our count they come from 12 recalls, 11 of the records cite lack of sterility assurance, and the 2016 record is for the reduced form, NADH. The most serious was a Class I recall of GenoGenix NAD+ injection for elevated endotoxin, started 30 July 202521. In 2024 FDA warned that compounders were using food-grade NAD+ from repackagers to make IV products2.

How it is sold

NAD+ reaches buyers three ways. Wellness clinics and med spas sell IV drips and shots627. Telehealth is moving in: Hims, which owns a compounding pharmacy it bought in 2025, told investors in August 2026 that it plans to sell NAD+ by the end of the year, Reuters reported28. And ‘research use only’ vials are sold online. One vendor’s best-seller list showed ‘Buffered NAD+ 500mg’ at $59.99, and NAD+ appeared on another vendor’s ‘most popular’ list (both accessed 30 September 2026)2930. By our count from the chart data on Finnrick’s June 2026 insights page, NAD+ accounted for 157 of 21,253 requests (about 0.7%) to its free testing program from May 2025 to May 2026; the chart shows none from July to December 202531. Enforcement has reached NAD+ too: a Utah physician indicted on 1 April 2026 is accused of receiving misbranded drugs from China, NAD+ among them, and selling them to patients32.

Side effects and risks

  • Endotoxin contamination: endotoxin is toxic material from bacteria. FDA has had reports of severe chills, shaking, vomiting and fatigue after NAD+ injections, which it said were consistent with too much endotoxin, and it has warned that some compounders used food-grade NAD+ to make IV products2. In one case, three patients given NAD+ from the same vial had low blood pressure and uncontrollable shaking and were sent to the emergency room; an unopened vial from that lot held too much endotoxin, FDA said9.
  • Infusion reactions: IV NAD+ commonly causes nausea, cramping, flushing and chest discomfort. In one clinic series every NAD+ recipient had such symptoms until the drip ended614.
  • Unknown benefit and long-term safety: a 2026 review of 113 studies found no outcome trial of NAD+ given into a vein or a muscle for anti-aging or wellness, and a second 2026 review says the human studies are not enough to judge the long-term safety of IV NAD+16.
  • Wrong or missing contents: most gray-market NAD+ samples tested in 2026 failed purity or dose checks, and one bodega vial had none of the labeled ingredient1026.
  • Unlicensed providers: after a Bronx death in July 2026, prosecutors said the medical examiner found that air let into the woman’s IV line during an NAD+ injection caused a fatal air embolism; the man who gave it, licensed in the US only as an esthetician according to investigators, was indicted on charges including murder, CBS reported2737.
  • Anti-doping: IV drips or injections over 100 mL per 12 hours are prohibited for tested athletes even though NAD+ itself is not11.

Documented harms

  • 30 Oct 2024FDA said it had received adverse event reports after NAD+ injectable drugs, including severe chills, shaking, vomiting and fatigue, some needing medical treatment. It said the reactions were consistent with excessive endotoxin and that compounders were using food-grade NAD+ to make IV products2.
  • 20 Jan 2026In a warning letter, FDA said three patients who got NAD+ from the same vial made by GenoGenix, a Florida outsourcing facility, developed low blood pressure, uncontrollable shaking, shivers and body aches and were directed to the emergency room. An unopened vial from the same lot contained 3,360 EU/mL of endotoxin9.
  • 2026In a retrospective clinic series, all 6 people given 500 mg of IV NAD+ reported moderate to severe abdominal cramping, diarrhea, nausea, vomiting, faster heart rate, throat pain, congestion and chest pressure during infusions14.
  • 19 Jul 2026A 27-year-old woman died a little more than an hour after she was injected with NAD+ at a Bronx lifestyle center, police said. The man who injected her told police “I am not a licensed doctor in New York” and was charged with reckless endangerment and unauthorized practice27. In September 2026 the medical examiner ruled her death a homicide, caused by a cardiac air embolism from air let into an IV catheter during the procedure, prosecutors said37. On 6 October 2026 CBS reported that the man, licensed in the US only as an esthetician, had been indicted on charges including second-degree murder; his lawyer called her death an accident37.

Questions people ask

Is NAD+ a peptide?

No. NAD+ is a coenzyme made of two nucleotides and contains no amino acids3. It is often sold by the same clinics and online vendors as peptides, which is why it gets lumped in with them2229.

Is NAD+ FDA approved?

No. FDA has not approved it for any use, though an NAD+ injection is approved in China53538. Because NAD is in 503A Category 1 (list updated 14 May 2026), pharmacies may compound it under an FDA interim policy, which is not an approval78.

Do NAD+ IV drips work?

There is no good evidence that they boost energy or slow aging: a 2026 review of 113 studies found no outcome trial of NAD+ drips for those uses1. The largest randomized trial used 10 mg a day in heart-failure patients and found a modest heart-function gain at 1 month5. A smaller one, at 50 mg a day, found no clear difference from saline at any follow-up visit533.

NAD+ vs NMN or NR: what’s the difference?

NMN and NR are smaller vitamin B3 compounds that the body converts to NAD+, usually taken as oral supplements117. They have more trials than NAD+ itself, with mixed results, and those results do not show that injected NAD+ works1.

Is NAD+ banned in sports?

NAD+ itself is not on WADA’s 2026 or 2027 lists1124. But IV infusions or injections totaling more than 100 mL in 12 hours are banned outside hospital care, so a drip can break the rules11.

What are the side effects of NAD+ injections?

During IV infusions people report nausea, cramping, flushing and chest discomfort, often enough to slow the drip614. In a 3-day pilot of shots into a muscle, a vein or under the skin, pain and discomfort were the most common complaints36. Contaminated products have caused chills, shaking and low blood pressure29.

What is still unknown

  • Whether injected NAD+ improves energy, aging markers or any health outcome in healthy people; a 2026 review of 113 studies found no outcome trial of it for anti-aging or wellness.
  • Whether subcutaneous or intramuscular NAD+ raises NAD+ in human tissues; no pharmacokinetic study was found.
  • What a 2026 pilot found for fatigue and blood NAD+ after 3 days of shots; the authors say those results will be reported elsewhere.
  • Whether the modest heart-function gain in the 2026 Chinese heart-failure trial holds up in larger, multicenter trials.
  • Why FDA’s January 2026 warning letter treats NAD+ as ineligible for the 503B interim policy while beta-NAD is listed in 503B Category 1; a salt-form difference may explain it, but this was not verified.
  • What ‘buffered’ means on vendor NAD+ labels; not verified.
  • Regulatory status of injectable NAD+ in the UK and EU; not verified.

Sources

  1. 1NAD+ supplementation for anti-aging and wellness: A PRISMA-guided systematic review of preclinical and clinical evidence Ageing Research Reviews, Apr 2026. pubmed.ncbi.nlm.nih.gov
  2. 2FDA reminds compounders to use ingredients suitable for sterile compounding U.S. Food and Drug Administration, 30 Oct 2024. fda.gov
  3. 3Nadide (nicotinamide adenine dinucleotide, NAD+), CID 5892 PubChem, U.S. National Library of Medicine, accessed 1 Oct 2026. pubchem.ncbi.nlm.nih.gov
  4. 4NAD+ Boosting Strategies Subcellular Biochemistry, 2024. pubmed.ncbi.nlm.nih.gov
  5. 5Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial American Journal of Cardiovascular Drugs, Jan 2026. pubmed.ncbi.nlm.nih.gov
  6. 6Narrative review of intravenous NAD+ and NAD+ precursors in wellness and translational medicine Frontiers in Aging, 2026. pubmed.ncbi.nlm.nih.gov
  7. 7Bulk Drug Substances Nominated for Use in Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act (categories list) U.S. Food and Drug Administration, 14 May 2026. fda.gov
  8. 8Bulk Drug Substances Used in Compounding Under Section 503A of the FD&C Act U.S. Food and Drug Administration, 14 May 2026. fda.gov
  9. 9Warning letter to GenoGenix LLC (MARCS-CMS 718739) U.S. Food and Drug Administration, 20 Jan 2026. fda.gov
  10. 10NAD+: safety testing results and vendor ratings Finnrick, 24 Sep 2026. finnrick.com
  11. 11World Anti-Doping Code International Standard: Prohibited List 2026 World Anti-Doping Agency, 24 Sep 2025. wada-ama.org
  12. 12Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review American Journal of Physiology: Endocrinology and Metabolism, 1 Apr 2024. pubmed.ncbi.nlm.nih.gov
  13. 13A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD Frontiers in Aging Neuroscience, 2019. pubmed.ncbi.nlm.nih.gov
  14. 14Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting Frontiers in Aging, 2026. pubmed.ncbi.nlm.nih.gov
  15. 15Symptomatic and Ultrasonographic Improvement in Rheumatoid Arthritis Temporally Associated with Intravenous NAD+ Therapy: A Case Report ACR Open Rheumatology, Sep 2026. pubmed.ncbi.nlm.nih.gov
  16. 16Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women Science, 11 Jun 2021. pubmed.ncbi.nlm.nih.gov
  17. 17A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects The American Journal of Clinical Nutrition, 1 Aug 2018. pubmed.ncbi.nlm.nih.gov
  18. 18NAD+ administration decreases ischemic brain damage partially by blocking autophagy in a mouse model of brain ischemia Neuroscience Letters, 23 Mar 2012. pubmed.ncbi.nlm.nih.gov
  19. 19Treatment with NAD+ inhibited experimental autoimmune encephalomyelitis by activating AMPK/SIRT1 signaling pathway and modulating Th1/Th17 immune responses in mice International Immunopharmacology, Oct 2016. pubmed.ncbi.nlm.nih.gov
  20. 20Bulk Drug Substances Nominated for Use in Compounding Under Section 503B of the Federal Food, Drug, and Cosmetic Act (categories list) U.S. Food and Drug Administration, 21 Mar 2025. fda.gov
  21. 21Drug recall enforcement reports for products described as ‘NAD’ or ‘nicotinamide adenine dinucleotide’ (openFDA query; 16 records, data through 30 September 2026) U.S. Food and Drug Administration (openFDA), 30 Sep 2026. api.fda.gov · data query
  22. 22Think twice before injecting peptides bought online: unauthorized products can seriously harm you (RA-81874) Health Canada, 9 Apr 2026. recalls-rappels.canada.ca
  23. 23Therapeutic Goods (Poisons Standard—October 2026) Instrument 2026 (F2026L01327) Federal Register of Legislation, Australian Government, 28 Sep 2026. legislation.gov.au
  24. 24World Anti-Doping Code International Standard: Prohibited List 2027 World Anti-Doping Agency, 21 Sep 2026. wada-ama.org
  25. 25NAD+ 500 mg Injection Dosage Chart PeptideDosages, 26 Sep 2026. peptidedosages.com
  26. 26Those Viral Bodega Peptides Aren’t Actually Peptides WIRED, 15 Sep 2026. wired.com
  27. 27Woman’s death after injection at Bronx lifestyle center puts spotlight on NYS probe of unlawful medical spas CBS News New York, 21 Jul 2026. cbsnews.com
  28. 28As Hims prepares for peptides launch, Wall Street cautious on prospects this year Reuters (via Yahoo Finance), 12 Aug 2026. finance.yahoo.com
  29. 29Orbitrex homepage, ‘Best-selling research peptides’ list Orbitrex (vendor), accessed 30 Sep 2026. orbitrex.com (seller page, deliberately not linked)
  30. 30Prime Peptides homepage, ‘Most Popular’ list Prime Peptides (vendor), accessed 30 Sep 2026. primepeptides.co (seller page, deliberately not linked)
  31. 31We’d Rather Buy the Future Than Wait For It Finnrick, 10 Jun 2026. finnrick.com
  32. 32Utah Licensed Osteopathic Physician Indicted for Allegedly Receiving Misbranded Drugs from China and Selling them to Patients U.S. Attorney’s Office, District of Utah, 1 Apr 2026. justice.gov
  33. 33Effects of Nicotinamide Adenine Dinucleotide on Older Patients with Heart Failure Reviews in Cardiovascular Medicine, Aug 2024. pubmed.ncbi.nlm.nih.gov
  34. 34Randomized, placebo-controlled, pilot clinical study evaluating acute Niagen®+ IV and NAD+ IV in healthy adults medRxiv (preprint, not peer reviewed), 10 Jun 2024. doi.org
  35. 35NAD+ Enhanced on Hearing Recovery in Sudden Sensorineural Hearing Loss: Randomized Controlled Trial The Laryngoscope, Mar 2026. pubmed.ncbi.nlm.nih.gov
  36. 36Preliminary Safety Analysis of Two Pilot Clinical Trials Involving Injections of Niagen®, Nicotinamide Riboside Chloride medRxiv (preprint, not peer reviewed), 30 Apr 2026. doi.org
  37. 37Unlicensed Bronx practitioner charged with murder in anti-aging NAD injection death CBS News New York, 6 Oct 2026. cbsnews.com
  38. 38Drugs@FDA via openFDA: search for active ingredient nadide or nicotinamide adenine dinucleotide (no matches) U.S. Food and Drug Administration (openFDA), 8 Oct 2026. api.fda.gov · data query

Not medical advice. This page reports what studies and regulators say; it does not recommend using any product. How we grade evidence · Report an error.