What NAD+ is
NAD+ (nicotinamide adenine dinucleotide) is not a peptide at all but a coenzyme central to cellular energy metabolism, injected subcutaneously in longevity and energy protocols. Evidence for injectable NAD+ specifically is thin; the practice is ahead of the literature.
The practical reason it appears here is dosing mechanics: it ships in large vials (500 and 1000 mg), reconstitutes like a peptide, and has a well-earned reputation for side effects when pushed too fast.
What we do not know
- Nearly all human trials use PRECURSORS, nicotinamide riboside or NMN, not NAD+. Evidence for one is not evidence for the other.
- NAD+ does not readily cross cell membranes, so whether infused or injected NAD+ raises intracellular levels where it matters is unresolved.
- The popular IV infusion protocols, including for addiction and withdrawal, have essentially no controlled trial support at the doses and durations used.
Reconstitution math
Concentration is everything: the same 500 mg vial gives a different draw for every amount of bacteriostatic water you add. The table uses the common 5 mL setup for each vial size, which puts every unit on a U-100 insulin syringe at 1 mg for the default vial. Dashes mark draws too small to measure or larger than the syringe.
| Vial | BAC water | Concentration | 25 mg | 50 mg | 100 mg |
|---|---|---|---|---|---|
| 100 mg | 5 mL | 20 mg/mL | - | - | - |
| 500 mg | 5 mL | 100 mg/mL | 25 u | 50 u | 100 u |
| 1,000 mg | 5 mL | 200 mg/mL | 12.5 u | 25 u | 50 u |
Dosing and protocol
Common ramp: 25 mg, then 50, then 100 mg per injection, two to three times weekly.
Start low. Rapid or large doses commonly cause flushing, nausea, and cramping, which fade when the dose is smaller or injected more slowly. The common ramp runs 25 mg per injection for two weeks, then 50, then 100 mg, at two to three injections per week.
Pharmacokinetics
No curve is shown, on purpose.
Injected NAD+ acts by feeding the intracellular NAD+ pool, not by maintaining a plasma level, and no robust subcutaneous pharmacokinetic profile exists. A concentration curve would not describe anything useful.
How it is thought to work
NAD+ is an essential coenzyme in redox reactions and the substrate consumed by sirtuins and PARPs. Tissue levels fall with age, which is the entire basis for supplementing it. The important detail is that most research studies precursors, not NAD+ itself.
What the evidence supports
This table grades how well each outcome has been studied in humans, not how well NAD+ works. A strong grade means the question was asked properly, and the answer may still have been negative. Nothing here is inherited from a drug class, a close analog, or the parent molecule of a fragment.
| Outcome | Strongest published evidence |
|---|---|
| Clinical outcomes from precursor supplementation | Human RCT |
| Precursor supplementation raises blood NAD+ | Human RCT |
| Addiction or withdrawal treatment | No data |
| Outcomes from injected or infused NAD+ | No data |
Storage and handling
Lyophilized vials keep best cold, dark, and dry; refrigeration is the community default and freezing lyophilized powder is common for long holds. After reconstitution, refrigerate at 2 to 8 C, do not freeze the solution, and date the vial. Bacteriostatic water's preservative keeps multi-dose use practical for about 28 days by USP convention, though our 120-day stability study found the preservative itself outlasts that window.
Got a certificate of analysis with your vial? Run it through our COA Reader: it reads the report in plain English, checks purity and mass against the label claim, and links the testing lab’s own verification page. Our guide to reading a COA explains what the numbers do and do not tell you.
Sources
- Braidy et al., NAD+ metabolism in health and disease, Antioxid Redox Signal 2019
- Conlon, The role of NAD+ in regenerative medicine, Plast Reconstr Surg 2022PMID 36170435 · DOI