NAD+: what clinics use it for and what the evidence shows
NAD+ is a molecule every cell uses to turn food into energy. It is not a peptide. It is a coenzyme, and it has become a popular injection and infusion for fatigue, recovery and healthy aging. This page explains what is being offered, what the research actually shows so far, and the side effects people report.
Information current as of November 10, 2026. Educational only. Confirm everything here with your own clinician before starting, stopping or changing any medication.
At a glance
What it is
Nicotinamide adenine dinucleotide, a coenzyme found in every cell. It is a small molecule, not a peptide.
What it is offered for
Low energy, recovery and general wellness. None of these uses is FDA-approved for NAD+ itself.
What the research shows
A 2026 systematic review found no eligible outcome trials of IV or injected NAD+. Effectiveness is inconclusive.
How it is given
By IV infusion or by injection under the skin or into muscle. Infusion rate matters for comfort.
Main side effects
Nausea, cramping, chest pressure and a fast heartbeat, especially with faster infusion.
Pharmacy status
On the FDA’s interim Category 1 list, meaning pharmacies may prepare it while the FDA reviews it.
Uses
What NAD+ is offered for
No NAD+ product is FDA-approved to treat a disease. Clinics that offer it usually describe it as support for energy, mental clarity, recovery after exercise or illness, and healthy aging. Some also offer it during substance withdrawal. These are marketing uses, not approved ones.
The idea has a real scientific root. NAD+ takes part in energy production and in repair of DNA, and levels in tissue fall with age in animal studies. The jump from that biology to a benefit from an injection is the part that has not been shown in people.
If your main problem is tiredness, the first steps are boring and effective: sleep, thyroid and iron labs, blood sugar, depression screening and medication review. Summit’s vitamin and nutrient program covers what can be checked and replaced.
How it works
How NAD+ is given
NAD+ can be given as an IV infusion, usually over a period of hours depending on the clinic, or as an injection under the skin or into muscle. Taking it by mouth does not raise levels well, because the molecule breaks down in the gut. That is why oral supplements use precursors such as nicotinamide riboside instead.
Summit is telehealth only and does not give infusions. Where NAD+ is appropriate, the prescription is for a pharmacy-prepared product, not an in-office infusion.
Evidence
What the studies show
A 2026 systematic review searched for human trials of IV or intramuscular NAD+ that measured real outcomes. It found no eligible studies. Its conclusion was that the effectiveness of NAD+ given this way remains inconclusive.
The most useful comparison is small. A retrospective pilot compared IV NAD+ with nicotinamide riboside, a related compound. Moderate to severe stomach symptoms, a faster heart rate and chest pressure were reported with IV NAD+, and the NAD+ infusion took longer, 97 minutes versus 37.
Oral nicotinamide riboside has better data on the narrow question of raising NAD+ levels. A study found that it does raise them and was well tolerated. Raising a blood level is not the same as improving how a person feels or lives. A review of IV longevity therapies describes them as experimental.
In short, NAD+ is a plausible idea without outcome trials behind it. Individual results vary, and trials in different populations are not directly comparable.
Safety
Side effects and cautions
The most common problems are nausea, belly cramping, flushing and a feeling of tightness in the chest. They tend to settle when the rate of an infusion is slowed. A faster heartbeat can occur. Any IV carries its own small risks, including vein irritation, infection and allergic reaction.
People with heart rhythm problems, heart disease or a history of cancer should talk with their physician first. There are no good data in pregnancy or breastfeeding, so it is not used.
Call your physician for
- Chest pain, a racing heartbeat or fainting
- Hives, swelling or trouble breathing
- Redness, warmth or swelling at an injection or IV site
- Vomiting that does not stop
Regulatory status
NAD+ and pharmacies
NAD+ is on the FDA’s interim Category 1 list of bulk substances nominated for compounding. Category 1 means the FDA does not intend to take action against pharmacies that compound it under section 503A while it reviews the substance. That is not an approval.
Compounded drugs are not FDA-approved. The FDA does not evaluate them for safety, effectiveness or quality before they are sold. Quality varies between pharmacies, which is why Summit uses an independent, state-licensed pharmacy and prescribes for a named patient only.
Summit’s role
What Summit does with NAD+
Dr. Miranda prescribes NAD+ after a physician evaluation. The prescription is prepared by an independent, state-licensed pharmacy for you as a named patient. Summit does not give infusions, and Dr. Miranda will tell you plainly where the evidence stops. Summit does not dispense or sell it, and it keeps no stock in the office.
Nothing on this page promises a prescription. If NAD+ does not fit your history, labs and goals, you will hear why. See pricing for what the program includes, including labs.
Common questions
Questions people ask
Is NAD+ a peptide?
No. It is a coenzyme, a small molecule. It is on the same FDA list as several peptides, which is why it appears here.
Is NAD+ FDA-approved?
No NAD+ product is FDA-approved to treat a condition. Pharmacies can prepare it under the FDA’s interim Category 1 policy.
Does NAD+ slow aging?
That has not been shown in people. A 2026 review found no eligible outcome trials of IV or injected NAD+.
Why not just take a supplement?
Oral precursors such as nicotinamide riboside raise NAD+ levels and are well tolerated in studies. Whether that helps how you feel is a separate question.
Why do infusions cause chest tightness?
The reports link it to infusion speed. Slowing the rate usually helps, which is why rate is set by the person giving it.
Sources
Where this comes from
All retrieved November 10, 2026.
- 2026 systematic review of intravenous and intramuscular NAD+ in humans. https://pubmed.ncbi.nlm.nih.gov/41655607/
- Retrospective pilot comparing IV NAD+ with nicotinamide riboside. https://pubmed.ncbi.nlm.nih.gov/41704678/
- Study of oral nicotinamide riboside raising NAD+ levels. https://pubmed.ncbi.nlm.nih.gov/29599478/
- Review of intravenous longevity therapies. https://pubmed.ncbi.nlm.nih.gov/41915584/
- FDA. Bulk drug substances nominated for use in compounding under section 503A: categories list, updated May 14, 2026. https://www.fda.gov/media/94155/download
Confirm with your provider. This page is general education, not medical advice, and it does not diagnose or treat anything. Every medication carries risks and is not right for everyone. Medication is prescribed only after a physician evaluation determines it is appropriate for you. Individual results vary and no outcome is guaranteed. Information current as of November 10, 2026.
Next step
Start with a physician evaluation
Dr. Miranda reviews your history, medications and goals before any decision about NAD+.