NAD+ is not a drug in any conventional sense — it is a coenzyme central to metabolism, cycling between NAD+ and NADH to shuttle electrons through glycolysis, the TCA cycle and oxidative phosphorylation. Separately, it is consumed as a substrate by sirtuins, PARPs and CD38, which is what links it to DNA repair and ageing biology. Tissue NAD+ declines with age, and that observation drives the entire field.
The pharmacological problem is fundamental: NAD+ is a large, charged molecule that does not readily cross cell membranes. Administered NAD+ is substantially degraded extracellularly to nicotinamide and related metabolites, which are then taken up and re-synthesised into NAD+ intracellularly. So intravenous NAD+ is, to a considerable degree, an expensive and uncomfortable way to deliver precursors — which is precisely the argument for NMN and NR instead.
The decline of NAD+ with age is well established. That raising it produces clinical benefit in humans is not. Precursor trials (NR, NMN) reliably raise blood NAD+ levels — a biomarker — while showing inconsistent and generally modest effects on the outcomes people actually care about. Evidence for intravenous NAD+ specifically, as sold by clinics, is close to nonexistent: it rests on uncontrolled observation and a very large amount of marketing.
Not an FDA-approved drug. Sold as an oral supplement (as precursors) and administered intravenously by clinics in a regulatory grey area. Nicotinamide riboside has NDI notification status; FDA has taken the position that NMN is excluded from the dietary supplement definition because it was authorised for investigation as a new drug, a determination that remains contested.
Oral precursors are well tolerated at studied doses. Intravenous NAD+ commonly causes chest tightness, nausea and flushing during infusion, which is why it is given slowly over hours. The deeper unknown is that NAD+ metabolism is not uniformly beneficial: NAD+ is also fuel for cancer cell proliferation, and long-term consequences of chronic elevation in humans have not been established.
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Regulatory status changes. This page reflects our reading of public sources as of July 2026 and should be independently verified before it is relied upon.