NAD+
Nicotinamide adenine dinucleotide, NAD
Essential metabolic cofactor sold as an injectable. The oral precursors have a dozen randomised trials behind them; the injections have none.
Anecdotal
NAD+ itself is a natural molecule, but injectable NAD+ products are unapproved drugs. Oral precursors NMN and NR are sold as supplements, with NMN's supplement status contested by the FDA.
What it is
NAD+ is a coenzyme present in every cell, central to converting food into ATP and required by the sirtuins and PARP enzymes involved in DNA repair. Levels decline with age. That decline is real and well documented, and it is the entire basis of the NAD+ supplement industry.
The evidence asymmetry
This is the cleanest example on the site of a claim outrunning its evidence:
| Form | Randomised controlled trials in humans |
|---|---|
| Oral NMN | 12+ |
| Oral NR | 10+ |
| Injectable NAD+ (SC or IV) | 0 |
The oral precursor trials consistently show one thing: they raise blood NAD+ levels safely. What they largely have not shown is that raising NAD+ produces the outcomes people want - more energy, better cognition, slower ageing. Even the well-studied form has a mechanism-to-outcome gap.
Injectable NAD+ has a genuine pharmacokinetic argument in its favour: it bypasses the gut and the enzymatic conversion steps that vary between individuals, so bioavailability is unambiguously higher. Higher bioavailability of a molecule whose clinical benefit is unproven is not the same as a better outcome, and there is no trial comparing the routes on anything that matters.
Practical notes
- The injection hurts. This is not a sourcing problem or a technique problem; it is characteristic of the molecule. Diluting further and injecting slowly helps.
- Rate is everything for IV. Flushing, nausea and chest tightness during infusion are rate-dependent and resolve on slowing down.
- Subcutaneous is more sustainable than IV for ongoing use - cheaper, done at home, no clinic time - which is why most people who continue past the novelty phase end up there.
- NAD+ degrades. Discolouration or precipitate means discard, not push through.
On sourcing
NAD+ is a case where batch quality varies more than usual, and vendors that test every batch and pull failures are behaving correctly rather than unusually. A supplier telling you a batch failed and is out of stock is giving you the most useful signal a supplier can give. See safety and sourcing.
Side effects and warning signs
Commonly reported
- Injection-site pain and stinging, consistently described as among the worst of any compound here
- Flushing, nausea and chest tightness - the hallmark of infusing too fast
- Headache and transient fatigue
- Anxiety-like sensations during IV administration
Stop and get medical help
- Chest tightness or severe nausea during administration - the standard response is to slow the rate substantially
- Persistent injection-site nodules or hardening
Sources
From the community
Discussion for this compound concentrates in r/Biohackers and r/Peptidesource.
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