Compounded metabolic / longevity
Prepared by the ezGLP team. Sources last checked . Profile reviewed .
Also known as Nicotinamide adenine dinucleotide, Oxidized NAD
Routes represented in the knowledgebase: Subcutaneous (SubQ).
No FDA-approved NAD+ wellness drug. FDA has reported severe reactions associated with compounded injections made from unsuitable ingredients.
NAD+ (nicotinamide adenine dinucleotide, oxidized form) is a coenzyme present in every living cell, not a peptide or hormone. It shuttles electrons in glycolysis, the citric acid cycle, and oxidative phosphorylation, and serves as a substrate for sirtuins, PARP enzymes, and CD38, which consume it during DNA repair, gene regulation, and immune signaling. Cells make NAD+ from tryptophan and from vitamin B3 forms such as nicotinamide, nicotinic acid, nicotinamide riboside (NR), and nicotinamide mononucleotide (NMN). Tissue NAD+ levels are reported to decline with age in animals and, less consistently, in humans, which is the premise behind marketing of NAD+ injections, infusions, and precursor supplements.
A 2026 PRISMA-guided systematic review in Ageing Research Reviews identified 113 intervention studies from 2010 to 2025: 80 in rodents and 33 in humans, 28 of them randomized. Rodent work frequently reported metabolic, mitochondrial, and functional improvements. Human trials, mostly of oral NR or NMN, reliably raised blood NAD+ but produced inconsistent clinical effects on muscle, metabolic, or cognitive endpoints. Direct NAD+ administration by injection or infusion has almost no controlled human evidence; the available reports are small pharmacokinetic studies and case series, and the review noted that parenteral NAD+ is used in wellness settings well ahead of its evidence. No trial has shown a lifespan or healthspan benefit in people.
No NAD+ drug is approved by the FDA, the EMA, or comparable agencies for anti-aging, energy, or wellness indications. Injectable and intravenous NAD+ products sold in the United States are compounded preparations, which are not reviewed for safety or efficacy before marketing. In October 2024 the FDA reminded compounders that food-grade NAD+ from repackagers is not suitable for sterile products and reported adverse events after NAD+ injections, including severe chills, shaking, vomiting, and fatigue, some requiring medical treatment. Oral NR and NMN are sold as dietary supplements in many countries, with NMN's US supplement status contested by the FDA since 2022. Nasal sprays and patches are likewise unapproved.
Compounded NAD+ for injection is supplied either as a lyophilized powder for reconstitution or as a prepared solution in a vial, and its storage, protection from light, and beyond-use date are set by the compounding pharmacy label rather than a reference standard, since no approved product exists. The compound is chemically unstable in solution and degrades faster at room temperature. A dose log for NAD+ commonly records pharmacy and lot, form, concentration, route, date the vial was opened, and any reaction, since chills, nausea, and flushing during administration are the most frequently reported effects. An inventory record tied to beyond-use dates matters because reconstituted NAD+ is typically discarded within weeks.
No verified PubMed or DOI link is available for this entry.
Serious or important: severe chills, shaking, vomiting, or fatigue reported with unsuitable compounded injectable ingredients.
No established general drug-interaction profile was identified; this is a sterile-product quality warning.
Safety evidence sourceThese are general, pairwise evidence notes. Green identifies the potential-synergy category, while Lv3/Lv2/Lv1 communicates evidence strength; it does not guarantee benefit or cancel a safety warning.
NAD+ and BPC-157 are proposed as complementary for cellular-energy and tissue-repair goals, but no direct animal or human combination study has established synergy or safety.
Interaction evidence sourceNAD+ evidence reviewFDA BPC-157 safety assessmentSS-31 plus the NAD+ precursor NMN produced complementary cardiac effects in aged mice, providing an indirect rationale for interest in SS-31 with NAD+.
Interaction evidence sourceNAD+ evidence reviewElamipretide labelNNMT inhibition by 5-Amino-1MQ-related compounds increased intracellular NAD+ in preclinical work, creating an indirect combination hypothesis.
Interaction evidence source5-Amino-1MQ preclinical studyNAD+ evidence reviewNo. There is no FDA-approved NAD+ drug for any wellness, longevity, or energy indication. NAD+ injections and infusions in the United States are compounded products, which are prepared by pharmacies without premarket review. In October 2024 the FDA warned that some compounders were using food-grade NAD+ unsuitable for sterile products and reported adverse events including severe chills, shaking, vomiting, and fatigue, some requiring medical treatment.
Oral precursors such as nicotinamide riboside and NMN reliably raise blood NAD+ in randomized trials, but a 2026 systematic review of 33 human intervention studies found inconsistent effects on muscle function, metabolism, and cognition, with stronger findings confined to rodents. Direct NAD+ injection has almost no controlled human data. No study has demonstrated slower aging or longer life in people from any NAD+ product.
No. NAD+ is a dinucleotide coenzyme built from nicotinamide, two ribose sugars, two phosphates, and adenine. It is grouped with peptides in wellness catalogs because it is sold in similar vials and injected, but it has no amino-acid chain, works as an electron carrier and enzyme substrate rather than a signaling ligand, and derives from vitamin B3. Regulatory status and evidence are also different from those of peptides.
The FDA's 2024 compounding notice cites adverse event reports of severe chills, shaking, vomiting, and fatigue after NAD+ injectable products, some needing medical treatment. Infusion reports also describe chest tightness, flushing, nausea, and headache during rapid administration, which typically ease when the rate slows. Because products are compounded, contamination and ingredient-grade problems are a distinct risk from the molecule itself.
Summarised from published literature for reference only, with citations to the source. Evidence is graded as reported and is not a recommendation to combine, dose, or use any compound.
For personal tracking and education only. Not medical advice, diagnosis, or treatment, and not a medical device. Peptides may be prescription-only or unapproved where you live. Consult a licensed healthcare professional.
