NAD+ IV Therapy

NAD as a coenzyme

Nicotinamide adenine dinucleotide (NAD) is a coenzyme found in cells. A 2019 review describes it as taking part in energy metabolism pathways, including glycolysis, beta-oxidation and oxidative phosphorylation, and as a required cofactor for enzymes such as sirtuins and poly(ADP-ribose) polymerases (PARPs), which are involved in DNA damage repair and gene expression. A 2018 review adds roles in calcium signaling and immune function, and describes two routes by which mammalian cells make NAD, the kynurenine pathway and the salvage pathway. The sources reviewed do not give a discovery date for the molecule.

Sirtuin and ageing research

A 2018 review describes sirtuins as NAD-dependent protein deacetylases and says their activity links NAD metabolism to processes including DNA repair, mitochondrial function and lifespan. That link prompted searches for more potent NAD precursors, typified by nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). Reviews also report that NAD levels fall with age and in obesity, which is the usual rationale for NAD boosting. A 2024 review co-authored by Leonard Guarente and David Sinclair, among others, lists NAD precursors as one of eight kinds of agent that have been tested in people in relation to ageing-related disease.

From oral precursors to infusion

In 2016 Trammell and colleagues reported what they described as the first clinical trial of NR pharmacokinetics in humans, in which single oral doses at three levels produced dose-dependent rises in the blood NAD metabolome. A 2026 study from a commercial clinic states that intravenous NAD and, more recently, intravenous NR became widely available in commercial clinics, likely with roots in early use for addiction disorders. The sources reviewed for this page do not document that earlier addiction-related use, including protocols associated with particular hospitals or clinicians, so that history is not described here.

NAD and NAD+

The sources use NAD and NAD+ for the same coenzyme, nicotinamide adenine dinucleotide. Gallagher and Emmanuel use the term parenteral NAD+ for administration by routes other than the gut, which in their review includes intravenous and intramuscular delivery. In clinics the product is usually called an NAD+ infusion, an NAD+ drip or NAD+ IV therapy, and the name describes a route of delivery for one compound, not a defined treatment protocol.

Infusion versus precursors

NAD+ boosting covers more than infusion. NAD precursors include nicotinamide (NAM), nicotinic acid (NA), NR and NMN, and they differ in where they enter the NAD synthesis pathways. A 2026 study explains that NAD itself cannot be absorbed intact from the gut or taken directly into cells, and that at high extracellular concentrations it is broken down into NMN and then into NR or NAM, which cells take up through specific transporters. These distinctions matter because findings for an oral precursor should not be read as findings for an infusion of NAD+.

Relation to IV therapy

NAD+ IV Therapy is one member of the wider family of elective infusions described on the Machipedia page IV Therapy, which is not duplicated here. A 2024 position statement by a clinical pharmacology society discusses hydration and vitamin infusions in general and names the Myers' cocktail, a mixture with its own Machipedia page, Myers' Cocktail. That statement does not name NAD+, so applying it to NAD+ infusions is an inference.

How a clinic infusion is described

A 2026 retrospective study describes the setting of one commercial wellness clinic in Texas. Clients were cleared by a nurse practitioner and had baseline blood tests. A nurse prepared the product from a freeze-dried powder, diluted it in saline and gave it through a small catheter in a vein while monitoring symptoms. Clients controlled their own infusion rate according to tolerance. The clinic repeated infusions on consecutive days, which the authors called a typical commercial series. This page does not give doses, rates or schedules, and practices differ between clinics.

Related products and routes

Clinics may also offer intravenous NR, and a systematic review notes parenteral NAD+ by intramuscular injection alongside infusion. Oral NR and NMN are sold as supplements and are the forms most studied in trials. Other infused products have their own Machipedia pages, including Intravenous Glutathione and Myers' Cocktail. The sources reviewed do not describe how often people use each form or how clinics choose between them.

Ageing, energy and wellness

Reviews describe NAD boosting as motivated by the reported decline of NAD with age, and describe supplementation with NAD and its precursors as commonly used with the aim of preventing age-related disease and extending healthspan. Gallagher and Emmanuel note that some wellness settings give NAD+ parenterally for these purposes. A 2024 position statement on hydration and vitamin infusions says companies advertise such infusions to boost immunity and energy without supportive data. That statement concerns infusions in general, and it does not name NAD+.

Brain health

A 2024 systematic review of NAD precursors in Alzheimer's disease found three preclinical studies of NMN and four of NR, no human trials of NMN, and two human trials of NR that reported improvements in plasma and neuroimaging biomarkers and cognitive measures. These were oral precursors, not infusions, and the authors state that further clinical studies are needed. The sources reviewed do not report trials of intravenous NAD+ for brain health.

Addiction

The 2026 clinic study notes that intravenous NAD therapies likely began with use for addiction disorders, and that deficiencies of the dietary NAD precursors niacin and tryptophan can occur in chronic alcohol use disorder. The authors present intravenous delivery as a plausible option for such groups, not as a tested treatment. The sources reviewed for this page include no controlled trial of intravenous NAD+ for addiction, and any account of success in this area rests on evidence not reviewed here.

Systematic review of NAD+ supplementation

A 2026 systematic review searched human and rodent intervention studies from January 2010 to October 2025 and included 113 studies: 33 in humans (28 randomized) and 80 in rodents. Rodent studies often reported improvements in metabolic, mitochondrial, inflammatory and functional outcomes, although effects varied. In humans, oral NR and NMN consistently raised circulating or cellular NAD-related metabolites and were generally well tolerated over weeks to months, but effects on functional, metabolic, vascular and other healthspan outcomes were mixed and often null. The authors concluded that clinical effectiveness for ageing or wellness remains inconclusive.

The same review found no eligible outcomes trials of intravenous or intramuscular NAD+ itself for ageing or wellness. It included one nonrandomized trial of intravenous NMN, which mainly supplied short-term safety and biomarker information, and it treated an intravenous NAD+ pharmacokinetic pilot without clinical outcomes as background only. Only the abstract of this review was available to the page author.

Oral precursor studies

The 2016 trial by Trammell and colleagues found that single oral doses of NR raised the blood NAD metabolome in a dose-dependent way, and that a related compound, nicotinic acid adenine dinucleotide, rose as a marker of NAD repletion. Some authors of that paper were employed by a company that supplies NR. A 2019 review notes that several human trials of NAD precursors have examined safety, pharmacokinetics and efficacy, including against glucose intolerance. A rise in blood NAD does not by itself show a health benefit.

Studies of intravenous infusion

The most direct report is a 2026 retrospective review of clinic records from 14 adults, 6 given intravenous NAD and 8 given intravenous NR, with 30 days of follow-up. It tracked symptoms, infusion time and blood markers. There were no significant changes in liver enzymes ALT and AST, C-reactive protein, kidney markers or thyroid hormone. Alkaline phosphatase fell in the NAD group and remained in the normal range. HDL cholesterol fell in the NAD group and HbA1c fell in the NR group, results the authors called exploratory.

The study had no placebo or matched control group, was retrospective and small, and its researchers were employed by the commercial clinic, which the authors list as a possible source of bias. It did not measure whether participants felt better. The authors refer to an unreviewed preprint trial and say longer, placebo-controlled randomized trials are needed. The study did not measure outcomes such as energy, ageing or addiction.

Reactions reported during infusion

In the 2026 clinic study, all six people given intravenous NAD reported moderate to severe abdominal cramping, diarrhea, nausea, vomiting, faster heart rate, throat pain, congestion and chest pressure during infusion. These stopped when the infusion ended, and people slowed the infusion in response, so average infusion time was about 97 minutes against 37 minutes for NR. Five of eight people given NR reported minor tingling of the tongue, jaw and arm or mild cramping. The authors document no adverse events beyond these experiences in 14 people, a sample too small to detect uncommon harms.

The authors report that clinicians and patients commonly describe nausea, malaise, sweating, stomach cramping and headache with NAD infusion, and suggest these may relate to high extracellular NAD, which cells can treat as a danger signal. They say slow, prolonged infusion is an anecdotal strategy that has not been formally studied.

Risks of elective infusions in general

A 2024 position statement from the American College of Clinical Pharmacology reports adverse events from elective hydration and vitamin infusions ranging from infusion site reactions to thrombophlebitis, cellulitis, hematoma and blood clots, and to fungal infection and septic shock, drawn from case reports. It notes that side effects often appear in the days after an infusion, when no medical oversight is present, and that kidney, heart and liver disease can increase sensitivity to fluid changes. It also raises concern that vitamin mixtures lack preparation standards and that the source, potency, purity and sterility of products are unclear. It gives typical treatment costs of $300 to $600.

Oversight, suitability and care boundaries

The college concluded that there is little to no evidence that benefits outweigh risks for hydration and vitamin infusions. It recommended that infusions be given with physician approval for a valid medical reason, by a licensed and trained person, with products compounded by a licensed pharmacist, emergency equipment and trained staff on site, informed consent, and coordination with the primary care provider. The statement does not name NAD+. The sources reviewed contain no society statement specific to NAD+ infusion, and no NIH Office of Dietary Supplements fact sheet on NAD precursors was found.

The clinic in the 2026 study listed pregnancy and a recent or family history of cancer as reasons not to infuse. This is one clinic's rule and not a general contraindication list. Chest pain, fainting, severe allergic symptoms or fever after an infusion warrant medical attention. This page is not a substitute for assessment, and infusions are not described by any source reviewed as a replacement for care of addiction or other illness.