NAD+ (nicotinamide adenine dinucleotide) is a coenzyme every cell uses to turn food into energy, and levels fall with age in many tissues. Telehealth providers sell compounded NAD+ as a small injection under the skin that you give yourself at home. It is not an FDA-approved drug: NAD sits in Category 1 of FDA's 503A list, substances under evaluation, in the version FDA posted in May 2026 [7]. For what NAD+ is and its full status, start with the NAD+ overview.
Short answer: unproven for what it's sold for
Oral precursors, clinic IV products and home injections are different interventions. The cited review chiefly found human precursor trials; small IV reports and one disease-specific randomized trial cannot establish benefits of a commercial home-injection preparation.
| Claim | Relevant cited evidence | Route tested | Result | Strength of evidence |
|---|---|---|---|---|
| More energy, less fatigue | Reyna collected questionnaires in a small retrospective IV cohort [8] | IV | No controlled wellness benefit established | Very limited, nonrandomized |
| Sharper focus or memory | Reyna collected questionnaires in a small retrospective IV cohort [8] | IV | No controlled wellness benefit established | Very limited, nonrandomized |
| Slower aging | No eligible trial (Gallagher 2026) [1] | None | Not tested | None |
| Raises NAD+ inside cells | Pilot study (Grant 2019) [3] | IV drip | Grant measured plasma/urine metabolites, not delivery into a target organ or a home-injection tissue response | Very low |
| Heart failure | Randomized trial, 180 patients (Yu 2026) [2] | IV, 7 days | Primary one-month LVEF 45.44% vs 42.44%, P=.024; secondary six-month MACCE 14.6% vs 24.7%, P=.089 | Low (one center) |
| Addiction recovery | No controlled benefit established by the cited sources | Selected historical reports and literature review | No clinical efficacy conclusion for a current commercial regimen | Unestablished |
| NAD markers in blood rise | Precursor trials [1] | Oral NMN or NR | Yes; health outcomes mixed or null | Moderate for markers, not for injections |
What a 2026 systematic review found: no eligible injection trials
Gallagher and a co-author reviewed human and rodent studies of NAD-boosting compounds published from January 2010 to October 2025 [1]. They found 113 eligible studies: 33 in people, 28 of them randomized, and 80 in rodents. Oral NR and NMN reliably raised NAD-related markers and were generally well tolerated, but effects on health outcomes were "heterogeneous and often null."
Within that search period, no eligible outcome trial evaluated IV or intramuscular NAD+ itself for anti-aging or wellness. This is a route-, eligibility- and date-limited finding, rather than proof that no observational report or later study exists [1].
The review’s stated absence concerns eligible IV/IM wellness outcomes, not every possible subcutaneous study. Reyna’s later retrospective commercial-clinic report collected fatigue, cognition, quality-of-life and sleep questionnaires, but a small nonrandomized design does not establish clinical benefit [8]. “Not proven” should not be confused with “never measured.”
The trial people point to was an IV course in heart failure
The cited randomized trial enrolled180 adults in China with ischemic heart failure, adding seven days of IV NAD+ or placebo to standard treatment. Its primary one-month ejection fraction was 45.44% versus 42.44%(P=.024) [2]. The publication identifies a Chinese manufactured product; its findings do not validate a US pharmacy compound.
The six-month rate of heart attacks, strokes, cardiac deaths and heart-failure hospital stays looked lower on NAD+, but the prespecified secondary difference was not statistically significant. The other secondary measures, a heart-strain blood marker and symptom class, also leaned toward NAD+ without reaching significance. It's a single-center trial in seriously ill hospital patients, given by IV. Its disease-specific population, product and route do not establish a home-injection benefit for healthy users.
Blood biomarkers do not establish clinical benefit
NAD+ is a large, charged molecule that does its work inside cells, and enzymes in the blood break it down. In a 2019 pilot, a six-hour IV infusion of NAD+ produced no change in plasma NAD+ or its breakdown products for the first two hours. The authors concluded NAD+ was "rapidly and completely removed from the plasma" in that window [3]. Two of them were affiliated with an NAD+ research company and a wellness clinic.
Grant’s pilot measured plasma and urine metabolites, not direct delivery into human organs [3]. Reyna’s methods also describe whole-blood NAD+ sampling, which is not a randomized demonstration of improved tissue function or a clinical benefit [8]. Neither report establishes what a current home preparation does in its intended target tissue.
Pills and injections are different evidence
NMN and NR are precursors: your body converts them into NAD+. They are the subject of most human NAD research, and trials show they raise NAD-related markers in blood [1]. That is a result for a pill. It doesn't show that an injection of NAD+ itself does the same, or anything useful.
| Form | Where it's given | Studied for wellness? | |
|---|---|---|---|
| At-home NAD+ injection | At home, by you | Benefits not established by cited sources | This page |
| IV NAD+ drip | Clinic or med spa | No eligible IV/IM wellness trial in the cited review’s search period | NAD+ IV therapy |
| Oral NMN or NR | At home, as a supplement | Markers rise; outcomes mixed | NMN overview |
The pill-versus-NAD+ question is set out in NMN vs NAD+, and the nasal form in NAD+ nasal spray.
Safety in brief, and FDA's 2024 alert
There is no FDA label for NAD+ injections, so there is no official side-effect list. What FDA has published is a quality alert. In a notice last updated in October 2024, FDA said it was aware of compounders making intravenous products from food-grade NAD+, which carries a high risk of microbial and endotoxin contamination [4].
FDA has received adverse event reports following use of NAD+ injectable drugs, including severe chills, shaking, vomiting and fatigue with some requiring medical treatment. These reactions are consistent with excessive levels of endotoxins.[4]
FDA’s dataset lists a recall initiated July 30, 2025 as Class I for elevated endotoxins [5]. Another record from the same manufacturer concerns lack of sterility assurance [6]. These product records do not determine the quality of every provider’s product. Read the route-specific safety review.
Are NAD+ injections worth it? What you pay for, and what to ask
Current offers differ by preparation, quantity and billing interval; price is not proof of benefit. Confirm a product-specific quote and ask what measurable outcome would justify continuing treatment. Questions about the pharmacy and batch information are particularly relevant to FDA’s quality alert:
- Which pharmacy compounds the NAD+, and is it a 503A or 503B facility?
- Does the pharmacy use pharmaceutical-grade NAD+, and does it test each lot for endotoxin?
- What result would tell us it's working, and how will we measure it?
- Who do I contact if I get chills, shaking or vomiting after a dose?
Clear answers to the first two matter most, given FDA's alert. How these pages pick their sources is on how we check.