IV NAD+ is marketed by clinics and wellness businesses for energy and healthy aging. The relevant human reports address different questions: pharmacokinetics, short-term tolerability and a disease-specific heart-failure outcome. A systematic review found no eligible IV/IM wellness outcome trial within its search period [5].
NAD+ IV therapy is a compounded drug given by drip
US wellness IV NAD+ products are not FDA-approved. FDA lists NAD in 503A Category 1, under evaluation; the interim policy is conditional, not product authorization or a waiver of the other requirements [2]. International studies may use differently regulated products, which should not be equated with US compounded preparations.
What happens at a session: an in-person IV procedure
A clinician places a line in a vein, usually in the arm, and NAD+ diluted in a bag of fluid runs in slowly. You sit for the length of the drip. The studies give a sense of scale: the 2019 pilot used a single six-hour infusion [3], and the heart-failure trial gave a daily IV course for 7 days [4].
This page doesn't list drip rates or amounts. Those are clinical decisions, and the reviewed protocols do not establish a wellness benefit. The point for you is the setting: an IV is a medical procedure, with the risks of any line into a vein, not a supplement.
IV, at-home injection, nasal spray, pill: four different products
IV NAD+ goes straight into a vein, in a clinic. Telehealth NAD+ is a small injection under the skin that you give yourself at home, or a nasal spray, patch or pill. None of the 46 telehealth providers selling NAD+ as of this update lists an IV option. Oral NMN and NR are precursors, a different product your body converts into NAD+.
| Form | Where | Who gives it | Status | Wellness outcome trials | |
|---|---|---|---|---|---|
| IV drip | Clinic or med spa | A clinician | Compounded; 503A Category 1 | None eligible [5] | This page |
| At-home injection | Home | You | Compounded; 503A Category 1 | No controlled benefit established by the cited sources | Do NAD+ injections work? |
| Nasal spray | Home | You | Compounded | Uncontrolled reports and a provider survey do not establish benefit | NAD+ nasal spray |
| Oral NMN or NR | Home | You | Sold as dietary supplements | Markers rise; outcomes mixed [5] | NMN overview |
Clinic or telehealth: what changes for you
The two routes differ in who prescribes, who makes the product, and what you can check before paying.
- Who prescribes. Ask who prescribes, who places the line and who supervises on site. A remote consultation and the administration procedure are separate services.
- Who compounds it. A clinic buys its NAD+ from a pharmacy or outsourcing facility. A telehealth provider ships product from a mail-order pharmacy. Either way, ask for the pharmacy's name and whether it is a 503A or 503B facility.
- What you can check. Ask whether the NAD+ is pharmaceutical grade and tested for endotoxin. FDA’s 2024 alert makes those relevant questions for injected or infused products.
- How it is priced. Ask for the complete IV session charge and any series commitment. A home-product monthly quote is not an IV-session price.
Selected IV evidence answers different questions
Gallagher’s 2026 review included 113 studies: 33 human interventions, 28 randomized, and 80 rodent studies, searching January 2010–October 2025. It found no eligible IV/IM NAD+ wellness outcome trial; the IV PK pilot supplied context rather than clinical efficacy [5]. That search period does not include all later studies or historical reports before 2010.
| Study | Who | People | Design | Finding | Caveat |
|---|---|---|---|---|---|
| Grant 2019 [3] | Healthy men | 11 total: 8 NAD+, 3 saline | Saline-controlled six-hour PK pilot; full text reports random assignment | No change in plasma NAD+ or its breakdown products for the first 2 hours | Two authors affiliated with an NAD+ research company and a wellness clinic |
| Yu 2026 [4] | Adults with ischemic heart failure | 180 | Randomized, placebo-controlled; 7-day IV course on top of standard care | Ejection fraction 45.4% vs 42.4% at 1 month; 6-month events 14.6% vs 24.7%, not significant | One center; sick hospital patients, not wellness users |
| Gallagher 2026 [5] | Review of 113 studies | 33 human studies | Systematic review, January 2010 to October 2025 | No eligible wellness outcome trial of IV or intramuscular NAD+ | Mostly oral NMN and NR data |
| Reyna 2026 [1] | Commercial clinic clients | 6 NAD+, 8 NR | Retrospective comparison; four infusion days, 30-day follow-up | Infusion symptoms resolved; mean 97 vs 37 minutes | No saline control; all seven authors employed by the clinic company |
Yu’s 180-person heart-failure trial met its primary one-month LVEF outcome: 45.44% versus 42.44%, P=.024. Secondary six-month MACCE was 14.6% versus 24.7%, P=.089 [4]. Its manufactured Chinese product, hospital population and concomitant standard therapy do not establish routine US compounded-wellness benefits.
Blood biomarkers do not establish clinical benefit
NAD+ does its work inside cells, and enzymes in the blood and on cell surfaces break it apart. In the 2019 pilot, plasma NAD+ didn't move for the first two hours of the drip. The authors concluded it was "rapidly and completely removed from the plasma" in that window, with NAD+ and a breakdown product showing up in urine by six hours [3].
Reyna’s commercial-clinic study is now a published retrospective report, not an unpublished interview claim [1]. Its methods describe whole-blood NAD+ sampling and symptom questionnaires. These measures and plasma PK findings do not establish direct delivery into a target organ or a controlled wellness benefit.
Other marketed uses require their own clinical evidence
The cited evidence does not establish IV NAD+ as an effective treatment for addiction recovery, depression, long COVID or hangovers. Search results and case reports do not replace controlled outcomes for a defined condition. Ask for the actual study, population, product and comparator rather than a general NAD+ mechanism.
Safety: FDA's 2024 alert and the 2025 recall
There is no FDA label for IV NAD+, so there is no official side-effect list. FDA's main statement is about supply. In a notice last updated in October 2024, FDA said it was aware of compounders using food-grade NAD+ from repackagers to make intravenous products [6]. Food-grade ingredients carry a high risk of contamination with microbes and endotoxins, toxins from bacterial cell walls that can cause fever and shock.
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.[6]
FDA’s dataset lists the July 30, 2025 NAD+ recall as Class I for elevated endotoxin, with another same-manufacturer record for lack of sterility assurance [7] [8]. A product-specific recall is not a finding about every clinic or every compounded vial.
A 2026 retrospective chart review compared six NAD+ recipients with eight NR recipients at a commercial clinic. All six NAD+ recipients reported moderate to severe infusion symptoms, which resolved after completion; average infusion time was 97 minutes versus 37 minutes for NR [1]. Without randomization or a saline placebo, this study cannot estimate general-population risk or long-term safety. All seven authors worked for the clinic company. The route-specific discussion is in are NAD+ injections safe.
Questions to ask before a session
- Which pharmacy or outsourcing facility made this NAD+, and is it a 503A or 503B facility?
- Is it pharmaceutical grade, and was this lot tested for endotoxin?
- Who supervises the drip, and what happens if I react during it?
- What evidence do you rely on for my goal, and what result would show it's working?
A written ingredient or testing claim is a starting point, not proof that a particular batch is suitable. Ask the assigned pharmacy to explain the preparation and relevant results. The methodology distinguishes public disclosures from product-specific verification.