NAD+ levels fall with age, and two very different products promise to bring them back up. One is NMN, a capsule sold in supplement aisles. The other is NAD+ itself, given as a shot, drip or spray by a telehealth prescriber. This page compares the two on what they are, how you get them, what FDA says and what the trials actually measured.
NMN is a precursor; NAD+ is the coenzyme it becomes
NMN is not NAD+. Cells convert NMN into NAD+, a coenzyme that hundreds of enzymes use to turn food into energy and to repair DNA. Taking NMN is an indirect route: you supply the raw material and let the body finish the job [4].
Taking NAD+ is the direct route, but it has its own problem. A pilot study of a 6-hour IV infusion found that NAD+ was "rapidly and completely removed from the plasma for at least the first 2 hours" [5]. Whether infused NAD+ reaches cells intact, or gets broken down and rebuilt, is not settled.
Side by side: NMN vs NAD+
| NMN | NAD+ | |
|---|---|---|
| What it is | A precursor the body turns into NAD+ | The coenzyme itself |
| How it's taken | Oral supplement (capsule, powder) | Compounded injection, IV drip or nasal spray |
| FDA status | Sold as a dietary supplement since FDA's 2025 reversal [10] | Not approved; compounded under 503A Category 1 (May 14, 2026) [8] |
| Prescription needed | No | Yes, from a licensed prescriber |
| Strongest human evidence | RCTs: blood NAD up in 80 adults over 60 days [1] | Heart-failure RCT in 180 patients [6]; IV pilot [5] |
| Outcome trials for aging | None | None [7] |
What NMN trials show: blood NAD goes up, benefits are mixed
Oral NMN reliably raises NAD in the blood. What that does for health is less clear, and several trials were run or funded by companies that make NMN.
- Yi 2023. 80 healthy middle-aged adults, four groups, 60 days. Blood NAD rose in every NMN group at days 30 and 60 (p≤0.001), and six-minute walk distance improved over placebo. Insulin resistance (HOMA-IR) did not change. The first author works for an NMN supplier and two co-authors for a chemical maker [1].
- Pencina 2023. 32 adults aged 55 to 80 with overweight or obesity took a pharmaceutical-grade NMN or placebo for 14 days. Blood NMN rose 1.7-fold and 3.7-fold in the two NMN groups, with dose-related rises in blood NAD [2].
- Morifuji 2024. 60 older adults, 12 weeks. The main test, a stepping test, showed no difference from placebo. Walking time over 4 meters and sleep scores were better on NMN. Three authors are employees of a food company [3].
- Yoshino 2021. Postmenopausal women with prediabetes and overweight, 10 weeks. Muscle insulin sensitivity and insulin signaling rose on NMN and did not change on placebo [4].
What NAD+ injection and IV studies show: almost nothing in healthy people
No trial has shown that NAD+ shots or drips improve aging or energy in healthy people. A 2026 systematic review of 113 studies found "no eligible outcomes trials" of IV or intramuscular NAD+ for anti-aging or wellness [7]. Its first author owns a company that provides management services to an aesthetics clinic, which does not offer NAD+ [7].
- Grant 2019. A pilot study of a 6-hour NAD+ infusion. Plasma NAD+ and its by-products did not rise for the first 2 hours, and NAD+ showed up in urine by 6 hours. Some co-authors are affiliated with an NAD+ research company and a wellness center [5].
- Yu 2026. 180 patients with heart failure from ischemic heart disease got a 7-day course of IV NAD+ or placebo on top of standard care. Ejection fraction at 1 month was 45.44% vs 42.44% (p=0.024). Major cardiac events at 6 months were 14.6% vs 24.7%, which was not statistically significant [6]. This is a disease population, not wellness use.
| Study | What was given | People | Length | What changed | Note |
|---|---|---|---|---|---|
| Yi 2023 [1] | Oral NMN | 80 | 60 days | Blood NAD up; walk distance up; HOMA-IR unchanged | Industry-affiliated authors |
| Pencina 2023 [2] | Oral NMN | 32 | 14 days | Blood NMN up 1.7x to 3.7x; NAD up | Biomarker study |
| Morifuji 2024 [3] | Oral NMN | 60 | 12 weeks | Main test unchanged; walking time and sleep scores better | Food-company authors |
| Yoshino 2021 [4] | Oral NMN | Women with prediabetes | 10 weeks | Muscle insulin sensitivity up | Narrow group |
| Grant 2019 [5] | IV NAD+ | Pilot | 6 hours | No plasma rise for 2 hours | NAD+ company and clinic affiliations |
| Yu 2026 [6] | IV NAD+ | 180 | 7 days, 6-month follow-up | Ejection fraction 45.44% vs 42.44% | Heart failure, not wellness |
| Gallagher 2026 [7] | Review | 33 human studies | 2010 to 2025 | No outcome trials of injected NAD+ for wellness | Author business tie disclosed |
For the full NAD+ record, see Do NAD+ injections work?, NAD+ IV therapy and NAD+ nasal spray.
FDA status: a supplement vs a compounded drug
NMN and NAD+ sit under different sets of FDA rules. NMN is regulated as a dietary ingredient. NAD+ shots are drugs made by compounding pharmacies.
NMN. In October 2022, FDA told an NMN maker that NMN was excluded from the supplement definition, because it had been authorized for study as a new drug before it was sold as a supplement, according to a legal analysis of the letter [9]. Trade groups petitioned FDA to reverse that. In September 2025 FDA responded to the petitions and changed its position, and in December 2025 it told ingredient makers that NMN is no longer excluded, according to trade press [10]. NMN is not an approved drug.
NAD+. NAD and its reduced form NADH are in Category 1 of FDA's 503A list, the group of ingredients FDA is still evaluating [8]. Under FDA's interim policy, state-licensed pharmacies may compound them on a prescription while that evaluation continues. That is not an FDA approval. For safety, see Are NAD+ injections safe?
What each costs
Compounded NAD+ injections run $79 to $468.28 a month across 46 prescribers. Two of the providers that sell it are Strut Health and AgelessRx; the provider list below this article shows the rest. The NAD+ page has the full price table by form.
NMN is sold over the counter as a supplement, so it doesn't appear in prescriber price tables here. Supplement prices and products vary widely, and supplements are not tested by FDA before sale.
If you're weighing NAD+ shots, ask these first
- Which pharmacy compounds the NAD+, and is it a state-licensed 503A pharmacy?
- Is it an injection, a drip or a nasal spray, and why that form for me?
- What result would tell us it's working, and when would we check?
- What is the monthly total after any intro price, including visit or lab fees?
There is no outcome trial to set expectations against, so a clear answer to the third question matters more than usual.
Taking both: what's known
No trial has tested NMN together with NAD+ injections. There is no evidence that combining them adds anything, and no data on safety for the pair. If you take one and are considering the other, raise it with the prescriber who would order the NAD+.
Who ends up with which
The choice people describe is less about evidence than about route. NMN is a capsule you can buy without a prescription, and it has the stronger trial record for raising blood NAD. NAD+ shots and drips need a prescriber and a compounding pharmacy, cost more, and have no trial showing a wellness benefit. Neither has been shown to slow aging. For how this site checks the providers that prescribe NAD+, see how we check, and for NMN itself, the NMN page.