NAD+

Origin and structure

NAD+ is not a peptide. Peptides are chains of amino acids; NAD+ is a dinucleotide, two nucleotides joined through their phosphate groups, one carrying the base adenine and the other nicotinamide, a form of vitamin B3. The plus sign marks the oxidised form: when the molecule picks up electrons it becomes NADH, and it is turned back into NAD+ when it hands them on. Every cell makes its own NAD+, from the amino acid tryptophan or from forms of vitamin B3: nicotinic acid, nicotinamide, nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN).

Two kinds of product are sold around it. NR and NMN are precursors, taken by mouth, that cells turn into NAD+. NAD+ itself is what wellness clinics give as an intravenous drip and what is sold for injection. The interest comes mainly from animal research: a 2026 systematic review counted 80 rodent studies in which raising NAD+ often improved metabolic, mitochondrial, inflammatory and functional outcomes, though not consistently across models and endpoints.

How it is thought to work

NAD+ has two jobs. As a coenzyme it carries electrons in the breakdown of sugar and fat and in the mitochondria, cycling between NAD+ and NADH without being used up. It is also consumed as a raw material by several enzyme families: sirtuins, which regulate metabolism and are linked to ageing in animal studies; PARPs, which help repair DNA; and CD38, an enzyme on immune cells. Because these enzymes break NAD+ down, the idea behind supplementation is that topping up the pool keeps them supplied.

What happens to NAD+ given by drip is less clear. When 8 healthy men received 750 mg over 6 hours, the NAD+ level in their plasma did not change during the first 2 hours: it was cleared as fast as it went in. Only by the end of the infusion was plasma NAD+ about four times its starting level, and the pattern of breakdown products pointed to enzymes that split NAD+ (NAD+ glycohydrolase and pyrophosphatase). NAD+ itself and methylnicotinamide, a breakdown product, then showed up in urine. Whether infused NAD+ reaches cells intact, or only as building blocks that cells rebuild into NAD+, has not been shown in people.

The precursors take a different route: taken by mouth, NR and NMN are absorbed and converted into NAD+ inside cells. Across trials they consistently raise NAD+ and related molecules in blood; whether that changes how tissues work is the open question.

Is NAD+ approved?

Not as a medicine in the EU or the US. China is the exception: there a low-dose NAD+ injection holds a national drug approval. The precursors are regulated as foods, and their status differs between the EU and the US.

Research-grade NAD+ is none of these products. It has no marketing authorisation, is not made under a medicines licence and is not intended for use in people. The approvals below describe the licensed products only.

• EU medicines: no medicine with NAD+ as its active substance is authorised. In the EMA's database of medicines authorised in the EU (October 2026 edition), NAD+ appears only as a homeopathic dilution ('Nadidum') in a handful of combination products in seven countries, including Germany and Austria; none of them is registered in the Netherlands.
• EU food law: the precursor NR, as nicotinamide riboside chloride, has been authorised as a novel food since 20 February 2020, in food supplements at up to 300 mg a day for adults and 230 mg a day in pregnancy and breastfeeding. NMN is not on the Union list of authorised novel foods (version of 10 August 2026). On 4 March 2026 EFSA concluded that synthetic β-NMN is safe in food supplements at up to 300 mg a day for adults, excluding pregnant and breastfeeding women; by late October 2026 the European Commission had not published an authorisation, so NMN is not an authorised food in the EU, including the Netherlands.
• China: NAD+ for injection, known there as 'coenzyme I', is a registered medicine; a 2026 Chinese trial used a 5 mg intramuscular product carrying a national drug approval number.
• US: no NAD+ product is approved by the FDA. The FDA lists NAD and its reduced form NADH among the bulk substances under evaluation for pharmacy compounding (category 1, list updated 14 May 2026); while that review runs, it does not intend to act against pharmacies that compound with them under set conditions. For NMN, the FDA said in October and November 2022 that it could not be a dietary supplement, because it had been authorised for investigation as a drug before it was lawfully sold as a supplement. On 29 September 2025 it reversed that position: it no longer requires the earlier sales to have been lawful, and NMN was sold as a supplement in the US as early as 2017, before the drug investigation was authorised.

What the research shows

There are two separate bodies of evidence: NAD+ itself, given by drip or injection, and the oral precursors NR and NMN. Most studies are small and short, apart from one large precursor trial, and both infusion studies below were partly funded by businesses linked to NAD+ drips:

• IV NAD+, pharmacokinetics (Grant, 2019): 11 healthy men aged 30 to 55; 8 received 750 mg NAD+ over 6 hours and 3 received saline. NAD+ and its metabolites in plasma did not change for the first 2 hours; by the end of the infusion plasma NAD+ was about four times its baseline, breakdown products had risen, and NAD+ and methylnicotinamide appeared in urine. No adverse events were seen at this slow rate. The study was co-funded by NAD+ Research Inc. and run at the clinic of a co-author that offers NAD+ drips.
• IV NAD+, tolerability (Reyna, 2026): a retrospective review of records at a US wellness chain, in which 6 clients received 500 mg NAD+ and 8 received 500 mg NR intravenously on four consecutive days. All 6 NAD+ clients reported moderate to severe abdominal cramping, diarrhoea, nausea, vomiting, a faster heart rate and chest pressure during the infusions, which ended when each infusion did; because of these symptoms, NAD+ infusions took 97 minutes on average against 37 for NR. ALT, AST, CRP, kidney function and TSH did not change over 30 days; alkaline phosphatase fell slightly but stayed within the normal range. The chain funded the study and employed the authors; the NR was donated by its maker.
• No outcome trials of drips: a 2026 systematic review of studies up to October 2025 found no trial that tested intravenous or intramuscular NAD+ for an ageing or wellness outcome.
• Intramuscular NAD+ in China (Gao, 2026): in a single-centre trial in Guangzhou, 45 adults with sudden hearing loss were randomised and 38 analysed. Those who received 5 mg NAD+ by injection daily on top of standard treatment regained more hearing after 3 months than those on standard treatment alone (40.2 against 23.1 decibels) and recovered faster (63 against 176 days). The control group got no placebo injection, the trial is small, and it was funded in part by the maker of the injection.
• Precursors (systematic review, 2026): 33 human intervention studies, 28 of them randomised, mostly of oral NR and NMN. Oral NR and NMN consistently raised NAD+-related molecules in blood and were generally well tolerated over weeks to months, but effects on physical function, metabolism, blood vessels and other health outcomes were mixed and often absent.
• NOPARK (JAMA, 2026): the largest trial of an NAD+ precursor, a phase 3 trial at 11 centres in Norway in 410 people with early Parkinson's disease. Participants received NR 500 mg twice daily or placebo for 52 weeks. On the main symptom scale (MDS-UPDRS) scores worsened by 2.45 points with NR and improved by 0.27 with placebo, a difference of 2.72 points in favour of placebo (95% CI 0.47 to 4.98); that is less than the 5.2-point worsening the trial report treats as clinically important, but in the wrong direction. Non-motor symptoms also worsened more with NR. The investigators concluded that the results do not support NR as a disease-modifying treatment.

Side effects and warnings

Infusions are where most side effects are reported. Given slowly, 750 mg over 6 hours, NAD+ caused no adverse events in 8 men. In the clinic review, all 6 clients given 500 mg drips reported moderate to severe abdominal cramping, diarrhoea, nausea, vomiting, a faster heart rate and chest pressure; because of these symptoms the drips took about two and a half times as long as NR infusions, and the symptoms ended when each infusion did. HDL cholesterol fell in the NAD+ group over 30 days, a finding of uncertain meaning in 6 people. In the Chinese hearing-loss trial no adverse events were reported with 5 mg injections, a dose 100 to 150 times lower than the drips in these studies.

Long-term safety is unknown. The published human data on injected NAD+ cover a few dozen people, and the studies cited here gave it for days, not months. Whether raising NAD+ can feed existing tumours is unresolved: in one animal model of triple-negative breast cancer, from a single lab, NR supplements made cancer more common and increased its spread to the brain. These are animal data only.

The oral precursors were generally well tolerated in trials lasting weeks to months. In NOPARK, serious adverse events were less frequent with NR than with placebo (8.3% against 14.1%), but Parkinson's symptoms ended up slightly worse. EFSA's 2026 assessment of NMN covers adults only and excludes pregnant and breastfeeding women.

Frequently asked questions

Is NAD+ legal in the Netherlands?

There is no NAD+ medicine on the Dutch market: no medicine with NAD+ as its active substance is authorised in the EU, apart from homeopathic dilutions in a few other EU countries. In food supplements, the precursor NR is authorised at up to 300 mg a day for adults, while NMN has not yet been authorised under EU novel-food rules, despite a positive EFSA safety opinion in 2026. Research-grade NAD+ is neither a medicine nor a food supplement and is not intended for use in people.

Is NAD+ banned in sport?

The substance is not named on the WADA Prohibited List for 2026. The method can be prohibited: under rule M2.2, intravenous infusions or injections of more than 100 mL in total within 12 hours are banned at all times, unless they are legitimately received during hospital treatment, surgical procedures or clinical diagnostic investigations; otherwise an athlete needs a Therapeutic Use Exemption. An NAD+ drip of more than 100 mL at a wellness clinic is therefore a prohibited method for athletes who are tested. The Dopingautoriteit's Dutch translation of the list contains the same rule.

Does an NAD+ drip work?

There is no good evidence that it does. The human data on intravenous NAD+ consist of one pharmacokinetic study in 8 men and small tolerability studies, and a 2026 systematic review found no trial that tested intravenous or intramuscular NAD+ for an ageing or wellness outcome. In the one pharmacokinetic study, infused NAD+ was cleared from the blood as fast as it went in for at least the first 2 hours, and its breakdown products pointed to enzymes that split it. In a clinic review, all 6 people given 500 mg drips had cramps, nausea and chest pressure, and their drips took far longer as a result.

What is the difference between NAD+, NMN and NR?

NMN and NR are precursors: smaller molecules, taken by mouth, that cells convert into NAD+. Across trials they reliably raise NAD+ in blood, but effects on health outcomes have been mixed and often absent, and the largest trial, NOPARK, found no benefit of NR in Parkinson's disease. NAD+ itself is given by drip or injection. Their legal status also differs: in the EU, NR is an authorised novel food at up to 300 mg a day, while NMN is not yet authorised; in the US, the FDA concluded in 2025 that NMN is not excluded from use in dietary supplements.

Is NAD+ a peptide?

No. Peptides are chains of amino acids; NAD+ is a dinucleotide, built from two nucleotides that carry adenine and nicotinamide, a form of vitamin B3. It is a coenzyme that every cell makes itself, not a peptide.

Storage and handling

Store according to product-label instructions and batch handling notes. Lyophilized research peptides are commonly kept dry, protected from light, and handled with clean laboratory technique.

References

Checked against these sources on 28 October 2026.

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