NAD+ injections: what does the evidence say?

Are NAD+ injections FDA-approved?

No. No NAD+ injection or infusion is an FDA-approved drug. NAD is on FDA’s 503A Category 1 list of bulk substances under evaluation, which lets a licensed pharmacy compound it for an individual prescription under FDA’s interim policy. Being on that list is not an approval. FDA

FDA states plainly that compounded drugs are not FDA-approved, and that compounders do not have to prove to FDA that their products meet the standards approved drugs must meet. FDA

What is NAD+?

NAD+ (nicotinamide adenine dinucleotide) is an essential cofactor present in cells. It takes part in energy production, DNA repair, cell signaling and gene expression. 2024

What do human studies show?

Little about benefit. A 2024 systematic review of randomized trials found 10 studies with 489 participants in total, across conditions such as chronic fatigue, Parkinson’s disease and prediabetes. The trials tested NADH and NAD precursor supplements, and the authors called for more research on clinical benefit. 2024

A 2026 review concluded that oral precursors such as nicotinamide riboside and NMN can raise NAD+ levels in blood, with variable clinical benefit, and that intravenous NAD+ is less well characterized and lacks robust clinical validation. NAD+ biology and supplementation

What side effects have been reported with IV NAD+?

In a 2026 review of records from a commercial infusion setting, people receiving IV NAD+ reported moderate to severe gastrointestinal symptoms, a faster heart rate and chest pressure during infusions. The symptoms resolved when infusions ended, and led to longer infusion times. Front Aging 2026

FDA has received adverse event reports after NAD+ injectable drugs, including severe chills, shaking, vomiting and fatigue, some needing medical treatment. FDA says these reactions are consistent with excessive endotoxin levels. FDA

FDA also says it is aware of compounders using food-grade NAD+ to make intravenous products, and that food-grade ingredients are not suitable for sterile compounding without appropriate processing. FDA

How are NAD+ injections different from NAD+ or NMN supplements?

Injections are prescription products made by compounding pharmacies; oral NAD+ and precursors such as NMN are sold as dietary supplements. FDA does not approve dietary supplements for safety or effectiveness before they are sold, so neither route has an FDA-reviewed claim of benefit. FDA

What should you ask a clinic that offers NAD+ injections?

Ask what the product is, who made it, and what the clinic will do if you react during an infusion.

• Which licensed pharmacy compounds the NAD+, and is it a 503A pharmacy or a 503B outsourcing facility? FDA
• Is the ingredient suitable for sterile compounding rather than food grade? FDA
• What evidence supports the reason I am considering it?
• Who monitors me during the infusion, and what happens if I feel unwell?
• Could it interact with my medicines or conditions?
• What is the full cost, and how many visits are you proposing?

NAD+ injections: questions, answered

Sources

1. FDA: 503A bulk drug substance categories list (May 14, 2026)
2. FDA: Is it really “FDA approved”? (updated May 4, 2026)
3. Safety and effectiveness of NAD in different clinical conditions: systematic review (2024)
4. NAD+ biology and supplementation: from mechanisms to clinical perspectives (Mol Biol Rep 2026)
5. Intravenous NAD+ versus nicotinamide riboside: retrospective tolerability pilot study (Front Aging 2026)
6. FDA: FDA reminds compounders to use ingredients suitable for sterile compounding (Oct 2024)
7. FDA: FDA 101, dietary supplements
8. FDA: Information for outsourcing facilities (503B)

Last reviewed October 7, 2026. Every source above was checked on or before that date. Educational information only, not medical advice; it does not replace a conversation with a licensed clinician. DiscoverMedica does not employ clinicians.