NAD+ (Nicotinamide Adenine Dinucleotide) plays many important roles in the body. NAD+ is produced in the body through the metabolism of niacin1. It is most well-known for its involvement in energy production as a coenzyme for redox reactions in the mitochondrial electron transport chain, which produces ATP. It is also involved in several other cellular processes, including acting as a cofactor for enzymes that regulate cellular functions.
Understanding Its Different Molecular Forms
NAD+ and NADH are both forms of Nicotinamide Adenine Dinucleotide. NAD+ is the oxidized form of Nicotinamide adenine dinucleotide. When NAD+ accepts a hydride ion, it is reduced to form NADH2.
Current Areas Of Scientific Investigation
NAD+ is being investigated for its role in the aging process and use in Alzheimer’s, as levels decline with age¹. It has been found that as people age, NADH levels increase in the brain, while NAD+ levels decrease, indicating an imbalance in the redox state3. It is proposed that replacing depleted levels of NAD+ could be beneficial for many processes related to aging and disease.
Potential Side Effects
While there are no large randomized controlled studies, some common side effects reported are nausea, brain fog, cramping, tenderness, swelling, or bruising at the injection site, headaches, fatigue, abdominal pain, and diarrhea.
Some uncommon side effects include infection at the injection site and phlebitis.
Quality And Compliance Standards
Currently, there are no US drug products containing NAD+ that the FDA has approved for any clinical indication. NAD+ is included on the FDA’s bulk list of drugs authorized for use in compounding.
Guidelines For Clinical Practice
NAD+ is normally produced in the body through dietary intake of niacin or recycled through intracellular processes. A diet alone can be insufficient to maintain the needed levels of NAD+2. NAD+ can be administered in multiple ways.
NAD+ and NADH are available in a variety of over-the-counter supplements and compounded oral forms. It is also available as subcutaneous and intramuscular injections, as well as intravenous infusions from a compounding pharmacy. The limitation of using these products orally is the limited systemic absorption. NAD+ is a highly polar molecule that inhibits its ability to pass through the intestinal tract.
Additionally, NADH supplements don’t effectively increase blood levels due to the difficulty the body has in oxidizing NADH. The most effective way to increase levels of NAD+ is through parenteral administration, which is only available through a compounded pharmacy3.
Dosing Protocols
There are no approved dosages or regimens for using NAD+, but the following are common dose ranges:
- Inject 20-100mg subcutaneously one to three times per week.
- Patients typically start at a low dosage and titrate up by 20mg every 1-2 weeks, depending on effectiveness and side effects.
Produce Specifications And Handling
- Strength and form: NAD+ 100mg/ml injection solution
- Vial sizes: 5ml or 10ml
- Route of administration SQ (subcutaneous) or IM (intramuscular)
Proper Storage And Beyond-Use Date
NAD+ should be stored in the fridge from 36°F to 46°F. It will have a beyond-use date of approximately one month after the patient receives it and should be used within 28 days after the first vial is punctured.
Pricing
NAD+ is not likely to be covered by insurance plans. NAD+ is compounded from a bulk drug powder, which is often excluded from most insurance’s prescription drug plans.
How does Medivera Support Care?
Medivera Compounding Pharmacy has a staff of trained pharmacists eager to discuss NAD+ or any other medications with you or your staff. They can address any questions you may have regarding dosing, storage, shipping, or any other matter you need assistance with.
Coordinated Prescription Fulfillment And Patient Care
Our pharmacy takes pride in providing excellent customer service. When we receive a prescription, our pharmacy team will contact the patient to arrange pick-up or delivery and have a pharmacist discuss the use of each medication. You can count on Medivera to accurately and quickly take care of your patients’ needs.
Discover How We Can Support Your Patients
Our team is ready to help with any questions you may have on starting your patients on NAD+ or any other medication. We can also help in transitioning patients over from different pharmacies. Contact us today to address your questions and help your patients begin their journey to improved health.
Disclaimer: NAD+ is a custom-compounded drug product. Compounded medications are prepared at the direction of a healthcare provider and are not approved by the FDA.
This document is provided as a response to solicited questions about the use of NAD+.
