NAD+ Injections: Are the Wellness Claims Backed by Science?

The wellness industry is booming. “Breakthrough” therapies are coming out at a breakneck pace—stroll into any wellness clinic, and you’ll probably be pitched on NAD+, or Nicotinamide adenine dinucleotide.

People seek out NAD+ injections for its purported benefits to energy, recovery, and vitality. But does the science stack up to the hype? This article examines that question.

What Is NAD+?

NAD+ is a coenzyme that exists in every living cell in your body. Its job is to help ferry electrons around during chemical reactions, acting as a component of energy production in mitochondria (the “powerhouse of the cell,” if you recall from high school biology).

Its role in cellular functionality has made NAD+ of high interest in anti-aging research and marketing alike. One study in 2021 argued that NAD+ deterioration may contribute to metabolic disorders, neurodegenerative disease, or even certain types of cancer.

However, a clinical connection does not mean there’s a causative relationship—much less one that can be packaged into a wellness product. Researchers are still working to understand NAD+’s potential utility.

Why NAD+ Is Popular in Wellness Care

The health and wellness industry is having a moment as the landscape shifts away from broad holistic practices to something resembling “biohacking.” Interest in NAD+ injections has risen in concert. Precursors to NAD+ are sold as supplements, IV infusions are available, and, most commonly, NAD+ injections are offered at medical spas or wellness clinics.

What the Evidence Can and Cannot Say

Much of this hype is driven by laboratory animal research connections that have yet to be extrapolated into practical, real-world benefits. Is NAD+ an anti-aging magic bullet? Probably not, but it’s simply too early to say for sure. The research below is largely on oral NAD+ precursors, not injections.

What We Know From Oral NAD+ Precursor Studies

• A 2023 literature review found that NAD+ precursor supplementation was safe and tolerable, and could potentially increase NAD+ concentrations in cells.
• In 2024, another review looked at 10 existing studies and the impact of NAD/NADH supplementation on various conditions. Individual studies reported positive findings, but the evidence wasn’t strong enough to draw broad conclusions.

Put simply, oral NAD precursors do not appear to be harmful to the body. We’ve also seen isolated evidence of positive impact on certain conditions that arise due to aging, but…

What We Can’t Say

• Those same reviews remarked on the limited availability of robust evidence on NAD+ injections. Sample sizes in the existing studies are often small, and the actual physiological mechanism of action is unclear.
• We can’t say that NAD+ is side-effect-free. There are potential hazards. The literature reviews identified potential NAD+ side effects of muscle pain, nervous disorders, fatigue, sleep disturbance, and headaches. However, the prevalence of side effects is limited enough that oral precursors are broadly considered safe. Injectables carry additional, FDA-flagged concerns
• There is no direct clinical support for the idea that NAD+ injections tangibly delay or reverse aging in any meaningful way.

When it comes to NAD+ injections, safety concerns remain, mostly because of a lack of evidence.

Is NAD+ hollow hype? Not necessarily; it’s an emerging area of research. Existing drugs and supplements find new utility all the time; GLP-1s, for example, have decades of clinical data backing their safety, despite arriving to the public relatively recently as a weight-loss agent. NAD+ injections, however, currently lack the comprehensive evidentiary support that has propelled GLP-1 medications into widespread use.

NAD+ Injections vs. IV Infusions vs. Oral Precursors

NAD+ injections are just one delivery mechanism for the active ingredient. Knowing the differences is important so you can make an informed decision if you’re considering trying them out.

Oral precursors (nicotinamide riboside or nicotinamide mononucleotide) are taken by mouth as supplements.

IV infusions deliver NAD+ to the bloodstream directly over an extended period. This is distinct from the “default” injection, which delivers a much stronger concentration more quickly. These injections are typically administered subcutaneously.

Delivery mechanisms are not interchangeable. The format of a drug or supplement is one of the first things you need to understand before diving in.

Format	How It's Used	What We Know
Oral NAD+ precursors	People take supplements such as NR or NMN by mouth.	Human studies show they can raise NAD+ levels, and reviews have found them safe and tolerable.
IV NAD+	NAD+ is delivered directly into the bloodstream over an extended period.	Delivery is slower and more gradual than an injection. Reported infusion side effects include chills, shaking, vomiting, and fatigue.
NAD+ injections	NAD+ is typically injected subcutaneously.	Clinical evidence for claimed wellness benefits is still emerging, and the FDA has raised safety concerns involving compounded injectable NAD+

FDA Safety Concerns Around Injectable NAD+

Up front: NAD+ injections are not FDA-approved to treat, prevent, or cure any medical condition or disease. As such, most access to NAD+ injections or similar comes through compounding pharmacies. Compounding pharmacies are licensed and regulated, but compounded drugs do not undergo FDA premarket review for safety, effectiveness, or quality.

In 2024, the U.S. Food & Drug Administration issued a terse reminder of the untested safety concerns related to NAD+ injections, citing “severe chills, shaking, vomiting, and fatigue, with some [side effects] requiring medical treatment.”

The FDA specified that it has received reports of adverse reactions to NAD+ injections that are consistently attributable to "excessive levels of endotoxins.” The organization also advised compounders to be mindful of how they source and utilize ingredients in crafting NAD+ injections.

Why is the FDA getting involved when the product hasn’t been formally approved? FDA approval doesn’t prevent people from accessing trendy health interventions. By communicating about NAD+, prospective patients can better understand the drug's risks and the hazards of how compounders produce NAD+ injections.

Possible Side Effects and When To Seek Help

Reported side effects of NAD+ injections or infusions include many of the issues highlighted by the FDA: Chills, shaking, vomiting, or fatigue. Some patients report injection site discomfort or flushing as well.

It’s worth mentioning that some of these effects are common after injections or infusions of any sort. That said, persistent symptoms that intensify over time warrant prompt medical attention. Do not try to manage acute, progressive symptoms at home.

Questions to Ask Before NAD+ Treatment

If you’re thinking about NAD+ treatment, the best thing you can do is get as informed as possible before your appointment. A clinic or provider should have no problem providing transparent, detailed answers to questions like:

• What delivery mechanism is used for NAD+ and why?
• Is the product compounded, and if so, by what supplier or pharmacy?
• What dose is the product administered at?
• Are there any contraindications for NAD+ use, and how are patients screened?
• What side effects should I watch out for?

Bottom Line

NAD+ injections are getting plenty of attention, but the evidence has not caught up with many of the wellness claims surrounding them. Research on oral NAD+ precursors is more developed, while injectable NAD+ still has important gaps around both benefits and safety.

If you’re considering treatment, it’s reasonable to ask where the product comes from, how it’s prepared, and what side effects to watch for. For now, a little caution and a good conversation with your provider can go a long way.