NAD+ (nicotinamide adenine dinucleotide) is a coenzyme found in every living cell, essential for energy metabolism, DNA repair, gene expression, and cellular signaling. It is the central molecule in the electron transport chain that powers ATP production in mitochondria.

NAD+ levels decline with age, chronic disease, alcohol use, and metabolic stress — contributing to fatigue, cognitive decline, impaired recovery, and accelerated aging. Compounded injectable and IV NAD+ is used in functional medicine, anti-aging protocols, addiction recovery programs, and neurodegenerative disease support.

No commercial injectable NAD+ product exists in the US — making compounding the only route to parenteral NAD+ therapy.

Mitochondrial Energy Production
NAD+ accepts electrons in glycolysis and the Krebs cycle, forming NADH which donates electrons to the mitochondrial electron transport chain to generate ATP. Adequate NAD+ is essential for efficient cellular energy production.

Sirtuin Activation
NAD+ is required for sirtuins (SIRT1–7) — a class of proteins regulating gene expression, stress response, and aging pathways. Higher NAD+ levels activate sirtuins, promoting cellular health and longevity.

DNA Repair via PARP
PARP enzymes (poly ADP-ribose polymerases) use NAD+ to detect and repair DNA strand breaks. PARP activation during DNA repair rapidly depletes NAD+ — why supplementation matters in aging and disease states.

IV infusion (clinic): 250–1000mg over 2–8 hours; series of 4–10 infusions for initial loading

SubQ injection (maintenance): 50–100mg daily or 2–3x per week

Nasal spray: 50–100mg daily; lower bioavailability than parenteral routes

IV infusion must be administered slowly to avoid flushing, chest tightness, and nausea. Faster administration increases side effect severity.