Peptide Relay

Gathering the record

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Relay is organizing the evidence and source boundaries.

Compound library

Coenzyme / cofactor

Endogenous pyridine-dinucleotide coenzyme / redox cofactor

NAD+

Not FDA approved for wellness use

A molecule every cell uses for energy and repair. People research direct NAD+ for energy and aging-related claims.

6-minute readFull profile reviewed July 25, 2026

Evidence is explained by question. Dosing references show their own check dates.

60-second overview

NAD+ at a glance

Why people look into it, what studies found, and what is still unknown.

Why people look into it: Energy, aging, recovery, and whether direct NAD+ produces meaningful health benefits.
What studies found: Small infusion studies describe short-term effects. A heart-failure study found a pumping-function signal, but other clinical measures were not clearly improved.
What is still unclear: Lasting benefits for energy, aging, or recovery remain unestablished. Studies of NR or NMN test different substances and do not prove direct NAD+ benefits.

About the evidence and review date

Educational information only. Evidence reviewed through July 25, 2026. Published studies, sponsor announcements, and trials without results are labeled separately. Evidence gaps apply to the specific finding beside them.

Research questions

Why people research it

Each label shows how much evidence supports that question.

Cellular energy and redox metabolismTheory only
Age-related NAD+ biologyTheory only
Heart failure from ischemic cardiomyopathySupported by human studies
IV metabolism and tolerabilityEarly human evidence
General energy, fatigue, or recoveryNot demonstrated
Cognition or brain healthNot demonstrated
Addiction withdrawal or recoveryNot demonstrated
Human anti-aging or longevityNot demonstrated

What studies show

What the evidence supports

The research behind the answer

A 180-person randomized placebo-controlled trial in ischemic-cardiomyopathy heart failure found a short-term LVEF signal; it was single-center, disease-specific, and not a wellness or anti-aging trial

See each finding and its sources (10)

Mechanistic rationale

NAD+ itself is not interchangeable with NADH, nicotinamide riboside, nicotinamide mononucleotide, niacin, or nicotinamide.

They are related members of the same metabolic network, but they enter the body and cells differently and have different human studies, routes, side effects, and regulatory contexts.

A study showing that an oral precursor raises a blood NAD-related biomarker does not demonstrate that injected or oral NAD+ produces the same exposure or clinical effect.

Peer reviewedHuman evidence and parenteral-evidence synthesis

Peer reviewedRoute and precursor interpretation

Peer reviewedDirect IV metabolic-disposition results

Mechanistic rationale

NAD+ is a core redox cofactor and a substrate for enzymes involved in metabolism, DNA repair, signaling, and cellular stress responses.

Cells use the NAD+/NADH pair to move electrons during energy metabolism. NAD+ is also consumed by sirtuins, PARPs, CD38, and related enzymes.

A molecule having an essential biological role does not mean that taking more of it improves energy, slows aging, or treats disease.

Peer reviewedBiological rationale

Peer reviewedMechanistic overview

No direct evidence located

Direct NAD+ has not been shown in eligible outcomes trials to provide anti-aging or general wellness benefits.

A 2026 systematic review found no eligible IV or IM NAD+ outcomes trial for anti-aging or wellness. The broader human literature mostly studied oral NR or NMN.

Absence of qualifying trials is not proof of no effect, but marketing claims exceed the direct clinical evidence.

Peer reviewedSystematic-review results and conclusion

Peer reviewedClinical validation boundary

Controlled human study

One randomized human trial found a short-term cardiac-function signal in ischemic cardiomyopathy.

Among 180 adults with heart failure from ischemic cardiomyopathy, seven days of hospital-administered IV NAD+ improved average LVEF more than placebo at 1 month.

Secondary clinical-event and functional outcomes were nonsignificant trends. The single-center result needs independent multicenter replication and does not generalize to healthy people or other goals.

Peer reviewedPrimary outcome, secondary outcomes, and limitations

Other human evidence

Directly infused NAD+ is rapidly removed or metabolized rather than simply remaining intact in plasma.

In an 11-person pilot, measured plasma NAD+ and metabolites did not rise during the first 2 hours, while urinary NAD+ and methyl-nicotinamide increased later.

This small study describes metabolic disposition, not a clinical benefit or an optimal infusion schedule.

Peer reviewedPlasma and urine metabolome results

Other human evidence

Commercial IV NAD+ can produce marked symptoms during infusion.

In a six-person NAD+ record review, clients reported gastrointestinal symptoms, faster heart rate, and chest pressure that resolved after the infusion; the average infusion took about 97 minutes.

The study was tiny, retrospective, nonrandomized, and company-linked. It cannot estimate population incidence or determine how product, dose, concentration, or flow rate contributed.

Peer reviewedAdverse-experience and infusion-time results

Other human evidence

Injectable NAD+ has a documented sterile-product and endotoxin risk.

FDA has received reports of severe chills, shaking, vomiting, and fatigue. In a 2026 warning letter, an unopened vial from a reaction-linked lot contained very high bacterial endotoxin levels.

These events demonstrate product-quality risk and do not establish the intrinsic adverse-event rate of correctly manufactured pure NAD+.

Regulatory sourceInjectable NAD+ adverse-event notice

Regulatory sourceComplaint investigation and endotoxin test

No direct evidence located

No FDA-approved NAD+ injection or wellness/anti-aging indication was located, and NAD+ was not eligible for 503B bulk compounding exemptions in FDA's 2026 enforcement record.

There is no approved U.S. NAD+ product label that establishes a standard indication, injectable formulation, dose, route, manufacturing specification, or storage procedure.

503A and 503B are different legal pathways, and regulatory status can change. Current FDA resources should always be rechecked.

Regulatory sourceFDA approval lookup and July 2026 search

Regulatory source503B bulk-drug-substance finding

No direct evidence located

No universal research dose, infusion rate, injection route, reconstitution method, or storage standard can be taken from the current direct NAD+ evidence.

Published studies used very different hospital or commercial IV regimens for different questions. Those protocols describe the studies; they are not general instructions.

Changing formulation, concentration, source, route, rate, population, or sterility controls can change exposure and risk.

Regulatory sourceSterile ingredient and endotoxin warning

Peer reviewedDisease-specific study protocol

Peer reviewedMetabolism-pilot protocol

Peer reviewedCommercial-record protocol

No direct evidence located

Direct NAD+ has not been demonstrated in controlled human trials to improve weight loss, appetite, cognition, athletic recovery, addiction withdrawal, chronic fatigue, or longevity.

These are common reasons people discuss NAD+, but direct clinical outcomes evidence is missing or insufficient. Precursor, NADH, animal, and mechanistic studies do not fill that gap.

This statement is limited to direct NAD+ evidence through the cutoff and should be updated if new molecule-specific trials publish.

Peer reviewedDirect NAD+ outcomes-trial boundary

Peer reviewedClinical-evidence limitations

Risks & unknowns

What needs caution

Reported side effects

Injectable NAD+ has a documented sterile-product and endotoxin risk.

Other human evidence

These events demonstrate product-quality risk and do not establish the intrinsic adverse-event rate of correctly manufactured pure NAD+.

Open source

Important warnings

Injectable NAD+ has a documented sterile-product and endotoxin risk.

Other human evidence

These events demonstrate product-quality risk and do not establish the intrinsic adverse-event rate of correctly manufactured pure NAD+.

Open source

Missing reports do not establish safety. Findings apply to the product, route, amounts, population, comparison, and follow-up studied.

Side-effect frequency, study withdrawals, and gaps

How often side effects occurred

The available information does not reliably show how often particular side effects occur.

Evidence boundary

Under-detected or under-reported events must not be described as rare.

Why people stopped in studies

Relay has not verified which side effects led people to stop treatment in studies.

Evidence boundary

This is an evidence gap, not proof that discontinuations did not occur.

Emergency instructions

This profile does not contain verified, product-specific emergency instructions.

Evidence boundary

Relay does not infer emergency guidance from study discontinuations, mechanism, or incomplete adverse-event reporting.

Dosing references

Dosing & preparation

Each table labels its source and applies only to the named route, product, or study. An online example or community report is not an approved dose.

View by route

IVSubQ

IV · Into a vein

Human study · source-specific regimenWhat this means

Amounts reported in a human study. A studied amount is not automatically an approved dose or a recommendation for an individual.

NAD+ · ischemic heart-failure trial

A single-center randomized trial enrolled 180 adults with ischemic cardiomyopathy and heart failure, alongside guideline-directed therapy.

Amount in this source: 10 mg/day
Frequency: Daily
Treatment period: 7 days

NAD+ · ischemic heart-failure trial
Stage / period	Amount in source	Frequency
7 days	10 mg/day	Daily

The study evaluated cardiac outcomes in a defined disease population. It does not establish a subcutaneous wellness regimen or replace standard heart-failure care.

NAD+ · randomized ischemic-cardiomyopathy trial Primary article · Methods / interventionThis reference checked Oct 20, 2026. The full-profile review date is shown at the top.

Preparation & concentration · IV

This source does not establish a mixing volume or storage period for independently sourced powder. Use formulation-specific instructions; the study amount alone is not a reconstitution recipe.

Concentration = total mass ÷ final volume. The calculator performs user-entered math; it does not choose a dose or diluent.

Open concentration calculator

Starting dose, maintenance, and trial targets explained

Starting dose: the amount used at the beginning of the named label schedule or trial.

Maintenance: the ongoing amount described by that product label.

Trial target: the amount assigned to a study group. Different groups may stop increasing at different targets.

Other source records, populations, and limits · all routes

Route-limited human evidence

Intravenous NAD+ ischemic-cardiomyopathy study material

Amount in this source: See the named dosing references above; this additional source record does not add a verified amount.
Frequency: Once daily during a seven-day trial protocol
Route: Intravenous administration in a hospital study
Duration: Seven treatment days; LVEF at 1 month and clinical follow-up through 6 months

Population, study design, and limitations

A single-center randomized trial investigated intravenous NAD+ alongside guideline-directed care in adults with heart failure caused by ischemic cardiomyopathy.

Population: 180 adults with heart failure caused by ischemic cardiomyopathy, LVEF at or below 45%, and NYHA class II or III

Design: Single-center, prospective, randomized, placebo-controlled trial alongside guideline-directed heart-failure therapy

The trial was disease-specific, single-center, short, and too small to establish effects on major clinical events.
It does not establish wellness, anti-aging, cognition, recovery, addiction, weight, or longevity benefits.

Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled TrialSelected study record

Mechanisms

How it works

Oxidized nicotinamide adenine dinucleotide is the electron-accepting member of the NAD+/NADH redox pair and a substrate for sirtuins, PARPs, CD38, and related enzymes. Direct human research includes an 180-person single-center randomized trial in ischemic-cardiomyopathy heart failure, an 11-person IV metabolic-disposition pilot, and a 14-person commercial-record comparison containing six NAD+ recipients. The heart-failure trial reported a larger short-term LVEF improvement but nonsignificant trends for clinical events and functional measures. The IV pilots show rapid metabolism and potentially substantial infusion symptoms, not wellness effectiveness. A 2026 systematic review found no eligible IV or IM NAD+ outcomes trial for anti-aging or wellness. FDA has also documented endotoxin-related injectable reactions and a 503B compounding-eligibility problem.

Why this matters

A plausible mechanism can explain why a study was attempted. It does not prove that the compound improves a human outcome.

Signals and targets

Proposed biological steps

NAD+/NADH redox cycling in energy metabolism
Electron transfer in glycolysis, the TCA cycle, and oxidative phosphorylation
Substrate activity for sirtuins
Substrate activity for PARP-mediated DNA repair
CD38 and extracellular NAD+ metabolism
Cellular compartment and salvage-pathway regulation

Research reference

How mature is the evidence?

A reference for the studies, populations, and routes behind this profile.

Research depthLimited direct human evidence

The direct NAD+ record is small; most broader literature belongs to NR or NMN.

Why this matters

Research depth describes how large and mature the overall record is. It does not tell you whether the results were positive.

Evidence confidenceLow outside a narrow cardiac setting

One controlled disease-specific signal has not established general wellness outcomes.

Why this matters

Confidence describes how reliable and consistent the conclusions are. It can be high for one outcome and low for another.

Strongest evidenceOne 180-person randomized hospital trial

Why this matters

The strongest evidence type shows what the best-supported conclusions are actually based on.

Human evidenceEarly and route-specific; wellness claims remain unproven

Why this matters

Human findings are more directly relevant than animal or laboratory results, but they still apply only to the populations and outcomes studied.

Route-specific record

Which product or study does this describe?

Intravenous NAD+ ischemic-cardiomyopathy study materialAmounts and schedules below belong to this source record.Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial Administration reference reviewed Aug 5, 2026

Route studiedIntravenous administration in a hospital study

Schedules studiedOnce daily during a seven-day trial protocol; Seven treatment days; LVEF at 1 month and clinical follow-up through 6 months

Amounts studiedWithheld: this record provides research context without a transferable amount

Why this matters

These are exposures used in cited research for a specific route and population—not an instruction for an individual.

Half-lifeNot established for this exact editorial record

Why this matters

Half-life describes how long it takes the measured amount in the body to fall by half. It is not a dosing recommendation.

Route evidenceA single-center randomized trial investigated intravenous NAD+ alongside guideline-directed care in adults with heart failure caused by ischemic cardiomyopathy.

Why this matters

Evidence can change by administration method. Findings from one route should not automatically be applied to another.

Evidence boundary: The trial was disease-specific, single-center, short, and too small to establish effects on major clinical events. It does not establish wellness, anti-aging, cognition, recovery, addiction, weight, or longevity benefits. Amounts shown describe cited research exposure—not a dosage recommendation.

Studies

Study-by-study record

Study arms are reported for transparency. They describe what researchers did in a defined record and do not transfer across identities, routes, formulations, or populations.

Why this matters

A later trial phase can ask a more mature question, but it does not guarantee a positive result, regulatory approval, or relevance outside the studied population.

Controlled human studyPeer reviewed

Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial

Peer reviewed

PhaseNot stated

Population180 participants

DurationSeven treatment days; LVEF at 1 month and clinical follow-up through 6 months

Design and population

Single-center, prospective, randomized, placebo-controlled trial alongside guideline-directed heart-failure therapy

180 adults with heart failure caused by ischemic cardiomyopathy, LVEF at or below 45%, and NYHA class II or III

Outcomes measured

Left-ventricular ejection fraction at 1 month
NT-proBNP at 7 and 30 days
Major cardiac and cerebrovascular events through 6 months
NYHA functional class
Laboratory and adverse-event monitoring

What was reported

The NAD+ group had a larger average LVEF improvement than placebo at 1 month. Secondary biomarker, hospitalization, event, and functional-class differences were trends that did not reach conventional statistical significance.

Study administration and important limits

Study administration: Intravenous NAD+ 10 mg once daily for 7 days versus matched glucose or saline placebo; this was a study-specific hospital protocol

Limitations: This was one single-center disease-specific trial, not a wellness study. It was too small for clinical events, follow-up was short, SGLT2-inhibitor use was low, and the manufacturer supplied study drug and funding. The result does not establish longevity, energy, cognition, addiction recovery, or a general IV protocol.

Other human evidencePeer reviewed

NAD+ supplementation for anti-aging and wellness: A PRISMA-guided systematic review of preclinical and clinical evidence

Peer reviewed

PhaseNot stated

Population113 participants

DurationLiterature search through October 2025

Design and population

PRISMA-guided systematic review of human and rodent NAD-related intervention studies published from 2010 through October 2025

113 studies: 33 human intervention studies and 80 rodent studies

Outcomes measured

NAD-related biochemical target engagement
Functional, metabolic, vascular, and healthspan outcomes
Tolerability
Availability of direct IV or IM NAD+ wellness outcomes trials

What was reported

NR and NMN usually raised NAD-related biomarkers, but functional and health outcomes were mixed and often null or endpoint-specific. The review found no eligible outcomes trial of IV or IM NAD+ itself for anti-aging or wellness.

Study administration and important limits

Study administration: NAD-related compounds across routes; most human evidence involved oral NR or NMN rather than direct NAD+

Limitations: The review combines different molecules, routes, populations, and endpoints. Results from NR, NMN, niacin, nicotinamide, or NADH cannot be assigned to direct NAD+.

Other human evidencePeer reviewed

Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting

Peer reviewed

PhaseNot stated

Population14 participants

DurationFour consecutive infusion days with 30-day follow-up

Design and population

Retrospective electronic-record review from a commercial wellness setting; nonrandomized NAD+ versus NR groups

14 commercial clients: 6 received IV NAD+ and 8 received IV nicotinamide riboside

Outcomes measured

Infusion symptoms and total infusion time
Blood pressure and resting heart rate
Liver, kidney, inflammatory, thyroid, and metabolic laboratory markers

What was reported

The six NAD+ clients reported moderate-to-severe gastrointestinal symptoms, increased heart rate, and chest pressure during infusions; symptoms resolved after infusion. NAD+ infusions averaged about 97 minutes versus 37 minutes for NR. Exploratory laboratory changes were variable and stayed within normal ranges.

Study administration and important limits

Study administration: 500 mg IV NAD+ or 500 mg IV NR on four consecutive days; participants could slow the flow rate for tolerability

Limitations: The sample was tiny, retrospective, commercially selected, nonrandomized, and company-employed investigators analyzed company records. It cannot establish effectiveness, comparative superiority, rare-event safety, or durability.

Other human evidencePeer reviewed

A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD

Peer reviewed

PhaseNot stated

Population11 participants

DurationSix-hour infusion with sampling through 8 hours

Design and population

Small randomized metabolic-disposition pilot with intensive plasma and urine sampling

11 men aged 30 to 55: 8 received NAD+ and 3 received saline

Outcomes measured

Plasma NAD+ and related metabolites
Urinary NAD+ and methyl-nicotinamide
Metabolic fate during and after infusion

What was reported

Plasma NAD+ and measured metabolites did not rise during the first 2 hours. By 6 hours, urinary NAD+ and methyl-nicotinamide increased, consistent with rapid removal and metabolism of infused NAD+.

Study administration and important limits

Study administration: The test group received 750 mg IV NAD+ over 6 hours; this was a study regimen derived from commercial-clinic practice, not an approved protocol

Limitations: Only eight participants received NAD+, the control group had three people, all were men, and the study measured disposition rather than fatigue, cognition, longevity, recovery, or other clinical benefit.

Community

Experience reports stay separate from published evidence

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Help strengthen the NAD+ experience record

Every structured report adds useful context about research setup, outcomes, and unwanted effects as the community dataset grows.

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Sources

Trace every major statement

Regulatory source

FDA reminds compounders to use ingredients suitable for sterile compounding

Regulatory source

Regulatory source

FDA: How to find out whether a drug is approved

Regulatory source

Peer reviewed

NAD+ biology and supplementation: From mechanisms to clinical perspectives

2026-07-23 · PMID 42489969 · DOI 10.1007/s11033-026-12351-3

Peer reviewed

Peer reviewed

NAD+ supplementation for anti-aging and wellness: A PRISMA-guided systematic review of preclinical and clinical evidence

2026-02-06 · PMID 41655607 · DOI 10.1016/j.arr.2026.103057

Peer reviewed

Peer reviewed

Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting

2026-02-02 · PMID 41704678 · DOI 10.3389/fragi.2026.1652582

Peer reviewed

Regulatory source

FDA warning letter: GenoGenix LLC

2026-01-20

Regulatory source

Peer reviewed

Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial

2025-09-15 · PMID 40954388 · ChiCTR2200059169 · DOI 10.1007/s40256-025-00764-7

Peer reviewed

Peer reviewed

A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD

2019-09-12 · PMID 31572171 · DOI 10.3389/fnagi.2019.00257

Peer reviewed

Profile identity

NAD+

Aliases: Nicotinamide adenine dinucleotide, Oxidized nicotinamide adenine dinucleotide, beta-NAD+, Coenzyme I

Targets: No single therapeutic receptor target, Sirtuins — NAD+-dependent enzymes, PARPs — NAD+-consuming enzymes, CD38 — NAD+ glycohydrolase

Evidence maturity: Early direct human evidence: one moderate-size disease-specific randomized trial plus very small IV metabolism and tolerability studies. Anti-aging, wellness, fatigue, cognition, recovery, addiction, weight, and longevity claims are not established for direct NAD+; most broader human evidence belongs to different precursor molecules.

Regulatory status: No FDA-approved NAD+ injectable or wellness/anti-aging indication located

Reviewed: July 25, 2026

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NAD+

NAD+ at a glance

Why people research it

What the evidence supports

NAD+ itself is not interchangeable with NADH, nicotinamide riboside, nicotinamide mononucleotide, niacin, or nicotinamide.

NAD+ is a core redox cofactor and a substrate for enzymes involved in metabolism, DNA repair, signaling, and cellular stress responses.

Direct NAD+ has not been shown in eligible outcomes trials to provide anti-aging or general wellness benefits.

One randomized human trial found a short-term cardiac-function signal in ischemic cardiomyopathy.

Directly infused NAD+ is rapidly removed or metabolized rather than simply remaining intact in plasma.

Commercial IV NAD+ can produce marked symptoms during infusion.

Injectable NAD+ has a documented sterile-product and endotoxin risk.

No FDA-approved NAD+ injection or wellness/anti-aging indication was located, and NAD+ was not eligible for 503B bulk compounding exemptions in FDA's 2026 enforcement record.

No universal research dose, infusion rate, injection route, reconstitution method, or storage standard can be taken from the current direct NAD+ evidence.

Direct NAD+ has not been demonstrated in controlled human trials to improve weight loss, appetite, cognition, athletic recovery, addiction withdrawal, chronic fatigue, or longevity.

What needs caution

Dosing & preparation

NAD+ · ischemic heart-failure trial

Preparation & concentration · IV

Intravenous NAD+ ischemic-cardiomyopathy study material

How it works

Signals and targets

Proposed biological steps

How mature is the evidence?

Which product or study does this describe?

Study-by-study record

Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial

Design and population

Outcomes measured

NAD+ supplementation for anti-aging and wellness: A PRISMA-guided systematic review of preclinical and clinical evidence

Design and population

Outcomes measured

Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting

Design and population

Outcomes measured

A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD

Design and population

Outcomes measured

Experience reports stay separate from published evidence

Help strengthen the NAD+ experience record

Keep the question moving

Trace every major statement

FDA reminds compounders to use ingredients suitable for sterile compounding

FDA: How to find out whether a drug is approved

NAD+ biology and supplementation: From mechanisms to clinical perspectives

NAD+ supplementation for anti-aging and wellness: A PRISMA-guided systematic review of preclinical and clinical evidence

Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting

FDA warning letter: GenoGenix LLC

Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial

A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD