NAD+
Cellular coenzyme
- Injection
- Oral
- Nasal spray
- Suppository
- Gel or cream
Injection · Oral — daily by mouth, or an infusion every one to two weeks.
NAD+ — nicotinamide adenine dinucleotide — is a coenzyme present in every cell, doing two kinds of work. The first is energy metabolism: it cycles between oxidized (NAD+) and reduced (NADH) forms to keep glycolysis, the TCA cycle, and mitochondrial respiration running. The second is regulatory: it’s consumed by enzymes called sirtuins, PARPs, and CD38 that control gene expression, DNA repair, and immune signaling.
The practical implication is that when NAD+ levels drop, both functions degrade. Mitochondria slow down. DNA repair stalls. Sirtuins quiet. And NAD+ does drop — measurably, across human liver, brain, muscle, and skin — as you age. The question NAD+ therapy tries to answer is whether restoring those levels through supplementation or infusion reverses any of that decline.
“NAD+ is the fuel gauge and one of the regulatory levers inside the cell. When it falls, both degrade at once.”
Most of the mechanistic work comes from animal models; the human trial landscape is newer and still building. The full study list and the pathway details live on our PeptideWellness deep-dive.
Who it's for (or who should avoid)
What it's aimed at
NAD+ protocols are most commonly prescribed for:
- Metabolic dysfunction — particularly older adults with insulin resistance, prediabetes, or early type 2 diabetes
- Cognitive complaints — subjective memory or focus issues in older adults, often alongside other longevity interventions
- Chronic fatigue — post-viral syndromes, long COVID, or unexplained low energy despite normal labs
- Recovery from physiological stress — surgery, illness, or high training load
- General longevity optimization — used by clinicians as part of a broader anti-aging protocol
Who should avoid it
- Anyone with active or recent cancer — NAD+ fuels tumor metabolism, and the net effect of long-term elevation on cancer risk is uncharacterized
- People considering IV NAD+ for the first time — the acute side-effect profile is harsher than oral precursors
- Anyone pregnant, breastfeeding, or planning a pregnancy — no controlled human data
- Patients with pre-existing liver or kidney disease — clearance pathways matter
Short-term studies look calm. Nobody has followed anyone for years — which is the timescale most people taking it have in mind.
The biomarker changes appear within weeks; subjective improvements in energy and metabolic markers build over the first month.
Route, dose and course
NAD+ precursors are prescribed as oral supplements (NR or NMN) or as IV infusions (NAD+ or NR). The oral route is better tolerated; the IV route raises blood levels faster but comes with a harsher side-effect profile.
What sellers and studies publish (we checked on 16 October 2026):
- Oral NR: the trials used 1,000 mg a day for six weeks (Remie et al. 2020) and 2,000 mg a day for twelve weeks (Dollerup et al. 2018)
- Injectable NAD+: Rx Peps Direct lists 50 mg per injection (checked 16 October 2026); the IV clinics we checked do not publish a dose
- IV NR: emerging as a better-tolerated alternative to IV NAD+ in recent tolerability work
- Cycling: none of the sellers we checked publishes one
A 2026 tolerability study found that IV NAD+ produced moderate-to-severe adverse effects in every participant — cramping, nausea, vomiting, chest pressure — while IV NR was substantially better tolerated.
No measured timeline
We found no source we trust for a week-by-week picture of how NAD+ feels, so we do not draw one. Agree with your prescriber what you will measure and when you will check it.
Available · from about $89/mo
Every headline price in this market excludes something. These are normalized to a calendar month, cheapest first, with the exclusion spelled out — the published figure is the footnote under it. Monthly figures here run from about $89 to $199. We may earn a commission when you purchase from some of the partners listed here, at no extra cost to you.
| Provider | From, per month | What that figure excludes | Coverage | Their own site |
|---|---|---|---|---|
| EverlifeMDSublingual and injectable peptide telehealth | $89read 2026-11-04 | A combination tablet taken by mouth, not an injection. | Not published | Go to site |
| ProvnRxCompounded storefront, launched April 2026 | $90read 2026-11-04 | Strength and vial size, published nowhere on the site. | A named list | Go to site |
| BiltRxPerformance telehealth, Houston TX (formerly DietDoc) | $97read 2026-11-10 | The $50 consult fee, billed once per 12 weeks, and $30 shipping per order. A three-month supply (3,000 mg) is $291. | All 50, stated | Go to site |
| Nu Image MedicalCash-pay telehealth since 2004, Tampa FL | $99read 2026-11-04 | Strength, which is not published; the figure assumes a 12-month supply. | All 50, stated | Go to site |
| MadeMedCompounded, billed every 30, 90 or 360 days | $103read 2026-11-04 | The CMP blood test required before prescribing, obtained and paid for separately, and a $20 consultation fee ($30 by video). The 200 mg/mL injection is a separate product, $119 a month on the same plan on its own page. | A named list | Go to site |
| Live VitalPhysician-led, monthly pricing, Draper UT | $115read 2026-11-04 | Strength and vial size, which are not published; sold as a 2-month subscription, $229 every 2 months. | All 50, stated | Go to site |
| TeleZenMDWidest peptide menu | $133read 2026-11-07 | The annual rate requires paying twelve months up front. IV infusions are billed per session by the clinic that runs them and are not part of this. | All 50, stated | Go to site |
| AgelessRxLongevity prescribing, runs its own trials | $149read 2026-11-04 | Their page states cold-shipped injectables cannot be reliably shipped to Alaska or Hawaii. | All 50, stated | Go to site |
| Hone HealthMembership telehealth for hormones and longevity | $199read 2026-11-04 | Route and strength, which are not published on the longevity page. | Not published | Go to site |
| New Blue HealthPeptide, GLP-1 and hormone telehealth | $199read 2026-11-04 | The 1-month plan is $279. Strength is not published. | All but some, named | Go to site |
| Strut HealthCompounded multi-category, Dallas | $199read 2026-11-05 | Their fine print states final pricing is determined after the online consultation. | All but some, named | Go to site |
| Defy MedicalTampa clinic, physician-led | No price for this compound | Peptides are priced per vial rather than per month, and neither the consultation nor the lab work that has to precede it is priced anywhere on the site. | Not published | Go to site |
| Invigor MedicalCompounded catalogue, Kennewick WA | No price for this compound | Nineteen of the twenty-six plan pages are priced "starting at", and no dose, vial size or concentration is published for any compound on the entire site. | All 50, stated | Go to site |
| Lavender Sky HealthTwelve named pharmacies, priced per vial | $165 per vialread 2026-11-04 | The $65 new-patient consultation and $40 follow-ups. The same vial is $280 from Hallandale; the pharmacy is the patient’s choice. | All 50, stated | Go to site |
| Mochi HealthCompounded marketplace | No price for this compound | Two subscriptions, not one: $79 of membership plus $60 of medication, and the membership does not stop. | Not published | Go to site |
| PeRxPeptide-only telehealth, Wellness MD Group PC | No price for this compound | The only peptide figure on the site is a floor for the whole menu — treatment plans "starting at $199" — so there is no price for any individual compound. The provider review is included; there is no separate consultation fee. | All 50, stated | Go to site |
| PeterMDMens health storefront, Vero Beach FL | $369 per vialread 2026-11-11 | The volume of the vial. Note also that the product URL says 200mg/ml while the page says 100mg/ml. | All but some, named | Go to site |
| RxPepsDirectPer-vial prices, 503A pharmacy in Texas | $100 per vialread 2026-11-04 | The $39 telehealth visit, charged per order. | A named list | Go to site |
Will it work where you live?
Most sellers claim all fifty states or publish nothing about coverage; a few name the states they serve or the ones they exclude, and the Coverage column says which. Either way it is the seller's own claim, so we can't filter this list by state without inventing a fact. What we can tell you is which state-level rules decide access: telehealth rules, non-resident pharmacy licensing, and who is allowed to prescribe.
Prices and providers change. We keep track.
Questions we get about NAD+
Is NAD+ FDA-approved?
NAD+ itself is not an FDA-approved drug. Oral precursors (NR and NMN) are available as dietary supplements — NR under the brand NIAGEN is GRAS-affirmed and FDA-notified; NMN's supplement status was restored by the FDA in September 2025 after a brief exclusion. IV NAD+ is administered by licensed clinicians under their own discretion but carries no FDA-approved indication.
Is it legal?
Yes, with a prescription from a licensed clinician for IV protocols, or over-the-counter for oral supplements (NR, NMN). Quality varies widely across supplement brands — ask your provider for a recommendation with third-party testing. Availability can vary by state — confirm current access with the provider or your clinician.
Are there side effects?
Oral NR and NMN are well tolerated in most people — occasional mild nausea, fatigue, or headache. IV NAD+ carries a harsher profile: a 2026 tolerability study found that every participant experienced moderate-to-severe cramping, nausea, vomiting, or chest pressure during infusion. Symptoms resolved when the drip stopped. Discuss route and dose with your provider.
Can I take it with my current medications?
Short-term studies have not flagged interactions, but long-term safety — years rather than weeks — has not been studied in any rigorous way, so treat the quiet record as untested rather than reassuring. Disclose your full medication list to your provider, particularly if you're on chemotherapy or immunosuppressants.
How much does it cost?
In the price table on this page, monthly figures run from about $89 to $199, read between November 4, 2026 and November 10, 2026. Some sellers price it per vial or unit instead, shown in the same table. Three different products, three different bills. Oral NR and NMN are sold over the counter and range too widely to quote. The figures in the table are for injections and nasal sprays from telehealth sellers, each with what it leaves out. IV infusions are billed per session by the clinic that runs them and priced locally, so you have to call and ask. Insurance covers none of it.
How the bill breaks downWe publish no medical reviewer by design. Every claim on this page traces to a source we hold on file, and the reviewed write-up with those citations lives on our hub. Read the full research on PeptideWellness ↗
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