NAD+.
Your cells run on this stuff.
Nicotinamide adenine dinucleotide — a coenzyme in every cell of your body. Levels decline with age. Injectable NAD+ is designed to support the cellular energy production that keeps everything running. Compounded in the USA by licensed 503A pharmacies. No hidden overseas supply chain.
What is NAD+?
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme present in every living cell. It plays a role in hundreds of metabolic processes — energy production, DNA repair, cellular signaling, and more. It's not a supplement trend. It's basic biochemistry.
Tissue NAD+ levels — measured in muscle, liver, and brain — decline with age in animal and human studies. Plasma NAD+ decline is less consistent across studies. The NAD+ decline hypothesis proposes that falling tissue NAD+ contributes to age-related changes in energy metabolism, DNA repair, and cellular stress response. Clinical trials are actively testing how much repleting NAD+ affects these outcomes in humans.
Injectable delivery avoids the digestive breakdown and first-pass metabolism that limit oral NAD+ absorption. Most researchers believe intact NAD+ is broken down extracellularly into precursors (nicotinamide, NMN) that cells then take up and resynthesize into NAD+ — so direct NAD+ delivery may function similarly to precursor administration, with different pharmacokinetics. Whether that translates to meaningfully higher tissue-level NAD+ is still being studied.
Is NAD+ therapy right for you?
NAD+ therapy is designed for people who want to support their cellular health as they age — not treat a specific condition.
Your PepScribe clinician determines eligibility based on your health history and goals. NAD+ therapy pairs well with other protocols — your clinician can help build a plan that fits.
How NAD+ therapy works
Cellular energy support
NAD+ is a substrate for enzymes involved in mitochondrial function, including sirtuins and PARPs. These enzymes play roles in energy metabolism, DNA repair, and cellular stress responses. Supporting NAD+ levels may help maintain these processes as they naturally decline.
Subcutaneous injection
Subcutaneous injection, with frequency determined by your clinician based on your goals and response. The injectable route bypasses digestive breakdown, delivering NAD+ more directly than oral precursors like NMN or NR.
What to expect early on
Some patients report improved mental clarity and energy within the first few sessions. Others notice more gradual changes over weeks. Response varies — NAD+ is supporting background cellular processes, so the experience is individual.
What to expect
NAD+ supports processes happening at the cellular level. Some changes are noticeable, others are working behind the scenes.
The fog lifts
Some patients report shifts in subjective energy, focus, or sleep quality in the first few weeks; others notice nothing in this window. The published human evidence for injectable NAD+ on these endpoints is small and largely uncontrolled — individual response isn't predictable from the literature.
Deeper cellular support
As the protocol continues, some patients describe gradual changes in exercise recovery or stamina. The mechanistic rationale — NAD+-dependent mitochondrial and DNA-repair enzymes — is well-characterized in biochemistry. Human RCT evidence for these specific functional outcomes from injectable NAD+ is limited and ongoing.
Sustained vitality
At ongoing maintenance dosing, the intent is long-term support of NAD+-dependent cellular processes. This is the least-studied phase of injectable NAD+ therapy in humans — long-term safety and efficacy data at supraphysiologic dosing is still accumulating. Your clinician refines the protocol to fit your response.
Individual results may vary. Timelines are based on commonly reported patient experiences and are not guaranteed outcomes.
Side effects — what to know
NAD+ therapy is generally well-tolerated. Most side effects are mild and related to the injection process itself.
Common (generally mild)
- •Injection site discomfort — temporary stinging or warmth at the injection area
- •Flushing — temporary warmth or redness, typically brief
- •Mild nausea — occasionally reported, usually transient
Less common
- •Lightheadedness during or shortly after injection
- •Muscle cramping (typically resolves with hydration)
Contraindications and cautions
- •Active malignancy or recent cancer history (relative contraindication) — NAD+–sirtuin and PARP pathways intersect with cellular proliferation; discuss with your clinician and oncology team
- •Pregnancy or breastfeeding
- •Known sensitivity to nicotinamide or NAD+ compounds
- •Severe kidney or liver dysfunction may require dose adjustment
Long-term safety data at supraphysiologic injectable doses is limited.
Talk to your clinician if you experience any side effects that concern you. Adjusting injection speed, frequency, or dosage often helps manage any discomfort.
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Deep dives on NAD+
Research-backed articles covering specific topics in depth.
NAD+: How It Works & What to Expect
NAD+: Mechanistic explainer bridging NAD+ precursor science, aging hallmarks (sirtuins, PARP, mitochondrial function), and what current human trial data...
NAD+ Injections: How It Works & What to Expect
NAD+: Clinically grounded explainer covering NAD+ injection mechanisms, administration protocols, and candidate criteria — differentiating through medic...
See if NAD+ therapy is right for you.
A quick assessment to see if NAD+ therapy is right for you. No commitments. No pressure. Takes about 3 minutes.
Start NAD+ therapy assessmentResearch references
Gomes et al. (Cell, 2013) — declining NAD+ disrupts nuclear–mitochondrial communication in aged mouse muscle; NAD+ repletion restored mitochondrial function. Martens et al. (Nature Communications, 2018) — oral nicotinamide riboside reliably raises blood NAD+ metabolite levels in healthy older adults; functional outcomes were mixed. Full evidence review, tissue-vs-plasma decline discussion, and contraindications on the NAD+ research hub.
Compounded medications are prepared by licensed pharmacies and are not FDA-approved. All prescriptions require approval by a licensed healthcare provider. Individual results may vary.