What a NAD+ IV does to people, and why the drip gets slowed down
Sources read September 2026. 5 documents cited.
People who sit through a NAD+ infusion describe feeling awful during it. There are exactly two published human studies of intravenous NAD+, and between them they say more about that than any clinic's website does.
The entire human literature is two studies
NAD+ infusion is sold in every major American city, usually by the session, usually somewhere between two and six hundred dollars, and usually with a paragraph about cellular energy. Before spending an afternoon in a chair, it is worth knowing how much has actually been published about what that afternoon does.
Two studies. That is the whole human literature on intravenous NAD+.
| Study | Design | What it set out to measure | n |
|---|---|---|---|
| Front Aging Neurosci 2019, PMID 31572171 | Open pilot, single arm, 6-hour infusion at 3 µmol/min | Where infused NAD+ goes — plasma and urine NAD metabolome | 8 |
| Front Aging 2026, PMID 41704678 | Retrospective chart review at a commercial IV clinic — not randomised, not blinded | Tolerability and short-term safety of NAD+ IV against NR IV, 500 mg over four consecutive days | chart review |
That is the whole evidence base for a service sold in every major US city. Neither study is a randomised controlled trial and neither was designed to test whether an infusion does anything for anybody.
Source: PubMed, searched 2026-09-05. A title-field search for NAD or nicotinamide adenine dinucleotide with infusion or intravenous returned 8 records; the broader 151-record set was read by title. Positive control through the same field tags in the same run: aspirin[ti] AND intravenous[ti], 100.
The 2019 paper is an eight-participant pilot that set out to answer a question nobody had asked in people. Its own words: “no data are currently available on the fate of directly infused NAD+ in a human cohort”. It found something counterintuitive — at 3 µmol/min, NAD+ was “rapidly and completely removed from the plasma for at least the first 2 h”, with no measurable change in plasma NAD+ or its metabolites until after two hours had passed. Where it went, the study does not say.
The 2026 paper is a retrospective chart review at a commercial IV clinic, comparing NAD+ infusions against nicotinamide riboside infusions in the clinic’s own patients. It is not randomised, it is not blinded, and the people in it were paying customers. It is also the only document anywhere that systematically records what an NAD+ drip feels like.
What people actually reported feeling
The retrospective review reports the two arms very differently, and the contrast is the finding:
“Participants that received NAD+ IV reported moderate to severe gastrointestinal symptoms, increased heart rate, and chest pressure during infusions. Participants receiving NR IV experienced minor tongue, jaw, and arm tingling and mild cramping during infusion. All symptoms resolved upon infusion completion.”
Frontiers in Aging, 2026, PMID 41704678 — retrospective chart review, 500 mg over four consecutive days.
Three things in that sentence deserve to be separated out. Moderate to severe is the authors’ own grading, not a hedge. Chest pressure and a raised heart rate are not what a wellness page prepares somebody for. And “all symptoms resolved upon infusion completion” is reassuring about persistence and says nothing about the hours in the chair.
What the study did not find matters too, and it is the reason this page is not alarmist. It measured liver enzymes, a general inflammation marker, kidney function and thyroid stimulating hormone across thirty days, and reported no significant change in any of them in either group. Feeling awful during an infusion and having something go wrong with an organ are different claims, and this study supports the first one only.
Why the drip gets slowed down, and what that costs
The same paper answers the practical question a clinic’s FAQ usually does not: why NAD+ drips take so long.
| Relative to 120 minutes | Minutes | |
|---|---|---|
| NAD+ intravenous | 97 minutes | |
| Nicotinamide riboside intravenous | 37 minutes |
The paper attributes the difference to symptoms, not to protocol: “Moderate to severe symptoms with NAD+ IV resulted in longer infusion times compared to NR IV.” Two arms of one retrospective chart review at one clinic. It is not a randomised comparison and this site does not present it as one.
Source: Front Aging 2026, PMID 41704678, retrospective chart review. Figures as stated in the abstract: “averaging 97 min versus 37 min, respectively”.
The authors attribute the gap to the symptoms rather than to any protocol: “Moderate to severe symptoms with NAD+ IV resulted in longer infusion times compared to NR IV.” The drip is slowed because people cannot tolerate it faster. That is the mechanism behind every anecdote about a nurse turning the dial down.
It is also, bluntly, a cost. An infusion service sells a seat and a nurse’s attention, and the difference between thirty-seven minutes and ninety-seven is more than double the chair time for one appointment — on a bag whose dose was the same in both arms. When a clinic quotes a session price, the session is the unit being bought, and how long it takes is a real part of what is being paid for. The 2019 pilot ran for six hours.
If two quotes are on different units altogether — a session here, a monthly subscription there — the price normalizer on this site will put both on one calendar month and print the conversion it performed. It will not tell you which is better value, because it does not know what either one includes.
The other reason a bag can make somebody ill
There is a second reason somebody can feel very unwell during a NAD+ infusion, and it has nothing to do with NAD+. In October 2024 FDA published a notice to compounders that names this category directly:
“The agency is aware of compounders using food-grade nicotinamide adenine dinucleotide (NAD+) sold by repackagers to make intravenous products. … Ingredients identified as food grade are not suitable for compounding sterile drugs without appropriate processing, due to the high risk of contamination with microbes and endotoxins, which can harm patients.”
FDA, “FDA reminds compounders to use ingredients suitable for sterile compounding”, content current as of 30 October 2024.
And then the part that maps onto what people describe:
“FDA has received adverse event reports following use of NAD+ injectable drugs, including severe chills, shaking, vomiting and fatigue with some requiring medical treatment. These reactions are consistent with excessive levels of endotoxins.”
Endotoxin is bacterial cell-wall debris. It survives sterilisation, it is not removed by filtering out bacteria, and injected in quantity it produces exactly that picture: rigors, shaking, vomiting, collapse. A food-grade powder is not tested to an injectable endotoxin limit because nobody expected it to be injected.
This is not hypothetical. In January 2026 FDA issued a warning letter to one outsourcing facility reporting that “an unopened vial from the same lot was found to contain excessive bacterial endotoxins with a reported value of 3,360 EU/mL”, after patients who received that lot needed emergency care. The same letter records that NAD+ “do not appear on the 503B bulks list”, which is the regulatory position this whole category sits in.
That letter concerns one named facility and one lot. It says nothing whatsoever about any seller in this site’s index, this site has not screened its roster against FDA enforcement, and one letter is an existence proof rather than a rate. What it establishes is that the failure mode FDA described in 2024 is real and has reached patients.
Nobody has published a safe infusion rate
Given that the drip rate is what determines how bad the two hours are, the obvious question is what rate is correct. Nobody has published one.
| What was counted | Out of 3 records returned by the guideline-filtered search, none of them about NAD+ |
|---|---|
| NAD terms with guideline[pt] — records returned | 3 |
| …of those, about NAD+ | 0 |
| Same filter, aspirin — the positive control | 206 |
AN ABSENCE NEEDS A CENSUS ATTACHED AND A CONTROL BESIDE IT. The three records the guideline filter returned are two neck-pain practice guidelines and a laboratory method standard. The filter is live — it returns 206 for aspirin in the same run — so the zero describes the literature and not the instrument. A separate search pairing NAD terms with “infusion rate” returned 7 records, of which the only relevant one is the eight-participant 2019 pilot.
Source: PubMed E-utilities, all run 2026-09-05, each with a positive control through the identical filter in the same run.
There is no clinical practice guideline, no FDA monograph and no compendial chapter naming an infusion rate for NAD+ that this site could find. NAD+ is on FDA’s 503A list under “Bulk Drug Substances Under Evaluation” as of a list printed in May 2026, so there is no US regulatory document to derive a rate from either. The only number in the published literature is the 3 µmol/min the 2019 pilot happened to choose for eight people.
So when a clinic tells you their protocol, it is their protocol. It may be careful and well-reasoned, and it is not derived from a published standard, because there is not one.
What to ask before you book
None of these is medical advice and none of them is a test a clinic must pass. They are the questions the documents above make answerable, and a clinic that cannot answer them has told you something.
- Where does the NAD+ come from, and is it labelled for injection? FDA’s 2024 notice is specifically about food-grade powder reaching IV bags through repackagers. A 503B outsourcing facility, a 503A pharmacy and a repackager are three different things.
- Is the finished product tested for bacterial endotoxin, and can you see a certificate for the lot? Sterility and endotoxin are separate tests, and the reported failure is the second one.
- What rate will it be run at, and what happens if it is uncomfortable? There is no published standard rate. There should be an answer to what happens when somebody cannot tolerate the one being used.
- What is the dose, in milligrams? Across the 376 figures this site has read from NAD+ sellers, 250 state no dose at all. A price with no dose behind it cannot be compared to anything.
- How long is the appointment, honestly? The one comparative study averaged ninety-seven minutes for NAD+ against thirty-seven for the alternative bag.
For what it is worth, intravenous NAD+ is a small part of what this site tracks: 2 of the 106 sellers in the index state an IV route at all, across 6 of 376 figures. Most of this market sells an at-home injection instead, and that board is here.
What this page cannot tell you
Whether a NAD+ infusion does anything for anybody. Two human studies exist and neither was designed to answer that; one measured where the molecule goes, the other reviewed charts for tolerability. There is no randomised trial of intravenous NAD+ for any indication.
How fast should a NAD+ infusion be run, and what rate is safe? No authoritative body has published guidance on this, and this site could not find any.
A published clinical practice guideline, an FDA monograph, or a USP chapter naming an infusion rate for NAD+. A PubMed search restricted to the guideline publication type returned three records and none of them is about NAD+, while the same filter returned 206 for aspirin in the same run — so the filter is live and the absence is real. NAD+ also sits in FDA's 503A Category 1, still under evaluation, so there is no US regulatory monograph to derive a rate from either.
Does intravenous NAD+ help with substance withdrawal? It is sold for this, and this site found no published human study of it.
A human trial indexed in PubMed. Three independent searches — combining NAD with withdrawal, detox, substance use disorder, opioid and alcohol terms — returned 16, 8 and 7 records between them and not one was a study of NAD+ in a withdrawal setting; every hit used NAD as a metabolic cofactor in unrelated liver or ethanol work. These are title-and-abstract searches, so they do not exclude literature outside PubMed, and this site does not claim they do.
How common is endotoxin contamination in the NAD+ being infused commercially? FDA says it has received adverse event reports consistent with it. Nobody publishes a rate.
An FDA surveillance figure, or published testing across a sample of compounded NAD+ lots. One warning letter naming one facility and one lot at 3,360 EU/mL is an existence proof, not a prevalence — and this site does not present it as one.
About this page
Nobody at this site holds a medical license and nothing here is medical advice, diagnosis or treatment. This is a price index; the pages like this one exist because a reader cannot judge a price without knowing what the thing is. Talk to a licensed clinician before starting or stopping anything, and see the medical disclaimer.
Every factual claim above points at a numbered document below. Each was fetched on September 2026, and each entry records the date printed on the document itself, which is not always the date on the page serving it. If something here is wrong, the corrections page says how that gets fixed and what has been fixed before.
Sources
- A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD+.
- Intravenous infusion of nicotinamide adenine dinucleotide (NAD+) versus nicotinamide riboside (NR): a retrospective tolerability pilot study in a real-world setting.
- FDA reminds compounders to use ingredients suitable for sterile compounding
- Warning Letter — GenoGenix LLC, 718739, 01/20/2026
- Bulk Drug Substances Nominated for Use in Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act