# NAD+ NAD+ is in Category 1: pharmacies may use it while FDA decides, which is not approval. The evidence grade is limited-human: one small heart trial and a few pilot studies. FDA has reports of harm after NAD+ drips and shots, and warns against food-grade NAD+. Status checked: 2026-10-26. Last verified: 2026-10-26. Primary source: https://www.fda.gov/media/94155/download This page has not been individually reviewed by a clinician. Information, not medical advice. | Fact | Value | Tier | Checked | Source | |---|---|---|---|---| | Also called | NAD, nicotinamide adenine dinucleotide | primary | 2026-10-26 | [source](https://www.fda.gov/media/94155/download) | | Class | non-peptide | peer-reviewed | 2026-10-26 | [source](https://pubmed.ncbi.nlm.nih.gov/31572171/) | | Regulatory status | category-1 | primary | 2026-10-26 | [source](https://www.fda.gov/media/94155/download) | | Status source read | 2026-10-26 | primary | 2026-10-26 | [source](https://www.fda.gov/media/94155/download) | | Evidence grade | limited-human | our assessment | 2026-10-26 | [source](https://peptideindex.ai/methodology#evidence-grade) | ## Name NAD+ Source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding ## Summary A coenzyme, a helper molecule found in every living cell. It helps turn food into energy and repair DNA. Clinics offer it for health and longevity. Source: https://www.ajc.com/news/2026/07/tempted-to-try-a-wellness-or-longevity-treatment-heres-what-experts-say/ ## Short answer NAD+ is in Category 1: pharmacies may use it while FDA decides, which is not approval. The evidence grade is limited-human: one small heart trial and a few pilot studies. FDA has reports of harm after NAD+ drips and shots, and warns against food-grade NAD+. Source: https://peptideindex.ai/methodology#short-answer ## Known risks - FDA has reports of severe chills, shaking, vomiting and fatigue after NAD+ shots and drips. Some people needed medical care [^5]. - FDA says these reactions fit too much endotoxin, a toxin from bacteria. Some products were made from food-grade NAD+, which is not fit for sterile drugs without proper processing [^5]. - A 2026 study of clinic records looked at NAD+ drips. People had moderate to severe stomach upset, a faster heart rate and chest pressure [^11]. - In the same review, the drips took longer because of these symptoms, and HDL, the good cholesterol, went down over 30 days [^11]. Source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding ## What nobody knows yet - Nobody knows if NAD+ drips or shots slow aging or help wellness. A 2026 review found no outcome trials of them for those uses [^14]. - NAD+ levels fall with age, but that does not show that taking NAD+ helps. Outcome trials have not tested it [^14] [^21]. - It is not settled how much NAD+ taken by mouth reaches the blood. A trial in Canada plans to measure it [^19]. - The one heart failure trial was small and at one hospital. Its authors call for larger trials at many centers [^12]. - FDA has not yet decided whether to add NAD+ to the federal list for pharmacies [^1] [^2]. Source: https://pubmed.ncbi.nlm.nih.gov/41655607/ ## What it is NAD+ is short for nicotinamide adenine dinucleotide. It is a coenzyme, a helper molecule found in every living cell [^21]. Cells use it to turn food into energy and to repair DNA [^21]. It is not a peptide. NADH is its reduced form, and FDA lists the two apart [^1]. It is sold in several forms. Clinics give it by drip into a vein or by shot [^5] [^11]. Pills and gels held under the tongue are sold too [^6] [^19]. A result for one form does not carry over to another [^14]. Many studies use precursors instead, such as nicotinamide riboside (NR) or NMN. The body turns these into NAD+, but they are different compounds [^14] [^15]. A study of a precursor is not a study of NAD+ [^14]. Source: https://www.fda.gov/media/94155/download ## Where it stands legally NAD+ is in Category 1: FDA's list of substances pharmacies may use while FDA decides whether to add them to the federal list [^1] [^2]. That is not approval, and FDA is still deciding [^1] [^2]. Checked 26 October 2026. FDA's May 2026 list names NAD and NADH under Category 1 [^1]. One salt form is in Category 3, which falls outside FDA's policy for Category 1 [^1] [^2]. For Category 1, FDA says it does not plan to act against a pharmacy that meets the policy's conditions [^2]. That is a choice not to act, not approval of NAD+ as a drug [^2]. NAD+ is also in Category 1 on FDA's list for outsourcing facilities, which make larger batches [^3]. It is not in Category 2, FDA's list of substances that may present significant safety risks [^1] [^4]. In 2020, FDA and the FTC warned a seller of NAD+ gels sold with COVID-19 claims. FDA called those gels unapproved new drugs [^6]. Pills and gels are often called supplements [^19] [^21]. No FDA page we checked names NAD+ as a dietary supplement ingredient [^7] [^8]. So this page does not give it that status. Source: https://www.fda.gov/media/94155/download ## What the evidence shows The evidence grade is limited-human: one randomized trial and a few small studies test NAD+ itself, and none test aging [^12] [^14]. Heart failure: in a trial in China, 180 adults with heart failure got NAD+ or a dummy drip for a week [^12]. At one month, heart pumping improved a little more with NAD+ [^12]. Hospital stays and symptoms showed only trends, not clear results [^12]. Drips in people: a 2019 pilot in people tracked NAD+ in the blood during a six-hour drip [^10]. It measured levels, not health [^10]. A 2026 review of clinic records found NAD+ drips caused more discomfort than drips of a precursor [^11]. NADH: a 1999 crossover trial of 26 people with chronic fatigue syndrome tested NADH pills, the reduced form [^13]. Eight improved on NADH and two on a dummy pill [^13]. That is a small result for a related form [^13]. Aging: a 2026 systematic review found no outcome trials of NAD+ drips or shots for aging or wellness [^14]. Precursor pills raised NAD+ levels, but health results were mixed or null [^14]. Animals: mouse studies often cited for NAD+ used nicotinamide riboside, a precursor [^16] [^17]. In mice, it slowed hearing loss with age and eased signs of an Alzheimer's model [^16] [^17]. Those are precursor results in mice, not NAD+ results in people [^16] [^17]. Source: https://pubmed.ncbi.nlm.nih.gov/40954388/ ## Legitimate ways to get it The legal ways to get NAD+ are from a pharmacy that compounds it, or in a clinical trial [^1] [^18]. A prescriber can order NAD+ made by a pharmacy, because it is in Category 1 [^1] [^2]. That is not FDA approval [^2]. FDA has told compounders to use only ingredients fit for sterile drugs [^5]. A trial in Alabama is recruiting healthy adults to compare NAD+ shots with a precursor [^18]. Other trials plan to start in Canada and China [^19] [^20]. The trials block on this page lists open trials with their dates. Source: https://www.fda.gov/media/94155/download ## How people are getting it anyway This section describes what happens and is not a recommendation. NAD+ drips and shots reach people through wellness clinics, med spas and drip bars [^11] [^21]. Some are made from food-grade NAD+ sold by repackagers [^5]. FDA says food-grade ingredients are not fit for sterile drugs without proper processing [^5]. FDA has reports of severe chills, shaking, vomiting and fatigue after NAD+ shots and drips [^5]. FDA says these fit too much endotoxin, a toxin from bacteria [^5]. Under section 503A, a licensed pharmacist or doctor compounds, using ingredients that meet FDA's conditions [^2]. A law firm notes that FDA treats adding vitamins to a drip bag as compounding [^9]. An online seller marketed NAD+ gels with disease claims. In 2020, FDA and the FTC warned that seller over COVID-19 claims [^6]. Source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding ## Access routes Source: https://www.fda.gov/media/94155/download ### Lawful compounding Detail: A pharmacy may compound NAD+ on a prescription because it is in Category 1. A compounded product is not FDA-approved. Source: https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding-under-section-503a-fdc-act ### Clinical trial Detail: A trial in the US is recruiting healthy adults to compare NAD+ shots with a precursor. The trials block lists open trials. Source: https://clinicaltrials.gov/study/NCT06919328 ## Unofficial channels Source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding ### Compounding outside the rules What it is: NAD+ drips and shots made from food-grade NAD+ sold by repackagers, which is not meant for sterile drugs. Legal position: FDA says food-grade ingredients are not fit for compounding sterile drugs without proper processing. (source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding) Documented risks: - FDA has reports of severe chills, shaking, vomiting and fatigue after NAD+ shots and drips. Some people needed medical care. (source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding) Enforcement: - 2024-10-30: FDA compounding alert: compounders used food-grade NAD+ to make drips; FDA reminded them to use ingredients fit for sterile drugs. (source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding) Source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding ### Clinic or med spa What it is: Wellness clinics, med spas and drip bars that give NAD+ by drip into a vein, often for aging or energy. Legal position: FDA does not plan to act against a licensed pharmacist or doctor who compounds with NAD+ under its Category 1 conditions. That is not approval. (source: https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding-under-section-503a-fdc-act) Documented risks: - In a review of clinic records, people given NAD+ by drip had moderate to severe stomach upset, a faster heart rate and chest pressure. (source: https://pubmed.ncbi.nlm.nih.gov/41704678/) Source: https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding-under-section-503a-fdc-act ## Recruiting trials Snapshot date: 2026-10-26. A listing is not a recommendation. Trials have strict eligibility rules. Talk to your doctor and read the official record. - nct NCT07839130, url https://clinicaltrials.gov/study/NCT07839130, phase Phase 2, title PEDIatric Cardiac Dysfunction Treated With Injectable Nicotinamide Adenine Dinucleotide, status not-yet-recruiting, sponsor Beijing Children's Hospital, countries China, us states none listed - nct NCT07692633, url https://clinicaltrials.gov/study/NCT07692633, phase Not applicable, title A Clinical Trial to Assess the Absorption, Safety, and Efficacy of an Oral Nicotinamide Adenine Dinucleotide (NAD+) Supplement in Healthy Adults, status not-yet-recruiting, sponsor Reus Research, countries Canada, us states none listed - nct NCT07328100, url https://clinicaltrials.gov/study/NCT07328100, phase Not applicable, title Efficacy and Safety of Coenzyme I for Injection on Vascular Aging., status not-yet-recruiting, sponsor Shanghai 10th People's Hospital, countries China, us states none listed - nct NCT06966583, url https://clinicaltrials.gov/study/NCT06966583, phase Phase 1, title NAD+ Supplement（NMN）With Radioimmunotherapy in Advanced NSCLC, status not-yet-recruiting, sponsor Sichuan University, countries China, us states none listed - nct NCT06558253, url https://clinicaltrials.gov/study/NCT06558253, phase Phase 1, title The Safety and Efficacy of Coenzyme I for Injection in Promoting Hematopoietic Recovery of Patients After sUCBT, status recruiting, sponsor Anhui Provincial Hospital, countries China, us states none listed - nct NCT06919328, url https://clinicaltrials.gov/study/NCT06919328, phase Not applicable, title Absorption and Tolerability of Injectable Administration of Niagen®+, as Compared to NAD+, status recruiting, sponsor Nutraceuticals Research Institute, countries United States, us states Alabama Source: https://clinicaltrials.gov/api/v2/studies?query.intr=AREA%5BInterventionName%5D%28%22NAD%2B%22+OR+%22Nicotinamide+Adenine+Dinucleotide%22+OR+%22Coenzyme+I%22%29+AND+NOT+AREA%5BInterventionName%5D%28precursor+OR+NMN+OR+mononucleotide%29&filter.overallStatus=RECRUITING%2CNOT_YET_RECRUITING&pageSize=50&sort=StartDate%3Adesc&countTotal=true&fields=NCTId%2CBriefTitle%2COverallStatus%2CPhase%2CLeadSponsorName%2CStartDate%2CLocationCountry%2CLocationState ## Sources Source: https://www.fda.gov/media/94155/download ### 1. FDA: 503A bulk drug substances category list, updated May 2026 Type: regulatory Tier: primary Source: https://www.fda.gov/media/94155/download ### 2. FDA: bulk drug substances used in compounding under section 503A Type: regulatory Tier: primary Source: https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding-under-section-503a-fdc-act ### 3. FDA: 503B bulk drug substances category list, updated March 2025 Type: regulatory Tier: primary Source: https://www.fda.gov/media/94164/download ### 4. FDA: bulk drug substances that may present significant safety risks Type: regulatory Tier: primary Source: https://www.fda.gov/drugs/human-drug-compounding/certain-bulk-drug-substances-use-compounding-may-present-significant-safety-risks ### 5. FDA compounding alert: use ingredients suitable for sterile compounding, October 2024 Type: regulatory Tier: primary Source: https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding ### 6. FDA and FTC warning letter: NAD+ and NMN gels sold with COVID-19 claims, May 2020 Type: regulatory Tier: primary Source: https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/alive-nature-inc-607435-05062020 ### 7. FDA: dietary supplements Type: regulatory Tier: primary Source: https://www.fda.gov/food/dietary-supplements ### 8. FDA: new dietary ingredient notification process Type: regulatory Tier: primary Source: https://www.fda.gov/food/dietary-supplements/new-dietary-ingredient-ndi-notification-process ### 9. Gordon Feinblatt: are IV businesses compounding prescriptions? Type: legal-analysis Tier: legal-analysis Source: https://www.gfrlaw.com/what-we-do/insights/are-iv-businesses-compounding-prescriptions ### 10. Pilot study: NAD+ in blood and urine during a six-hour intravenous infusion in people, 2019 Type: human-trial Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/31572171/ ### 11. Retrospective study: intravenous NAD+ compared with nicotinamide riboside, 2026 Type: human-trial Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/41704678/ ### 12. Randomized trial: NAD+ in heart failure from ischemic cardiomyopathy, 2026 Type: rct Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/40954388/ ### 13. Crossover trial: oral NADH in chronic fatigue syndrome, 1999 Type: human-trial Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/10071523/ ### 14. Systematic review: NAD+ supplementation for anti-aging and wellness, 2026 Type: systematic-review Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/41655607/ ### 15. Meta-analysis: NAD+ precursor supplements, glucose, CRP and liver enzymes, 2024 Type: systematic-review Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/38915015/ ### 16. Mouse study: nicotinamide riboside, a precursor, in a model of Alzheimer's disease, 2021 Type: animal Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/34497121/ ### 17. Mouse study: nicotinamide riboside, a precursor, and age-related hearing loss, 2023 Type: animal Tier: peer-reviewed Source: https://pubmed.ncbi.nlm.nih.gov/37395319/ ### 18. ClinicalTrials.gov NCT06919328: injected nicotinamide riboside compared with NAD+ in healthy adults Type: reference Tier: primary Source: https://clinicaltrials.gov/study/NCT06919328 ### 19. ClinicalTrials.gov NCT07692633: an oral NAD+ supplement in healthy adults Type: reference Tier: primary Source: https://clinicaltrials.gov/study/NCT07692633 ### 20. ClinicalTrials.gov NCT07839130: injectable NAD+ in children with cardiac dysfunction Type: reference Tier: primary Source: https://clinicaltrials.gov/study/NCT07839130 ### 21. Atlanta Journal-Constitution: what experts say about wellness and longevity treatments, July 2026 Type: reference Tier: established-news Source: https://www.ajc.com/news/2026/07/tempted-to-try-a-wellness-or-longevity-treatment-heres-what-experts-say/ Last verified: 2026-10-26. Sources: - https://clinicaltrials.gov/api/v2/studies?query.intr=AREA%5BInterventionName%5D%28%22NAD%2B%22+OR+%22Nicotinamide+Adenine+Dinucleotide%22+OR+%22Coenzyme+I%22%29+AND+NOT+AREA%5BInterventionName%5D%28precursor+OR+NMN+OR+mononucleotide%29&filter.overallStatus=RECRUITING%2CNOT_YET_RECRUITING&pageSize=50&sort=StartDate%3Adesc&countTotal=true&fields=NCTId%2CBriefTitle%2COverallStatus%2CPhase%2CLeadSponsorName%2CStartDate%2CLocationCountry%2CLocationState - https://peptideindex.ai/methodology#evidence-grade - https://peptideindex.ai/methodology#short-answer - https://pubmed.ncbi.nlm.nih.gov/31572171/ - https://pubmed.ncbi.nlm.nih.gov/40954388/ - https://pubmed.ncbi.nlm.nih.gov/41655607/ - https://www.ajc.com/news/2026/07/tempted-to-try-a-wellness-or-longevity-treatment-heres-what-experts-say/ - https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding - https://www.fda.gov/media/94155/download [^1]: FDA: 503A bulk drug substances category list, updated May 2026 https://www.fda.gov/media/94155/download [^2]: FDA: bulk drug substances used in compounding under section 503A https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding-under-section-503a-fdc-act [^3]: FDA: 503B bulk drug substances category list, updated March 2025 https://www.fda.gov/media/94164/download [^4]: FDA: bulk drug substances that may present significant safety risks https://www.fda.gov/drugs/human-drug-compounding/certain-bulk-drug-substances-use-compounding-may-present-significant-safety-risks [^5]: FDA compounding alert: use ingredients suitable for sterile compounding, October 2024 https://www.fda.gov/drugs/human-drug-compounding/fda-reminds-compounders-use-ingredients-suitable-sterile-compounding [^6]: FDA and FTC warning letter: NAD+ and NMN gels sold with COVID-19 claims, May 2020 https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/alive-nature-inc-607435-05062020 [^7]: FDA: dietary supplements https://www.fda.gov/food/dietary-supplements [^8]: FDA: new dietary ingredient notification process https://www.fda.gov/food/dietary-supplements/new-dietary-ingredient-ndi-notification-process [^9]: Gordon Feinblatt: are IV businesses compounding prescriptions? https://www.gfrlaw.com/what-we-do/insights/are-iv-businesses-compounding-prescriptions [^10]: Pilot study: NAD+ in blood and urine during a six-hour intravenous infusion in people, 2019 https://pubmed.ncbi.nlm.nih.gov/31572171/ [^11]: Retrospective study: intravenous NAD+ compared with nicotinamide riboside, 2026 https://pubmed.ncbi.nlm.nih.gov/41704678/ [^12]: Randomized trial: NAD+ in heart failure from ischemic cardiomyopathy, 2026 https://pubmed.ncbi.nlm.nih.gov/40954388/ [^13]: Crossover trial: oral NADH in chronic fatigue syndrome, 1999 https://pubmed.ncbi.nlm.nih.gov/10071523/ [^14]: Systematic review: NAD+ supplementation for anti-aging and wellness, 2026 https://pubmed.ncbi.nlm.nih.gov/41655607/ [^15]: Meta-analysis: NAD+ precursor supplements, glucose, CRP and liver enzymes, 2024 https://pubmed.ncbi.nlm.nih.gov/38915015/ [^16]: Mouse study: nicotinamide riboside, a precursor, in a model of Alzheimer's disease, 2021 https://pubmed.ncbi.nlm.nih.gov/34497121/ [^17]: Mouse study: nicotinamide riboside, a precursor, and age-related hearing loss, 2023 https://pubmed.ncbi.nlm.nih.gov/37395319/ [^18]: ClinicalTrials.gov NCT06919328: injected nicotinamide riboside compared with NAD+ in healthy adults https://clinicaltrials.gov/study/NCT06919328 [^19]: ClinicalTrials.gov NCT07692633: an oral NAD+ supplement in healthy adults https://clinicaltrials.gov/study/NCT07692633 [^20]: ClinicalTrials.gov NCT07839130: injectable NAD+ in children with cardiac dysfunction https://clinicaltrials.gov/study/NCT07839130 [^21]: Atlanta Journal-Constitution: what experts say about wellness and longevity treatments, July 2026 https://www.ajc.com/news/2026/07/tempted-to-try-a-wellness-or-longevity-treatment-heres-what-experts-say/