Everything You Need to Know About NAD+ IV Therapy

Everything You Need to Know About NAD+ IV Therapy

From celebrities and influencers to actors and athletes, NAD+ IVs have officially left the research labs and entered the mainstream.

But as you should definitely not get all your health advice from Keeping Up With the Kardashians, we’re here to tell you everything you need to know about NAD+ IV therapy, including which forms are superior, how they work, potential benefits, side effects, and more.

What Are NAD+ IVs?

NAD+ IVs are intravenous solutions of nicotinamide adenine dinucleotide—a molecule that is fundamental to life as we know it.

NAD+ is a coenzyme, meaning it helps other enzymes to function correctly (supporting approximately 500 enzymatic reactions!). Essentially, NAD+ is the fuel that makes our cells and organs run smoothly. We need NAD+ for everything from repairing DNA and pumping blood to contracting muscles and helping our mitochondria turn food into fuel.

However, NAD+ levels tend to decline as we age due to an accumulation of DNA damage and cellular or metabolic requirements, dropping by up to 65% between age 30 and 70. When we have lower NAD+, signs of age-related physiological decline—both internally and externally—can accelerate. Therefore, maintaining your NAD+ levels is a core component of healthy aging and longevity.

You may think that boosting NAD+ levels is as easy as popping an NAD+ capsule. However, oral NAD+ is ineffective because it cannot easily cross cell membranes in its original form—the phosphates need to be removed because they’re too large to cross cell membranes. Then, it needs to be converted into its components before it can be taken up by the cell and turned into NAD+.

Fortunately, there are other options, including intravenous NAD+ and Niagen® IVs, which use the NAD+ precursor Niagen, a patented, pharmaceutical-grade form of NR called nicotinamide riboside chloride (NRCl).

Directly infusing your bloodstream with NAD+ or Niagen bypasses the digestive system, which may allow for higher bioavailability than capsules. However, there are some prominent differences between NAD+ IVs and Niagen IVs, which we will get into later in this article.

Benefits of Maintaining Healthy NAD+ Levels

Both NAD+ IVs and Niagen IVs elevate NAD+ in the body, and research has shown that elevating or maintaining NAD+ levels can support the following areas:

  • Cellular energy production: NAD+ is absolutely vital for helping cells produce energy in the form of ATP. Without ATP, we cannot function; with low ATP, we can feel signs of mental and physical fatigue.
  • Mitochondrial function: As you may recall from 7th-grade Biology, the mitochondria are the powerhouse of the cell, meaning they turn the food we eat into fuel (a process known as mitochondrial respiration). Higher NAD+ levels can support more efficient mitochondrial function.
  • DNA repair: Depleted NAD+ stores are associated with reduced abilities to repair damaged DNA—an essential component of cellular health and healthy aging.
  • Healthy autophagy: NAD+ is involved in autophagy, or the removal of toxic and dysfunctional cells and proteins to maintain cellular homeostasis.
  • Aspects of longevity: NAD+ supports sirtuin activity (a group of enzymes that help regulate cellular health and repair DNA) and reduces telomere dysfunction.
  • Muscle health and recovery: Muscles are also substantial energy users, and low NAD+ may be implicated in age-related muscle loss and poor recovery after activity.

How to Increase NAD+ Levels

Intravenous therapy is not the only way to increase NAD+ levels. You can also use other methods like NAD+ precursors to support healthy cellular function and increase your NAD+ stores. The different forms and derivatives of vitamin B3 are known as NAD+ precursors. While you can obtain vitamin B3 through your diet, it’s difficult to elevate NAD+ to sufficient levels through diet alone, which is where supplementation with NAD+ precursors can help.

NAD+ Precursors

The most well-known NAD+ precursors that are B3 vitamins are nicotinamide riboside (NR), nicotinamide or niacinamide (NAM), niacin, and nicotinamide mononucleotide (NMN), which is a vitamin B3 derivative.

These similar compounds work in slightly different ways, but they all contribute to NAD+ stores by participating in the “NAD salvage pathway,” which can be thought of as a recycling program that makes NAD+ from forms of B3 vitamins, including NR.

The NAD+ precursors NR and NMN are thought to be more effective at raising NAD+ levels than nicotinamide or niacin, and the patented form of NR (Niagen) is the most well-researched, clinically backed, and safety-reviewed NR supplement in the world. Per an FDA decision in November 2022, NMN is no longer allowed to be sold as a dietary supplement in the U.S.

NAD+-Boosting Foods

Foods that support NAD+ status contain only a fraction of the NR, NMN, or niacinamide you’d get in a supplement.

Some of the top foods that provide NAD+ precursors like NR or NMN include:

  • Broccoli
  • Edamame
  • Cucumber
  • Cabbage
  • Beef
  • Avocado
  • Mushrooms

However, you would need to consume very large amounts of each of these foods to get clinically relevant amounts of NAD+ precursors.

For example, this study found that non-organic cow’s milk contained 3.9 micromoles of NR per liter, which would translate to about 0.23mg per one-cup serving of milk. Comparatively, a typical supplemental dose of NR is 300mg. You would need to drink about 88 gallons of milk per day to reach the equivalent of 300mg of NR.

Similarly, vegetables like edamame, broccoli, cucumber, and cabbage contain just 0.25-1.88mg of NMN per 100 grams (approximately one cup of veggies). Although these foods are healthy and provide many other beneficial compounds, they are not the most effective at increasing NAD+ levels.

NAD+-Supportive Supplements

Lastly, some other compounds can support NAD+ levels, typically by acting on enzymes that inhibit its degradation.

Some of the main NAD-supportive compounds are known as CD38 inhibitors.

CD38 is an enzyme that activates immune cells to produce compounds called cytokines, using significant amounts of NAD+ in the process. Rather than elevating NAD+, inhibiting CD38 activity can preserve NAD+ levels by preventing its overconsumption in this process.

CD38-inhibiting compounds are often antioxidants known as flavonoids, including quercetin, apignein, and luteolin.

What You Need to Know About NAD+ IV: Top FAQs

Let’s take a look at some of the most frequently asked questions about getting NAD+ IVs. Keep in mind that these answers are based on NAD+ IVs, not NR (Niagen) IVs.

Does NAD+ IV have side effects?

Yes, NAD+ IVs are known to produce side effects. Although the adverse effects are fleeting and typically only last during the infusion, this can still be a 2-4 hour period of feeling discomfort. Side effects of NAD+ IVs include:

  • Chest tightness
  • Anxiety
  • Headaches
  • Nausea or vomiting
  • Hot flashes
  • Stomach cramping
  • Lightheadedness
  • Diarrhea

How long does NAD+ IV take?

NAD+ IV infusions can take several hours, often in the 2 to 4-hour range. In a pilot study, NAD+ IV infusions took up to 184 minutes (just over 3 hours).

What do NAD+ IVs feel like after?

Although NAD+ IVs typically produce unpleasant side effects during the treatment, you should expect to feel better afterward. People report feeling more energy, clearer-headed, more focused, and better able to recover after exercise.

What do I need to do to prepare for NAD+ IV?

You can prepare for your first NAD+ IV by drinking enough water in the days leading up to it, eating a healthy and nutrient-dense meal beforehand, avoiding caffeine and alcohol, and getting enough sleep. On the day of your IV, wear comfortable clothes and bring something you want to read or use to pass the time. NAD+ IVs can take several hours.

Is there downtime from NAD+ IV?

There is likely only a little downtime needed from getting an NAD+ IV unless you had overly severe side effects. In that case, you could expect some side effects to linger for a day or two. Most people report feeling better after getting NAD+ IVs.

How often can you get NAD+ IVs?

There is no one-size-fits-all answer for how often you should get NAD+ IVs—it’s based on factors like your overall health, any health conditions you have, your current NAD+ status, and the results you are hoping for. Some wellness clinics recommend getting NAD+ IV treatments a few times per month, but you should speak with your physician to determine the right amount for you.

How long do the effects of NAD+ IV last?

The effects of NAD+ IV therapy can vary individually depending on factors like your health and current NAD+ status. You might feel noticeable effects on energy, mental clarity, and mood within hours to days, and they may last 1 to 2 weeks. If you undergo NAD+ IVs regularly, you may see cumulative benefits, and the effects may last longer each time.

NAD+ IV vs. Niagen IV: Which One Is Better?

Although they seem pretty similar, NAD+ IVs and Niagen IVs have several prominent differences.

NAD+ IVs should be composed of nicotinamide adenine dinucleotide, but there may be inconsistent formulations, including outsourcing facilities that may not follow good manufacturing practices. As NAD+ IVs are not strictly regulated and there is no widely accepted standard dose, it’s difficult to know if you are getting a pure NAD+ infusion.

Conversely, Niagen IVs consist only of pharmaceutical-grade Niagen® (nicotinamide riboside chloride or NRCl) mixed with bacteriostatic or sterile water in intravenous form.

The other leading differences between NAD+ IVs and Niagen IVs include:

  • Side effects: NAD+ IVs are known to cause uncomfortable and painful side effects. NAD+ IVs can cause chest tightness, anxiety, headaches, nausea, hot flashes, stomach cramping, lightheadedness, and diarrhea. Conversely, Niagen IVs have been shown to cause minor adverse effects, including feeling congested, tingling in the mouth, and slight pressure in the head and ears.
  • Infusion time: NAD+ IVs take much longer to complete the treatment, typically taking 2 to 3 hours but may be 4 or more hours. Niagen IVs take one-quarter of the time, usually 30 minutes to 1 hour.
  • Inflammatory potential: A pilot study found that NAD+ IVs increased white blood cell counts, which is suggestive of an inflammatory immune response. Niagen IVs did not produce the same inflammatory response.
  • Blood NAD+ elevation: Niagen IVs raise blood NAD+ levels 20% faster at 3 hours post-infusion than NAD+ IVs.

Key Takeaways: Which NAD+ Treatment Is Right for You?

Niagen IV is a superior NAD-boosting infusion treatment due to its pharmaceutical-grade ingredients (nicotinamide riboside chloride), shorter infusion times, minimal and more tolerable adverse effects, and faster elevation of NAD+ in the bloodstream.

NAD+ IVs cause more significant side effects and take much longer for the infusion to enter the bloodstream completely. Blood NAD+ levels also peak later than Niagen IVs. However, the type of NAD+ infusion you choose is ultimately up to you and your healthcare provider to decide!

—

Sources:

Amjad S, Nisar S, Bhat AA, et al. Role of NAD+ in regulating cellular and metabolic signaling pathways. Mol Metab. 2021;49:101195. doi:10.1016/j.molmet.2021.101195

Braidy N, Villalva MD, van Eeden S. Sobriety and Satiety: Is NAD+ the Answer?. Antioxidants (Basel). 2020;9(5):425. Published 2020 May 14. doi:10.3390/antiox9050425

Brakedal B, Dölle C, Riemer F, et al. The NADPARK study: A randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease. Cell Metab. 2022;34(3):396-407.e6. doi:10.1016/j.cmet.2022.02.001

Custodero C, Saini SK, Shin MJ, et al. Nicotinamide riboside-A missing piece in the puzzle of exercise therapy for older adults?. Exp Gerontol. 2020;137:110972. doi:10.1016/j.exger.2020.110972

Goody MF, Henry CA. A need for NAD+ in muscle development, homeostasis, and aging. Skelet Muscle. 2018;8(1):9. Published 2018 Mar 7. doi:10.1186/s13395-018-0154-1

Imai SI, Guarente L. It takes two to tango: NAD+ and sirtuins in aging/longevity control. NPJ Aging Mech Dis. 2016;2:16017. Published 2016 Aug 18. doi:10.1038/npjamd.2016.17

Janssens GE, Grevendonk L, Perez RZ, et al. Healthy aging and muscle function are positively associated with NAD+ abundance in humans. Nat Aging 2022;2, 254–263. https://doi.org/10.1038/s43587-022-00174-3

Massudi H, Grant R, Braidy N, Guest J, Farnsworth B, Guillemin GJ. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS One. 2012;7(7):e42357. doi:10.1371/journal.pone.0042357

Matasic DS, Brenner C, London B. Emerging potential benefits of modulating NAD+ metabolism in cardiovascular disease. Am J Physiol Heart Circ Physiol. 2018;314(4):H839-H852. doi:10.1152/ajpheart.00409.2017

Rajman L, Chwalek K, Sinclair DA. Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence. Cell Metab. 2018;27(3):529-547. doi:10.1016/j.cmet.2018.02.011

Remie CME, Roumans KHM, Moonen MPB, et al. Nicotinamide riboside supplementation alters body composition and skeletal muscle acetylcarnitine concentrations in healthy obese humans. Am J Clin Nutr. 2020;112(2):413-426. doi:10.1093/ajcn/nqaa072

Ruszkiewicz JA, Bürkle A, Mangerich A. Fueling genome maintenance: On the versatile roles of NAD+ in preserving DNA integrity. J Biol Chem. 2022;298(6):102037. doi:10.1016/j.jbc.2022.102037

Stock AJ, Liu Y. NAD-Linked Metabolism and Intervention in Short Telomere Syndromes and Murine Models of Telomere Dysfunction. Front Aging. 2021;2:785171. Published 2021 Oct 27. doi:10.3389/fragi.2021.785171

Wilson N, Kataura T, Korsgen ME, Sun C, Sarkar S, Korolchuk VI. The autophagy-NAD axis in longevity and disease. Trends Cell Biol. 2023;33(9):788-802. doi:10.1016/j.tcb.2023.02.004

— Niagen Plus Staff
Back to The Niagen Report Newer articles