NAD+ is nicotinamide adenine dinucleotide, a cofactor involved in cellular energy metabolism and redox reactions. Human randomized trials mainly study NAD+ precursors such as NMN and nicotinamide riboside, not every NAD+ product form. Evidence is active but mixed, so NAD+ should be considered through clinician review rather than self-directed treatment 1 5.
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See if you qualify →What it is
NAD+ stands for nicotinamide adenine dinucleotide. It is a cofactor, meaning cells use it to help enzymes run chemical reactions, especially reactions tied to energy and redox balance.
Names, class, and basic definition
You may see NAD+ written as NAD, nicotinamide adenine dinucleotide, or reduced and oxidized forms in biochemistry discussions. Related substances include NMN, also called β-nicotinamide mononucleotide, and nicotinamide riboside or nicotinamide riboside chloride; these are NAD+ precursors studied in human trials 1 2 5.
NAD+ is not the same thing as niacinamide or vitamin B3, but vitamin B3-related compounds can feed into NAD+ metabolism. In human research, this matters because a trial of NMN or nicotinamide riboside does not automatically prove the same result for NAD+ injection, NAD+ nasal spray, or any other form 1 5. For a broader plain-English overview, see our guide to NAD treatment.
| Term | What it means | How to read the evidence |
|---|---|---|
| NAD+ / NAD | Nicotinamide adenine dinucleotide, a cellular cofactor | Mechanism context; human product-form evidence must be checked separately |
| NMN | β-nicotinamide mononucleotide, an NAD+ precursor | Studied in randomized human trials in healthy middle-aged adults, prediabetic women, and other groups 1 2 |
| Nicotinamide riboside | A vitamin B3-related NAD+ precursor | Studied in randomized human trials, including safety and metabolism work in healthy overweight adults 5 |
| Niacinamide / vitamin B3 | A related nutrient family term | Not interchangeable with all NAD+ products or clinical claims |
Mechanism of action
NAD+ helps cells move electrons during redox reactions and supports energy metabolism. Human studies in this evidence set mostly test whether NAD+ augmentation changes measured endpoints, such as insulin sensitivity, arterial stiffness, metabolism, or safety markers, rather than proving one single mechanism in people 2 3 4 5.
NAD+ as a redox cofactor
Redox reactions are chemical reactions that move electrons. NAD+ is part of that system, which is why it is discussed in cellular energy and aging research; however, redox biology by itself is not proof of a clinical benefit 4.
NAD+ and mitochondrial metabolism
Mitochondria are the parts of cells that help turn fuel into usable energy. NAD+ augmentation has been studied as a physiologic question in overweight or obese middle-aged and older adults, but that should not be read as a proven weight-loss treatment claim 4. If you are learning how mitochondrial pathways fit into longevity care, our article on mitochondrial therapy explains the difference between mechanisms, biomarkers, and proven outcomes.
NAD+ and sirtuin signaling
Sirtuin signaling is often discussed in longevity research because some enzymes in that family depend on NAD+. The human trials cited here do not prove that sirtuin signaling changes translate into longer life, better performance, or broad anti-aging effects in people 1 3 5.
Evidence
NAD+ receives evidence grade A in this review because the supplied PubMed index summary reports 248 human randomized controlled trials related to NAD+ or NAD+ augmentation 9. That grade describes study quantity and design, not whether NAD+ works for a given person and not whether it is safe.
What Grade A means, and what it does not mean
Grade A means there are at least two human randomized controlled trials in the supplied evidence set. It does not mean that every NAD+ form has the same evidence, that outcomes are proven for all patients, or that NAD+ extends human lifespan 1 2 5 9.
What human studies of NAD+ precursors show
NMN has been studied in a randomized, multicenter, double-blind, placebo-controlled, dose-dependent trial in healthy middle-aged adults that assessed efficacy and safety 1. NMN also increased muscle insulin sensitivity in a randomized trial of prediabetic women, so that finding should be limited to that population and endpoint 2.
Long-term NMN supplementation has been studied in relation to NAD metabolism and arterial stiffness in a randomized, double-blind, placebo-controlled trial 3. NAD+ augmentation has also been studied as a physiologic intervention in overweight or obese middle-aged and older adults, but the study title supports a physiology discussion, not a claim that NAD+ is a weight-loss treatment 4.
Nicotinamide riboside chloride has randomized, double-blind, placebo-controlled safety and metabolism data in healthy overweight adults 5. Nicotinamide riboside has also been tested in older adults with mild cognitive impairment and in Parkinson’s disease research; these support active clinical research, not broad cognitive, neurologic, or anti-aging claims 6 7.
| Evidence area | Human evidence type | What can be said | What cannot be said |
|---|---|---|---|
| Healthy middle-aged adults | Randomized, multicenter, double-blind, placebo-controlled NMN trial | NMN efficacy and safety have been studied in this population 1 | This does not prove all NAD+ forms have the same effects |
| Prediabetes | Randomized NMN trial in prediabetic women | NMN increased muscle insulin sensitivity in that study population 2 | This is not a broad diabetes treatment claim |
| Arterial stiffness | Randomized, double-blind, placebo-controlled NMN trial | Long-term NMN was studied for NAD metabolism and arterial stiffness 3 | This does not prove fewer heart attacks, strokes, or longer life |
| Overweight and obesity | Randomized physiologic NAD+ augmentation study | NAD+ augmentation has been studied for physiologic endpoints 4 | This is not proof of weight-loss efficacy |
| Safety and metabolism | Randomized nicotinamide riboside chloride trial | Long-term safety and metabolism were studied in healthy overweight adults 5 | This does not remove the need for medical screening |
| Mild cognitive impairment | Randomized placebo-controlled trial | Nicotinamide riboside has been tested in older adults with mild cognitive impairment 6 | This is not proof of better cognition for healthy adults |
| Parkinson’s disease research | Randomized phase I trial | Nicotinamide riboside supplementation has been studied in a phase I Parkinson’s disease trial 7 | This is not a treatment recommendation |
This is the main theme of NAD+ research: human studies exist, but the details matter. Our broader guide to human longevity research explains why biomarkers, mechanisms, and small clinical endpoints should not be treated as proof of longer human life.
What studies exist
| Year | Design | Study | Journal | Record |
|---|---|---|---|---|
| 2023 | Randomised controlled trial | The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel- | GeroScience | PMID 36482258 |
| 2020 | Randomised controlled trial | Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation | Journal of the American College of Cardiology | PMID 32586585 |
| 2021 | Randomised controlled trial | Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women | Science (New York, N.Y.) | PMID 33888596 |
| 2020 | Randomised controlled trial | Single-Dose Nirsevimab for Prevention of RSV in Preterm Infants | The New England journal of medicine | PMID 32726528 |
| 2023 | Randomised controlled trial | Nicotinamide adenine dinucleotide metabolism and arterial stiffness after long-term nicotinamide mononucleotide supplementation: a randomized, double-blind, placebo-controlled tria | Scientific reports | PMID 36797393 |
| 2024 | Clinical trial | Zinc promotes microbial p-coumaric acid production that protects against cholestatic liver injury | Cell host & microbe | PMID 39610253 |
| 2023 | Randomised controlled trial | Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study | The Journal of clinical endocrinology and metabolism | PMID 36740954 |
| 2023 | Randomised controlled trial | Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence | The New England journal of medicine | PMID 36856614 |
| 2019 | Randomised controlled trial | Safety and Metabolism of Long-term Administration of NIAGEN (Nicotinamide Riboside Chloride) in a Randomized, Double-Blind, Placebo-controlled Clinical Trial of Healthy Overweight | Scientific reports | PMID 31278280 |
| 2024 | Randomised controlled trial | Landiolol for heart rate control in patients with septic shock and persistent tachycardia. A multicenter randomized clinical trial (Landi-SEP) | Intensive care medicine | PMID 39297945 |
| 2024 | Randomised controlled trial | A randomized placebo-controlled trial of nicotinamide riboside in older adults with mild cognitive impairment | GeroScience | PMID 37994989 |
| 2022 | Randomised controlled trial | The NADPARK study: A randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease | Cell metabolism | PMID 35235774 |
| Registration | Phase | Status | Enrolment | Title |
|---|---|---|---|---|
| NCT02103998 | PHASE3 | WITHDRAWN | — | Study of Thyroid Hormones in Prematures |
| NCT06214078 | NA | UNKNOWN | 48 | Preliminary Clinical Study of NMN Intervention in Mild Ulcerative Colitis |
| NCT06802679 | PHASE4 | COMPLETED | 44 | Comparison of Standard Versus High Dose Urokinase for Dysfunctional Tunneled Dialysis Catheters in Haemodialysis Patients: A Randomized Controlled Trial |
| NCT05366088 | NA | TERMINATED | 100 | RCT of MBCT vs HEP for Late-Life Depression |
| NCT02064569 | PHASE1, PHASE2 | COMPLETED | 19 | Safety Evaluation of Gene Therapy in Leber Hereditary Optic Neuropathy (LHON) Patients |
| NCT05500170 | NA | RECRUITING | 50 | Benefits of Nicotinamide Riboside Upon Cognition and Sleep |
| NCT04784767 | PHASE1 | COMPLETED | 29 | PHASE 1 SARS-COV-2-Spike-Ferritin-Nanoparticle (SpFN) Vaccine With ALFQ Adjuvant for Prevention of COVID-19 |
| NCT04934189 | NA | COMPLETED | 62 | Empowerment Self-Defense Training for the Prevention of Victimization of Transgender Women |
This table is retrieved from PubMed and ClinicalTrials.gov rather than assembled by hand, so it shows what is indexed — including the absences. Last retrieved 2026-09-03.
Reported dosing ranges
NAD+ dosing should not be copied from a study, a supplement label, or a social media protocol. The table below reports what the supplied human-study records identify as studied substances and designs; where the retrieved citation record does not provide exact dose numbers, we do not fill them in.
| Source | Substance studied | Population or context | Reported dosing information from supplied record | How to interpret it |
|---|---|---|---|---|
| Yi et al., 2023 1 | β-nicotinamide mononucleotide (NMN) | Healthy middle-aged adults | Dose-dependent randomized trial; exact dose levels are not included in the supplied citation record | Study context only, not a dosing instruction |
| Yoshino et al., 2021 2 | Nicotinamide mononucleotide | Prediabetic women | Exact dose level is not included in the supplied citation record | Population-specific research, not general dosing advice |
| Katayoshi et al., 2023 3 | Nicotinamide mononucleotide | Long-term supplementation study | Exact dose level is not included in the supplied citation record | Endpoint-specific research, not a protocol |
| Pencina et al., 2023 4 | NAD+ augmentation | Overweight or obese middle-aged and older adults | Exact dose level is not included in the supplied citation record | Physiologic study, not weight-loss dosing guidance |
| Conze et al., 2019 5 | Nicotinamide riboside chloride | Healthy overweight adults | Long-term administration studied; exact dose level is not included in the supplied citation record | Safety and metabolism context only |
| Orr et al., 2024 6 | Nicotinamide riboside | Older adults with mild cognitive impairment | Exact dose level is not included in the supplied citation record | Clinical research context, not cognitive-use guidance |
| Brakedal et al., 2022 7 | Nicotinamide riboside | Parkinson’s disease phase I study | Exact dose level is not included in the supplied citation record | Clinical research context, not disease-treatment guidance |
Why patient dosing should be clinician-guided
Human trials differ by molecule, population, duration, and endpoint, so a dose studied in one setting should not be treated as the right dose for another person. This is especially important for people with chronic disease, pregnancy, cancer history, specialist care, or multiple medications, because the supplied evidence set does not establish one universal NAD+ protocol 2 4 6. For more dosing context, see our patient guide to NAD+ injection dosage.
Legal status
Our regulatory log holds no confirmed federal action for NAD+. That means we have not found one with a primary source — not that none exists.
This section is generated from a dated log of federal actions rather than written by hand, and it is re-checked daily against the Federal Register and FDA sources. Last checked 2026-09-03. See the full legal-status tracker for every compound we follow.
Safety
NAD+ safety is best read by form. Human randomized trials provide safety and metabolism context for precursors such as NMN and nicotinamide riboside, but they do not prove that all NAD+ product forms have the same safety profile 1 5.
What safety data from human precursor trials can and cannot tell us
The supplied records include an NMN trial that assessed efficacy and safety and a nicotinamide riboside chloride trial focused on safety and metabolism 1 5. The supplied citation records do not provide enough detail to list exact adverse-event rates, so a careful clinician should review the full study context and the patient’s medical history before making treatment decisions.
Evidence in prediabetes, overweight or obesity, mild cognitive impairment, and Parkinson’s disease research comes from specific study populations 2 4 6 7. Those studies should not be used to promise benefits or safety for a different person, condition, or product form.
Why source, form, and clinical screening matter
Source quality matters because products sold as “research use only” are not made for human treatment. The practical risks include wrong identity, contamination, impurities, and sterility problems, especially for products meant to be injected or sprayed into the nose 11.
At Chia, our safety lens is licensed care: a health questionnaire, review by a licensed US provider, provider-guided dosing when appropriate, and fulfillment through state-licensed 503A compounding pharmacies. That process is different from buying an unlabeled or “research chemical” product without medical review. If you are comparing formats, our guide to NAD+ injection covers practical safety questions around injectable treatment.
Interactions
NAD+ interaction evidence is limited in the supplied records. The retrieved studies include specific groups such as prediabetic women, healthy overweight adults, older adults with mild cognitive impairment, and Parkinson’s disease research participants, but they do not establish a complete drug-interaction map 2 5 6 7.
Medication and supplement review
A clinician review should include prescriptions, over-the-counter medicines, vitamins, peptides, and supplements. This is important because NAD+ precursor trials often study selected populations under research conditions, which is not the same as unsupervised use with multiple products 1 5.
Pregnancy, chronic disease, cancer history, and specialist care
People who are pregnant, trying to conceive, managing chronic disease, living with a cancer history, or under specialist care should discuss NAD+ or NAD+ precursors with their clinician before use. The supplied evidence set does not establish safety across all of those situations 4 6.
How to obtain it legally
NAD+ should be approached through a medical process, not a self-directed protocol. That process starts with a health history, medication review, goals discussion, and a clinician’s decision about whether treatment is clinically appropriate.
Clinician evaluation and treatment decision
At Chia, NAD+ care starts online with a short health questionnaire. A licensed US provider reviews the information and decides whether treatment is clinically appropriate; treatment is not guaranteed.
NAD+ injection and NAD+ nasal spray options at Chia
Chia offers NAD+ as an injection, with plans currently starting at $179/mo, and as a nasal spray, with plans currently starting at $119/mo. Medications are compounded in the US by state-licensed 503A compounding pharmacies and shipped to the patient’s door; compounded drugs are not FDA-approved. A clinician can also discuss whether any proposed use is appropriate for the patient’s goals and medical history.
| Chia option | Form | Current starting price | Fit to discuss with a provider |
|---|---|---|---|
| NAD+ | Injection | From $179/mo | May fit patients who prefer an injectable route and are comfortable with provider-guided administration |
| NAD+ | Nasal spray | From $119/mo | May fit patients who prefer a non-injection option |
Where NAD+ fits in Chia protocols
NAD+ is also part of several Chia longevity and weight-support protocols. Foundation Longevity includes Sermorelin Injection, NAD+ Injection, and Glutathione Injection; Glow includes GHK-Cu Cream, Glutathione Injection, and NAD+ Injection; and Weight + Energy includes NAD+ Injection plus a choice of GLP-1. These protocols may involve compounded drugs, which are not FDA-approved. For a broader view of where this fits, read our guide to longevity health.
Licensed pharmacy fulfillment and why research-chemical vendors are different
A licensed pharmacy pathway includes a clinician’s review, a patient-specific treatment decision, pharmacy quality controls, and a way to contact the care team. A research-chemical vendor is different: “research use only” material is not made for people, and it may carry identity, sterility, impurity, and contamination risks 11.
Using Chia or DoctorMCP for a clinician-reviewed pathway
You can start directly through Chia’s online visit, and eligible agentic workflows can reach Chia through DoctorMCP at mcp.chia.health when that access path is relevant. The patient-facing next step is still the same: a clinician-reviewed process, not an automatic order.
3-min quiz
Start a clinician-reviewed NAD+ visit
Chia offers NAD+ injection and NAD+ nasal spray through an online evaluation. A licensed provider reviews your health history and prescribes only when clinically appropriate; a prescription is never guaranteed. Compounded drugs are not FDA-approved. You can also read more on the NAD+ product page.
FAQ
No. NAD+ is not a GLP-1 medication and is not used in the same way as semaglutide products such as Ozempic. NAD+ is discussed in cellular energy and longevity research, while GLP-1 drugs act on incretin pathways involved in appetite, glucose, and weight regulation 10.
No. NAD+ is nicotinamide adenine dinucleotide. Vitamin B3-related compounds, including niacinamide and nicotinamide riboside, can be connected to NAD+ metabolism, but they are not all the same product or the same evidence base.
The main downside is uncertainty by form, dose, and patient group. Human trials exist for NAD+ precursors such as NMN and nicotinamide riboside, but that does not prove every NAD+ injection, nasal spray, or supplement has the same benefits or safety profile. Source quality and clinician screening matter.
No. NMN and nicotinamide riboside are NAD+ precursors, meaning they are related to NAD+ metabolism. Many human trials study those precursors, so their findings should not be treated as proof that all NAD+ forms work the same way.
No cited human trial in this guide proves that NAD+ extends human lifespan. NAD+ is studied in longevity research because of its role in metabolism and cell biology, but biomarkers and mechanisms are not the same as proven longer life.
Yes. Chia offers NAD+ as an injection and as a nasal spray through clinician-reviewed care when appropriate. Treatment requires medical review, and a prescription is never guaranteed. Compounded drugs are not FDA-approved.
You should not copy a dose from a study, supplement bottle, or online protocol. Published studies differ by molecule, population, and endpoint, so dosing should be discussed with a licensed clinician who can review your medical history and medications.
References
- 1.PMID 36482258 [randomised controlled trial] Yi L, Maier AB, Tao R, et al. The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial. GeroScience. 2023.
- 2.PMID 33888596 [randomised controlled trial] Yoshino M, Yoshino J, Kayser BD, et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science (New York, N.Y.). 2021.
- 3.PMID 36797393 [randomised controlled trial] Katayoshi T, Uehata S, Nakashima N, et al. Nicotinamide adenine dinucleotide metabolism and arterial stiffness after long-term nicotinamide mononucleotide supplementation: a randomized, double-blind, placebo-controlled trial. Scientific reports. 2023.
- 4.PMID 36740954 [randomised controlled trial] Pencina KM, Valderrabano R, Wipper B, et al. Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study. The Journal of clinical endocrinology and metabolism. 2023.
- 5.PMID 31278280 [randomised controlled trial] Conze D, Brenner C, Kruger CL. Safety and Metabolism of Long-term Administration of NIAGEN (Nicotinamide Riboside Chloride) in a Randomized, Double-Blind, Placebo-controlled Clinical Trial of Healthy Overweight Adults. Scientific reports. 2019.
- 6.PMID 37994989 [randomised controlled trial] Orr ME, Kotkowski E, Ramirez P, et al. A randomized placebo-controlled trial of nicotinamide riboside in older adults with mild cognitive impairment. GeroScience. 2024.
- 7.PMID 35235774 [randomised controlled trial] 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 metabolism. 2022.
- 8.PMID 39610253 [clinical trial] Li D, Wan M, Xue L, et al. Zinc promotes microbial p-coumaric acid production that protects against cholestatic liver injury. Cell host & microbe. 2024.
- 9.2026. PubMed search index summary for ("NAD+" OR "Nicotinamide adenine dinucleotide" OR "NAD"), filtered for human studies and randomized controlled trials. Retrieved 2026-09-03.
- 10.U.S. Food and Drug Administration. Ozempic (semaglutide) injection prescribing information; mechanism and pharmacology of GLP-1 receptor agonist semaglutide. 2023.
- 11.U.S. Food and Drug Administration. The special risks of pharmacy compounding, including contamination, potency, and sterility concerns; research-use-only products are not approved or labeled for human treatment. 2024.
About this article
Chia Health Editorial Team — Evidence-reviewed health education
This article is for educational purposes only and is not a substitute for individualized medical advice. Talk to a licensed clinician before starting, stopping, or changing any prescription.
AI tools may assist with research and drafting. Chia's editorial team reviews source use, clarity, treatment information, and safety framing before publication. A clinician is named only after explicit sign-off. Read our editorial standards.
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