Exact standard formulation
| Ingredient | Typical dose | Mechanism of action | Osmolarity contribution |
|---|---|---|---|
| NAD+ (β-nicotinamide adenine dinucleotide), compounded vial | 250, 500, 750 or 1,000 mg per session | Redox coenzyme (NAD+/NADH) for glycolysis, the TCA cycle and oxidative phosphorylation; co-substrate for sirtuins, PARP DNA-repair enzymes and CD38 | Small: ≈ 1.5 mOsm per 500 mg (molecular weight ≈ 663) |
| Carrier: 0.9% NaCl | 250–1,000 mL (larger doses in larger volume) | Dilutes NAD+ so rate can be finely controlled by drip count or pump | 308 mOsm/L; final bag stays ≈ 308–315 mOsm/L |
| Optional: Lactated Ringer’s carrier | 500–1,000 mL | Used by some protocols for patients who also want rehydration; confirm compatibility with the compounding pharmacy | ≈ 273 mOsm/L |
| Optional: glutathione slow push after NAD+ | 600–2,000 mg, separate syringe | Thiol antioxidant given after the NAD+ bag finishes; not mixed into the NAD+ bag | ≈ 6–7 mOsm per gram (buffered); hypertonic in the syringe |
| Optional: B12 IM injection | 1,000 mcg hydroxocobalamin or methylcobalamin | Methylation and energy-metabolism cofactor, given intramuscularly | Not in the bag |
Cellular bioenergetics and sirtuins: what is known
NAD+ is a coenzyme present in every cell. It shuttles electrons in energy metabolism as the NAD+/NADH pair and is consumed as a substrate by three enzyme families: sirtuins (SIRT1–7, which regulate gene expression and mitochondrial function), PARPs (which repair DNA) and CD38 (an NAD-degrading enzyme whose activity rises with age and inflammation).
Animal research and some human tissue studies show NAD+ levels fall with age, and raising NAD+ in animals improves several markers of metabolic health. That is the scientific basis for “sirtuin activation” marketing. The gap is that very little human data show IV NAD+ raises NAD+ inside human tissues or changes clinical outcomes.
A small 2019 pilot study that infused 750 mg over six hours found plasma NAD+ did not rise for the first two hours, while urinary metabolites increased, which suggests rapid uptake or breakdown. Extracellular NAD+ is largely broken down to smaller precursors (nicotinamide mononucleotide, nicotinamide riboside, nicotinamide) before cells take it up.
NAD+ is also marketed for addiction recovery and withdrawal. Evidence for that use is anecdotal; a person in active alcohol or opioid withdrawal needs medically supervised detoxification, not a wellness drip.
Carrier fluid and dilution
Most protocols dilute NAD+ in 0.9% Sodium Chloride, which is compatible and keeps the final bag close to isotonic. Because NAD+ itself adds very little osmolarity, carrier volume is chosen for rate control and patient fluid tolerance, not to dilute a hypertonic load.
- 250 mg: commonly 250 mL NS.
- 500 mg: 250–500 mL NS.
- 750–1,000 mg: 500–1,000 mL NS, which spreads the dose over a longer drip.
Lactated Ringer’s is used by some practices, but compatibility data for compounded NAD+ in LR are thinner; follow the compounding pharmacy’s stated diluent. Sterile water is not used as an NAD+ carrier. For the electrolyte differences between carriers, see Normal Saline vs Lactated Ringer’s.
NAD+ vials are typically stored refrigerated and protected from light, and the beyond-use date is set by the pharmacy. Mobile nurses need a monitored medical refrigerator in the vehicle; the cold-chain storage guide covers data loggers and temperature excursions.
Infusion rate and titration protocol
NAD+ is rate-limited by symptoms rather than by osmolarity. Infused too fast, it commonly causes chest tightness or pressure, abdominal cramping, nausea, flushing, headache, and a restless or anxious feeling. These effects usually ease within minutes of slowing or pausing the drip. One proposed explanation is adenosine signaling from NAD+ breakdown products, though the mechanism is not settled.
| Dose | Typical carrier | Typical duration | Average rate |
|---|---|---|---|
| 250 mg | 250 mL NS | 60–120 min | ≈ 2–4 mg/min |
| 500 mg | 250–500 mL NS | 2–3 hours | ≈ 3–4 mg/min |
| 750 mg | 500 mL NS | 3–4 hours | ≈ 3–4 mg/min |
| 1,000 mg | 500–1,000 mL NS | 3.5–4+ hours, sometimes split across two days | ≈ 4 mg/min |
Average rates are derived from common session lengths; they are not a dosing standard. The medical director’s written protocol governs.
How titration usually works
- Start at the slowest rate for the first 15–20 minutes while watching for early symptoms.
- Step the rate up gradually if the patient is comfortable, using an infusion pump or rate-controlled tubing where available.
- At the first report of chest pressure, cramping or nausea, slow or pause, reassess vital signs, and restart at a lower rate once symptoms resolve.
- Recheck blood pressure, heart rate and SpO₂ at baseline, about every 30 minutes, and at the end.
Glutathione co-administration
Many clinics offer a glutathione push at the end of an NAD+ session. Glutathione is not added to the NAD+ bag: compatibility data for the two in one bag are lacking, and glutathione’s free thiol group oxidizes readily. Instead, the nurse flushes the line with saline after the NAD+ bag finishes, then gives 600–2,000 mg of glutathione as a slow push over several minutes or as a small piggyback. Details are on the glutathione IV push page.
Patients sometimes ask for a Myers’ or other vitamin bag on the same day. That is usually given before or after the NAD+ bag rather than mixed with it, and the total visit length grows accordingly.
Session and package pricing
NAD+ prices reflect two things: the cost of the compounded drug, and two to four hours of a registered nurse’s chair time. National ranges are $375–$850 in a lounge and $450–$1,100 for mobile concierge, where the nurse stays in your home or hotel room for the whole infusion.
Clinics commonly sell loading series (for example four to ten sessions over a few weeks) at a per-session discount, followed by monthly maintenance. There is no clinical standard for how many sessions anyone needs, so treat a package as a pricing decision, not a medical prescription. Check whether unused sessions are refundable.
Use the NAD+ configurator to compare 250, 500, 750 and 1,000 mg sessions in your state.
Who it is for and who it is not for
The typical NAD+ client is a healthy adult interested in energy, focus or healthy-aging protocols who can sit for several hours. Patients new to NAD+ often start at 250 mg to learn how they tolerate the rate before moving to higher doses.
Oral precursors such as nicotinamide riboside and nicotinamide mononucleotide are a lower-cost alternative that have more published human pharmacokinetic data than IV NAD+, though outcome evidence for them is also limited.
Lounge vs. mobile price benchmarks
| Setting / dose | Typical price | What is included | Notes |
|---|---|---|---|
| Lounge, 250 mg | $375–$450 | NAD+ in 250 mL NS, 1–2 hours of monitoring | Common first session |
| Lounge, 500 mg | $500–$650 | 2–3 hours, titrated | Most common maintenance dose |
| Lounge, 750–1,000 mg | $650–$850 | 3–4+ hours | Some clinics split 1,000 mg across two visits |
| Mobile concierge, any dose | $450–$1,100 | Nurse remains on site for the full infusion | Price scales with chair time; trip fees may apply |
| Glutathione push add-on | +$35–$65 | 600–2,000 mg after the NAD+ bag | Separate syringe, line flushed first |
| Loading series / package | Often 10–20% off per session | Prepaid block of sessions | No clinical standard for session count |
Prices are national self-pay medians; the drip configurator applies your state’s regional index, add-ons and group tiers.
Mandatory screening & contraindications
Required before the infusion
- Good Faith Exam by an MD, DO, NP or PA before the first infusion and when health history changes
- Cardiac history: chest pain, heart attack, arrhythmia, uncontrolled hypertension
- Medication review, including chemotherapy and other investigational or compounded products
- Pregnancy and breastfeeding status
- Vital signs at baseline, about every 30 minutes, and at discharge
- Confirmation that the NAD+ vial is within its beyond-use date and was stored cold
- Advice to eat beforehand and stay hydrated, which many protocols use to reduce nausea
Contraindications & stop signals
- Absolute: prior severe reaction to NAD+
- Absolute: pregnancy or breastfeeding (no safety data)
- Absolute: unstable angina, recent myocardial infarction or uncontrolled arrhythmia
- Relative: active cancer or cancer treatment (theoretical concern about supporting tumor metabolism; oncologist input required)
- Relative: uncontrolled hypertension or significant anxiety or panic disorder (rate symptoms can mimic panic)
- Relative: severe hepatic or renal impairment
- Relative: heart failure or fluid restriction (limit carrier volume)
Configure this protocol for your group or event
Choose mobile or lounge, volume, add-ons and participants; the estimate, safety flags and printable brief update instantly and carry into your booking request.
Where this protocol is in demand
NAD+ bookings concentrate in high-income executive and longevity markets with dense hotel and in-home concierge demand.
For clinics offering this drip: FDA Section 503A vs 503B Outsourcing Facilities: Sourcing Sterile IV Nutrients Legally · Cold-Chain Logistics & Medication Storage in Mobile IV Vehicles · Clinical Standing Orders, Inclusion and Exclusion Criteria, and Emergency Protocols for Mobile IV.
Frequently asked questions
Why does an NAD+ IV take so long?
Fast infusion causes chest pressure, cramping and nausea, so NAD+ is dripped slowly and titrated to comfort. A 500 mg dose usually takes two to three hours and 1,000 mg can take four hours or more.
What does NAD+ feel like during the infusion?
Many people feel nothing at a slow rate. If the rate is too fast, common sensations are chest tightness, stomach cramping, flushing, headache or restlessness, which usually fade within minutes when the nurse slows the drip.
Is NAD+ IV FDA-approved?
No. NAD+ for injection is a compounded preparation with no FDA-approved indication. Clinics source it from 503A or 503B pharmacies, and claims about longevity or addiction treatment are not supported by strong human trials.
How many NAD+ sessions do I need?
There is no evidence-based number. Clinics often sell loading series followed by monthly sessions, but those schedules are commercial conventions rather than clinical standards.
Can NAD+ be mixed with glutathione in one bag?
Most protocols keep them separate. The nurse finishes the NAD+ bag, flushes the line, then pushes glutathione slowly, because data on mixing the two are lacking and glutathione oxidizes easily.
Is IV NAD+ better than oral NR or NMN?
That has not been shown. Oral precursors have more published data on raising blood NAD+ levels and cost far less, while IV NAD+ is largely broken down outside cells before uptake.
Sources & standards reviewed
- Grant R, et al. A pilot study investigating changes in the human plasma and urine NAD+ metabolome during a 6 hour intravenous infusion of NAD+. Frontiers in Aging Neuroscience, 2019 Frontiers
- Rajman L, Chwalek K, Sinclair DA. Therapeutic potential of NAD-boosting molecules: the in vivo evidence. Cell Metabolism, 2018 Cell Press
- Bulk drug substances used in compounding under Section 503A and 503B of the FD&C Act U.S. Food and Drug Administration
- USP General Chapter <797> Pharmaceutical Compounding—Sterile Preparations USP
- Infusion Therapy Standards of Practice Infusion Nurses Society
Reviewed under the IVConnection clinical and regulatory review policy. Report a correction to clinical@ivconnection.com.