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Key Takeaways
- NAD+ helps your cells turn food into energy and supports enzymes that maintain DNA.
- Tell your provider about any supplements you take, especially nicotinamide riboside.
- LIV offers NAD+ as an injection, a nasal spray or oral drops, and your provider helps you choose.
- A licensed provider looks at your health history before prescribing and checks in on you before every refill.
If you're considering NAD+ injections, you might wonder what NAD+ actually does. More than 400 enzymes need it to do their work.
What Does NAD+ Do in Your Body?
NAD+ is a coenzyme, which means it helps enzymes do their work. Your body makes it from niacin, also called vitamin B3, and your cells rely on it in a few important ways:
- Food into energy: every cell you have converts food into usable energy, and that conversion runs on NAD+.
- DNA upkeep: your DNA takes small hits every day. The enzymes that repair it spend NAD+ to do the work.
- Cell communication: cells coordinate through enzymes that manage stress and signaling. Those enzymes depend on NAD+.
How NAD+ Levels Differ With Age
In one study, plasma NAD+ was significantly lower in people in their early 50s than in adults in their 20s. Across the whole age range studied, levels were lower with age. A small brain-imaging study of healthy adults found the same pattern, with lower NAD+ levels at older ages.
Choose the Format That Fits Your Routine
LIV offers NAD+ three ways, and all three contain the same active ingredient:
- Injection: a shot you give yourself at home, with instructions in your shipment.
- Nasal spray: a metered spray you use instead of giving yourself an injection.
- Oral drops: liposomal drops, an option if you don't want another pill.
Tell your provider which you'd prefer and whether you have trouble absorbing medicine through your gut. They'll review your health history and help you choose.
What Compounded Means for Your Prescription
It means a licensed pharmacy prepares your NAD+ injection for you, after your provider prescribes it, rather than making it in large batches. LIV works with licensed pharmacy partners.
How Your Provider Builds Your Plan
First, you answer a few questions online about your health history, the medicines you take and your goals. A licensed provider uses your answers to decide whether NAD+ is right for you and, if it is, chooses your dose and how much to prescribe. After approval, delivery usually takes 3 to 5 days, and compounding can add time.
Follow the directions that come with your prescription rather than a routine you read about online, which may use a different strength or route. Ask your provider or pharmacy about anything unclear, including storage.
Before each refill, you'll answer a short questionnaire about how you're doing, and your provider reviews your plan. You'll also check in every three months, and your care team is there between refills. Check with your provider before switching formats.
Side Effects and What to Tell Your Provider
Tell your provider about any side effects before changing your dose. If your starting dose doesn't agree with you, LIV's protocol lets your provider keep the same strength and prescribe it less often.
In your health form, also list:
- Nicotinamide riboside: your provider may decide not to prescribe NAD+ alongside it.
- Other supplements: such as niacin or NMN. Ask before swapping one for your prescription.
- Medicines: everything you take.
Start With the Question That Matters to You
It helps to know what you'd like to talk through at your evaluation. These three questions are a good place to start:
Before You Choose a Format
- Your goal What change do I hope to notice?
- The evidence Was that outcome studied in people?
- Your options Why does this format fit my history?
Questions to bring to your evaluation.
Bring them to your evaluation.
Frequently Asked Questions
Will NAD+ injections make me feel more energetic?
There is not enough evidence to know whether NAD+ injections improve day-to-day energy. NAD+ has an essential role inside cells, but that alone does not tell us how you might feel after an injection. The cell roles described here don't establish improved energy, recovery or focus from LIV's NAD+ products. Tell your provider about tiredness or other changes so they can review what may be causing them.
Where do the age figures come from?
The plasma figures come from a cross-sectional study of 29 healthy adults ages 20 to 87 (Clement et al., Rejuvenation Research, 2019), with group mean ages of 22.8, 52.8 and 76.9. It was a small sample of largely Caucasian US participants, and it compared age groups rather than following the same people over time.
The brain-imaging study measured 17 healthy adults ages 21 to 68 and didn't test NAD+ injections. These findings describe how NAD+ levels differ by age. They aren't results from LIV's NAD+ products and don't show that raising NAD+ improves energy, aging or any health outcome.
Is the injection stronger than the spray or drops?
No study shows one format works better than the others. All three contain NAD+, so the choice comes down to what suits you, such as comfort with needles or trouble absorbing medicine through your gut. Your provider can also change the format later if your needs change.
What does compounded mean for my NAD+ injection?
A licensed pharmacy prepares it for you, to the prescription your provider writes. Compounded medicines aren't FDA-approved, and the FDA doesn't review their safety, effectiveness or quality before they're marketed. Follow the directions on your prescription and the pharmacy label that comes with it.
Do I need a prescription for an NAD+ injection?
Yes. LIV's NAD+ injection is a prescription medicine, so a licensed provider reviews your health history and decides whether it's right for you. If it isn't, you'll hear that during your evaluation.
Is this the same as taking niacin?
Niacin is vitamin B3, which your body uses to make NAD+, so it isn't NAD+ itself. LIV's compounded NAD+ injection is a prescription medicine, and a niacin supplement is a different product. Ask your provider before substituting one for the other.
References
Clement, J., Wong, M., Poljak, A., Sachdev, P., & Braidy, N. (2019). The plasma NAD+ metabolome is dysregulated in "normal" aging. Rejuvenation Research, 22(2), 121-130. Read October 1, 2026. https://pubmed.ncbi.nlm.nih.gov/30124109/
National Institutes of Health, Office of Dietary Supplements. (n.d.). Niacin: Fact sheet for health professionals, Introduction. Read September 11, 2026. https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/
U.S. Food and Drug Administration. (n.d.). Compounding and the FDA: Questions and answers. Read September 11, 2026. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers
Zhu, X.-H., Lu, M., Lee, B.-Y., Ugurbil, K., & Chen, W. (2015). In vivo NAD assay reveals the intracellular NAD contents and redox state in healthy human brain and their age dependences. Proceedings of the National Academy of Sciences, 112(9), 2876-2881. https://pubmed.ncbi.nlm.nih.gov/25730862/
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