NAD+ Injections: What to Know Before You Start

[HERO IMAGE: see the hero block above.]

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. It also makes some from tryptophan, an amino acid in protein. 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+.

Three more enzyme families, sirtuins, CD38 and PARPs, need NAD+ as a helper to do their work.

How NAD+ Levels Differ With Age

NAD+ levels tend to be lower as people get older. A major research review describes this gradual fall in tissues and cells, in people as well as in animals.

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.

A study of skin samples from 49 people, from newborns to age 77, also found lower NAD+ at older ages. That held for both men and women. PARP is an enzyme that uses up NAD+, and in the men its activity rose with age as NAD+ levels fell.

Researchers point to possible reasons for the difference: cells using more NAD+, making less of it, or tissues changing in makeup with age.

Levels also move within a single day. A research review describes NAD+ rising and falling with food intake, exercise and the time of day. Because these studies describe groups of people, they can't tell you where your own levels are.

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.

Start with an evaluation

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 state-licensed compounding pharmacies for this.

When a compounding pharmacy isn't registered as an outsourcing facility, its state board of pharmacy generally oversees it day to day, and the FDA can inspect it too.

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 an evaluation

What to Ask Before Starting NAD+ Injections

It helps to know what you'd like to talk through at your evaluation. These three questions are a good place to start:

Bring them to your evaluation.

Frequently Asked Questions