Key Takeaways
- NAD+ is a coenzyme your cells use to turn the food you eat into usable energy.
- The enzymes that help maintain your DNA and send signals between cells rely on it too.
- Your body makes NAD+ from niacin, and most products sold as NAD+ supplements contain a building block your cells turn into NAD+.
- In a study of healthy adults, plasma NAD+ was lower in people in their early 50s than in people in their 20s.
- You can get NAD+ from LIV by prescription as an injection, nasal spray or oral drops, and a licensed provider reviews your history before prescribing.
Your cells use NAD+ all day long. Its full name is nicotinamide adenine dinucleotide, and it's a coenzyme: a helper molecule an enzyme needs to do its job.
What Does NAD+ Do in Your Body?
It helps your cells turn food into energy, and it supports the enzymes that maintain your DNA and send signals between cells. More than 400 enzymes need NAD+, more than for any other vitamin-derived coenzyme. Here's where that work shows up.
Feel More in the Tank
Every cell you have converts food into usable energy, and that conversion runs on NAD+. Much of that work moves the energy in carbohydrates, fats and proteins into adenosine triphosphate (ATP), the form of energy your cells spend.
Built to Bounce Back
Your DNA takes small hits every day. The enzymes that repair it spend NAD+ to do the work.
Firing on All Cylinders
Cells coordinate through enzymes that manage stress and signaling. Those enzymes depend on NAD+.
What's Actually in an NAD+ Supplement?
Most products sold as an NAD+ supplement are actually a building block, and your cells make NAD+ from it.
That building block is called a precursor. Niacin, also called vitamin B3, is one, and NAD+ is the main active form every tissue makes from the niacin you absorb. Most of what's on the supplement shelf is a precursor too.
You'll see three kinds most often:
- Nicotinic acid and nicotinamide: the two classic niacin forms. The recommended dietary allowance for niacin is 16 mg niacin equivalents for adult men and 14 mg for adult women.
- Nicotinamide riboside (NR): sold widely as a supplement ingredient.
- Nicotinamide mononucleotide (NMN): a precursor with a different legal status from the other two.
In a six-week study of healthy middle-aged and older adults, NAD+ in blood cells was about 60% higher on oral NR than on placebo.
WHERE NAD COMES FROM
Most of the shelf sells a precursor.
- Niacin from food, or from a supplement
- Converted in the body every tissue does it
- NAD the working coenzyme
NAD eaten as NAD is converted to nicotinamide in the gut first, so it arrives as a precursor too.
More than 400 enzymes require NAD: energy from carbohydrates, fats and proteins; genome integrity, gene expression, cell communication.
How Does NAD+ Change With Age?
Studies find it lower in older adults. In a study of healthy adults aged 20 to 87, plasma NAD+ was significantly lower in people in their early 50s than in people in their 20s, and levels were lower at older ages across that range. Earlier work in human skin, from newborns to age 77, found NAD+ content lower with age too.
A study average can't tell you much about your own levels, so talk with your provider about what you're hoping for and whether NAD+ is right for you.
NAD+ by Prescription at LIV
LIV's NAD+ is a prescription medicine, and a licensed pharmacy prepares it for you. Before prescribing, a licensed provider reviews your health history and goals, then checks in on you before every refill at no extra cost.
You can choose how you take it. The injection, nasal spray and oral drops all contain NAD+, the same active ingredient. If you have trouble absorbing medicine through your gut, or you'd rather not take another pill, tell your provider. They'll help you choose. For more, see our guides to NAD+ injection dosing and NAD+ IV therapy.
Side Effects and Safety Notes
Side effects depend on the form. If you take more nicotinic acid than your body needs, it can make your skin flush, while nicotinamide doesn't.
Your provider will ask about:
- Supplements: especially nicotinamide riboside, since your provider may decide not to prescribe NAD+ alongside it.
- Medicines: list everything you take.
Tell your provider about side effects before changing your dose. For injections, your provider can keep the same strength and prescribe it less often.
What to Bring to Your Evaluation
Bring a list of your current supplements and medicines, especially anything with niacin or NR in it. It also helps to think about what you'd like help with and how you'd prefer to take NAD+. When you're ready, your evaluation is the next step, where a licensed provider reviews your history with you and decides whether NAD+ is right for you.
Frequently Asked Questions
Is an NAD+ supplement the same thing as NAD+?
Usually not. Most products sold under that name supply a building block such as nicotinamide riboside or a niacin form, which your body converts. Even NAD+ taken by mouth is converted to nicotinamide in the gut before it's absorbed.
Can a supplement raise your NAD+ levels?
In one study it did, in blood cells. Healthy middle-aged and older adults had about 60% higher NAD+ in their blood cells after six weeks of oral nicotinamide riboside, 500 mg twice daily, than after placebo (Martens et al., Nature Communications, 2018). The figure compares NR with placebo, not with each person's starting level; it was a crossover study with 24 people completing it and NAD+ measured in 21. It tested an oral building block, so it isn't evidence for NAD+ injections, nasal spray or oral drops.
Where does the age finding come from?
From a cross-sectional study of 29 healthy adults aged 20 to 87, in groups with average ages of 22.8, 52.8 and 76.9 (Clement et al., Rejuvenation Research, 2019). It was a small sample of largely Caucasian US participants. The 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.
Will NAD+ give me more energy?
There isn't enough evidence to know whether NAD+ improves day-to-day energy. The cell roles described above explain what NAD+ does inside cells; they 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.
Why does niacin make my face flush?
Nicotinic acid, one of the two common niacin forms, can cause flushing in amounts beyond what your body needs. Nicotinamide, the other form, doesn't. Inositol hexanicotinate is sold as "flush free" niacin, but it's a distinct substance that's absorbed less well than either form, so check the ingredient list.
Is NMN a legal supplement?
Not as a dietary supplement. NMN had been authorized for investigation as a new drug before it was sold as a supplement, so in November 2022 the FDA said it may not be lawfully marketed as a dietary supplement. Ask your provider before using any supplement alongside a prescription.
What does compounded mean for LIV's NAD+?
A licensed pharmacy mixes your medicine for you, to the prescription your provider writes, rather than in large batches. Compounded medicines aren't FDA-approved, and the FDA doesn't review their safety, effectiveness or quality before they're marketed.
How do I choose between the injection, spray and drops?
All three contain NAD+. 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.
References
National Institutes of Health, Office of Dietary Supplements. (n.d.). Niacin: Fact sheet for health professionals. Read 2026-08-20. https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/
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. doi:10.1089/rej.2018.2077. PubMed record checked October 1, 2026. https://pubmed.ncbi.nlm.nih.gov/30124109/
Martens, C. R., Denman, B. A., Mazzo, M. R., Armstrong, M. L., Reisdorph, N., McQueen, M. B., et al. (2018). Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nature Communications, 9(1), 1286. PubMed record checked October 1, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC5876407/
Massudi, H., Grant, R., Braidy, N., Guest, J., Farnsworth, B., and Guillemin, G. J. (2012). Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS ONE, 7(7), e42357. Read 2026-08-20. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0042357
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
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