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Telehealth Graded
Peptide evidence

NAD+ drips: one randomized trial, and it wasn't about energy

NAD+ is the most widely sold item on the telehealth longevity menu and the thinnest evidence base on it. One randomized trial of intravenous NAD+ appears in PubMed. It ran in patients with heart failure from ischemic cardiomyopathy, gave 10 mg a day for seven days, and measured heart function — nothing to do with energy, focus, or aging.

Evidence read September 2026. Nobody here holds a medical license and none of this is medical advice. Every source below is listed so you can check it yourself.

What this comes down to

  • One randomized trial with NAD in its title and an intravenous route: 180 patients with ischemic cardiomyopathy, at a single hospital in China.
  • The oral precursors are the ones with a trial record. Nicotinamide riboside returns 24 randomized trials through the identical filter, against one for intravenous NAD+.
  • No product with nicotinamide adenine dinucleotide as an active ingredient exists in Drugs@FDA.
  • NAD+ is not on the FDA's list of compounding substances with identified safety risks. That is an absence of a specific finding, not a clearance.
IV NAD+ randomized trials
1
Nicotinamide riboside trials
24
Oral, not IV
Approved products
None
Dose in the one IV trial
10 mg/day for 7 days

The one trial, in full

Published in early 2026, it enrolled 180 adults with heart failure from ischemic cardiomyopathy, all with an ejection fraction of 45% or below, and randomized them to intravenous NAD+ at 10 mg a day or a placebo infusion for seven days on top of standard therapy[1]. At one month the NAD+ group's ejection fraction was 45.4% against 42.4% for placebo. The composite of major cardiac and cerebrovascular events at six months was 14.6% against 24.7% — a difference the trial itself reports as not statistically significant. It was one hospital, one country, and the authors call for multicenter validation.

10 mg is the number to notice

A telehealth NAD+ infusion is typically sold at several hundred milligrams and up. The only randomized intravenous trial in the literature used 10 mg a day, in sick patients, for a week. Nothing in it speaks to the dose or the population a wellness drip is sold to.

The search behind that claim

PubMed, via the E-utilities API

("nicotinamide adenine dinucleotide"[ti] OR "NAD+"[ti] OR "NAD"[ti]) AND (intravenous[tiab] OR infusion[tiab] OR "IV"[ti]) AND "randomized controlled trial"[pt] AND "humans"[mh]

Returned 1. Positive control — nicotinamide riboside in the title, identical filter — returned 24 through the identical filter in the same session. Read September 2026.

A second control, semaglutide in the title through the same filter, returned 258. A looser search that allows NAD anywhere in the abstract returns six records, and reading them, five are about something else — NADPH oxidase, an amino-acid infusion, a sodium study. The title restriction is what makes the number mean what it says.

The precursors are where the research went

Almost all of the serious NAD+ work in humans has been done with oral precursors, and the results are real but narrower than the marketing suggests. Nicotinamide riboside raises blood NAD+ in healthy middle-aged and older adults[2]. Nicotinamide mononucleotide increased muscle insulin sensitivity in prediabetic women[3]. Trials in mild cognitive impairment[4] and peripheral artery disease[5] have run and reported.

Notice what those studies establish and what they don't. Raising a blood level is a pharmacology result. Whether raising it makes a person feel or function better is a separate question, and it is asked far less often than the first one.

Where it sits with the FDA

There is no approved drug whose active ingredient is nicotinamide adenine dinucleotide. We queried Drugs@FDA by ingredient with a fabricated ingredient name as a control in the same run; the fake returned nothing and so did NAD+, while tesamorelin returned one approved product[6].

NAD+ also doesn't appear on the FDA's table of compounding substances with identified safety risks, whose second table names seventeen substances, nearly all of them peptides[7]. Read that as what it is: the agency has published no specific safety finding about it, which is not the same as having reviewed it and cleared it. The general rules still apply — an injectable made from ingredients that were not manufactured for injection is the exact failure the FDA described in an August 2026 alert about a different infusion productsold on the same menus.

Several of the companies we grade sell NAD+ alongside GLP-1s. Our letter is about the seller — what it publishes and what it charges once the introductory rate ends — and the standard is on how we grade.

Questions people actually ask

Does an NAD+ IV give you more energy?

No randomized trial has tested that. The single randomized trial of intravenous NAD+ measured heart function in patients with heart failure. Energy, focus and mood claims rest on anecdote and on preclinical work, not on human trials.

Is oral NAD+ better than an IV?

The oral precursors have far more human data — 24 randomized trials for nicotinamide riboside alone against one for intravenous NAD+. That is a statement about how much has been studied, not proof that oral works better for any particular purpose.

Is NAD+ therapy FDA-approved?

No. There is no approved drug product with nicotinamide adenine dinucleotide as an active ingredient. What a clinic gives you is a compounded preparation, made outside the approval process.

What should I ask before buying an NAD+ program?

Which pharmacy compounds it and whether that pharmacy is a registered outsourcing facility; what a single month costs if you cancel after one; and whether the price you were shown is a prepaid annual rate divided by twelve. The last one catches most people.

Sources

Every source here was fetched and read for this article, with the identifier taken off the record that came back and the claim it supports written down beside it.

  1. Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial. American Journal of Cardiovascular Drugs, 2026. PMID 40954388 · doi:10.1007/s40256-025-00764-7 · Read September 2026
    180 adults with ischemic cardiomyopathy and an ejection fraction of 45% or below were randomized to intravenous NAD+ at 10 mg a day or placebo for seven days; ejection fraction at one month was 45.44% against 42.44% (p = 0.024), and the six-month composite event rate was 14.6% against 24.7% (p = 0.089).
  2. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD(+) in healthy middle-aged and older adults. Nature Communications, 2018. PMID 29599478 · doi:10.1038/s41467-018-03421-7 · Read September 2026
    Oral nicotinamide riboside raises blood NAD+ levels in healthy middle-aged and older adults.
  3. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science, 2021. PMID 33888596 · doi:10.1126/science.abe9985 · Read September 2026
    Oral nicotinamide mononucleotide increased muscle insulin sensitivity in prediabetic women.
  4. A randomized placebo-controlled trial of nicotinamide riboside in older adults with mild cognitive impairment. GeroScience, 2024. PMID 37994989 · doi:10.1007/s11357-023-00999-9 · Read September 2026
    Nicotinamide riboside has been tested in a randomized placebo-controlled trial in older adults with mild cognitive impairment.
  5. Nicotinamide riboside for peripheral artery disease: the NICE randomized clinical trial. Nature Communications, 2024. PMID 38871717 · doi:10.1038/s41467-024-49092-5 · Read September 2026
    Nicotinamide riboside has been tested in a randomized clinical trial in peripheral artery disease.
  6. Drugs@FDA: FDA-Approved Drugs, queried through the openFDA API. U.S. Food and Drug Administration, 2026. Source · Read September 2026
    No approved product in Drugs@FDA lists nicotinamide adenine dinucleotide as an active ingredient; a fabricated ingredient name returned the same empty result in the same run, and tesamorelin returned one approved product.
  7. Substances in Compounding that May Present Significant Safety Risks. U.S. Food and Drug Administration, 2026. Source · Document dated April 2026; read September 2026
    The FDA's page carries two tables — fourteen substances currently in category 2 and seventeen whose nominations were later withdrawn — and nicotinamide adenine dinucleotide appears in neither.