Important Safety Information — NAD+

About NAD+

Nicotinamide adenine dinucleotide (NAD+) is a coenzyme found in all living cells that plays a central role in energy metabolism, DNA repair, and cellular signaling. NAD+ supplementation is used to support cellular energy production, cognitive function, and overall vitality. NAD+ is administered as a compounded formulation and is not an FDA-approved drug for these indications.

Contraindications

• Known allergy or hypersensitivity to NAD+, nicotinamide, or any component of the formulation
• Active cancer or history of cancer (NAD+ is involved in cell growth and DNA repair pathways; consult your oncologist before use)

Warnings and Precautions

• Limited FDA oversight: NAD+ supplementation for anti-aging and wellness purposes is not FDA-approved. The complete safety and efficacy profile has not been fully established through large-scale clinical trials.
• Inflammatory response: Elevating NAD+ to supraphysiologic concentrations may create a proinflammatory environment in some individuals.
• Cellular effects: High-level NAD+ administration may affect poly(ADP-ribose) polymerases (PARPs), cellular energy metabolism, and DNA/protein methylation. The long-term consequences of chronic supplementation are not fully understood.
• Injection site reactions: Subcutaneous administration may cause local reactions including redness, swelling, or discomfort at the injection site.
• Pre-existing conditions: Patients with liver disease, kidney disease, or metabolic disorders should consult their healthcare provider before starting NAD+ supplementation.

Common Side Effects

• Nausea
• Headache
• Fatigue or malaise
• Stomach cramping or abdominal discomfort
• Sweating (diaphoresis)
• Flushing
• Injection site reactions (redness, swelling, tenderness)
• Mild diarrhea

Serious Side Effects

Seek medical attention immediately if you experience any of the following:

• Signs of a serious allergic reaction: hives, difficulty breathing, swelling of the face, lips, tongue, or throat
• Chest pain or rapid heartbeat
• Severe nausea or vomiting that does not resolve
• Signs of liver problems: yellowing of the skin or eyes, dark urine, persistent abdominal pain
• Severe or worsening injection site reaction with signs of infection

Drug Interactions

NAD+ drug interactions have not been extensively studied in controlled clinical trials. However, patients should inform their healthcare provider of all medications and supplements they are taking, including:

• Niacin (vitamin B3) and nicotinamide supplements: May increase total NAD+ levels and the risk of side effects.
• Chemotherapy agents: NAD+ may theoretically affect the efficacy of certain cancer treatments that rely on DNA damage pathways. Do not use without oncologist approval.
• Immunosuppressants: The immunomodulatory effects of elevated NAD+ levels are not fully characterized.
• Blood thinners: Inform your provider if you take anticoagulant or antiplatelet medications.

Use in Specific Populations

• Pregnancy: There is no information available about the use of NAD+ supplementation during pregnancy. Avoid use unless directed by your healthcare provider.
• Lactation: It is unknown whether exogenous NAD+ supplementation affects breast milk composition. Consult your healthcare provider before use.
• Pediatric use: Safety and effectiveness have not been established in children. Not recommended for use in pediatric patients.
• Geriatric use: Older adults may benefit from NAD+ supplementation, but should start at lower doses and be monitored for adverse effects.
• Hepatic/Renal impairment: Consult your healthcare provider before use. Dose adjustments may be necessary.