NAD+ (1000 mg)

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At a Glance

NAD+ (Nicotinamide Adenine Dinucleotide) is a cellular coenzyme required for ATP production, DNA repair via PARP enzymes, and sirtuin-mediated metabolic regulation. Intracellular NAD+ declines with age, and injectable NAD+ is used in research settings to achieve rapid systemic repletion that bypasses the limited oral bioavailability of the molecule itself.[1]

• Reconstitute: Add 3.0 mL bacteriostatic water → 333.3 mg/mL concentration.
• Subcutaneous dose range: 50–100 mg once daily, titrated up over the first weeks.
• Easy measuring: At 333.3 mg/mL on a U-100 syringe, 1 unit = 0.01 mL ≈ 3.33 mg. A 50 mg dose = 15 units / 0.15 mL.
• Storage: Lyophilised: freeze at −20 °C; reconstituted: refrigerate at 2–8 °C; use within 4 weeks.

Overview

• Goal: Restore intracellular NAD+ pool to support sirtuin and PARP activity, mitochondrial biogenesis, and oxidative metabolism.[1][2]
• Schedule: Once-daily subcutaneous injection, started low and titrated up; periodic IV infusion is a separate clinical-setting option.
• Dose range: 50–100 mg SC once daily (titrated, max 100 mg). IV reference: 500–1000 mg in 250–500 mL saline over 1–4 hours in a clinical/infusion setting only.
• Reconstitution: 3.0 mL BAC water per 1000 mg vial → 333.3 mg/mL.
• Injection site (SC): Abdomen, thigh, or upper arm; rotate sites daily.
• Cycle: 8–16 weeks total; titration occupies the first 2 weeks, then 100 mg maintenance from Week 3 onward.

What You'll Need

Plan based on an 8-week titrated cycle (Week 1 = 50 mg, Week 2 = 75 mg, Weeks 3–8 = 100 mg once daily; 56 injections, ~5,075 mg total).

• NAD+ Vials (1000 mg each): ~5,075 mg needed ÷ 1000 mg per vial → 6 vials.
• Insulin Syringes (U-100, 1 mL / 100-unit): 56 injections → 56 syringes.
• Bacteriostatic Water (10 mL bottles): 3.0 mL per vial → 2 × 10 mL bottles (covers all 6 vials with margin).
• Alcohol Swabs: 2 per injection → 112 swabs per 8-week cycle.

Extending maintenance toward the full 16-week arc scales these up proportionally (a 16-week course runs ~112 injections and ~11 vials).

How to Reconstitute

1. Allow frozen lyophilised vial to reach room temperature (10–15 minutes).
2. Draw 3.0 mL bacteriostatic water with a sterile syringe.
3. Inject slowly down the inner vial wall to avoid foaming.
4. Gently swirl until fully dissolved — do not shake. Solution should be clear and colourless.
5. Label with reconstitution date; refrigerate at 2–8 °C, protected from light. Use within 4 weeks.

Dosing Schedule

Start at 50 mg once daily in Week 1, increase to 75 mg in Week 2, then hold at the 100 mg maintenance dose from Week 3 onward. This gradual titration avoids the insomnia, anxiety, and fatigue that can follow starting too high. All daily SC volumes stay at or under 0.30 mL at this concentration, so a single injection site is sufficient.

Protocol Details

• Starting dose: 50 mg (15 units / 0.15 mL) once daily SC for Week 1.[1]
• Week 2: 75 mg (22.5 units / 0.225 mL) once daily SC.
• Maintenance dose: 100 mg (30 units / 0.30 mL) once daily SC from Week 3 onward — this is the daily ceiling for the SC protocol.
• IV reference (clinical/infusion setting only): Dilute 500–1000 mg in 250–500 mL normal saline; infuse over 1–4 hours. Reduce infusion rate if flushing, chest tightness, or nausea occurs. This is not part of the standard at-home SC protocol.
• Cycle: 8–16 weeks total; titration occupies only the first 2 weeks, then 100 mg maintenance. The evidence base does not define a single optimal cycle length.

Storage

• Lyophilised: Store at −20 °C (−4 °F); protect from moisture and light.
• Reconstituted: Refrigerate at 2–8 °C. Do not freeze. Use within 4 weeks.
• Appearance: Clear, colourless solution. Discard if cloudy, discoloured, or particulate.

How NAD+ Works

NAD+ is a dinucleotide coenzyme (adenosine + nicotinamide) that participates in cellular metabolism in two distinct capacities. As a redox carrier, it accepts electrons during glycolysis and the tricarboxylic acid cycle (becoming NADH), then donates them to Complex I of the mitochondrial electron transport chain to drive ATP synthesis — the fundamental mechanism of aerobic energy production.

As a consumed substrate, NAD+ is cleaved by sirtuins (SIRT1–7) and poly(ADP-ribose) polymerases (PARPs) during DNA repair and gene expression control. SIRT1 deacetylates PGC-1α to drive mitochondrial biogenesis; SIRT3 activates antioxidant enzymes within mitochondria. Both require adequate NAD+ as a co-substrate. PARPs consume NAD+ at high rates during DNA strand-break repair; chronically activated PARPs under accumulated genotoxic stress accelerate depletion.[1]

Intracellular NAD+ declines approximately 50% between young adulthood and middle age across multiple tissues, driven by increased PARP activity and rising expression of CD38 (an NAD+-hydrolyzing ectoenzyme upregulated by age-related inflammatory signaling).[2] Injectable NAD+ bypasses gut-wall degradation that limits oral bioavailability, achieving rapid blood-level elevation.

For mechanism and evidence detail, see What Is NAD+?

Good to Know

• NAD+ solution is acidic (pH ~3–4) and commonly causes a burning sensation on SC injection; injecting slowly and starting at the low 50 mg dose reduces local discomfort while you assess tolerance.
• Titrating gradually (50 → 75 → 100 mg over the first weeks) limits the insomnia, anxiety, and fatigue that can occur when starting too high.
• IV infusion rate-dependent reactions (flushing, chest tightness, nausea, palpitations) are common and resolve by slowing the drip — they are not allergic reactions.
• NAD+ is not FDA-approved as a drug in injectable form; it is a research compound.
• Oral precursors (NMN, NR) have published human RCT data that injectable NAD+ lacks; they are alternatives for research contexts where injection is not required.
• Sirtuins activated by NAD+ include SIRT1 (nuclear, regulates PGC-1α and FOXO) and SIRT3 (mitochondrial, activates SOD2 and IDH2); both are silenced when NAD+ is depleted.[1]

Tips for Best Results

• Administer in the morning; NAD+ drives mitochondrial biogenesis via SIRT1/PGC-1α activation, which may synergise with morning exercise.
• Allow reconstituted vial to reach room temperature before drawing; cold solution increases injection discomfort.
• Rotate injection sites daily and document site, dose, and time to track local reactions.
• Adequate dietary protein and B-vitamins (particularly niacin/B3) support the salvage pathway that recycles NAD+ intracellularly.

Injection Tips

• Clean the vial stopper and injection site with separate alcohol swabs; allow both to air-dry fully before proceeding.[4]
• Use a 29–31 gauge insulin syringe (5/16″ to 1/2″ needle); draw the calculated dose precisely.
• Pinch a fold of skin and insert the needle at 45° into subcutaneous fat; 90° is acceptable with a short needle into a well-pinched fold.
• Inject slowly over 3–5 seconds (the acidic solution benefits from a slower injection pace). Do not aspirate. Withdraw the needle, apply gentle pressure.
• Rotate injection sites (abdomen, thighs, upper arms) and dispose of each syringe in a sharps container immediately after use.