NAD+

• Week 1-2: Some feel more energy within days; the shot may sting
• Week 2-4: Users report gradual gains in energy and focus
• Week 4-8: Want more? Some users step up to 100 mg
• Week 8-12: Course ends; pause before the next one
• Side effects: Often stinging or a flush; stop for chest pressure or racing heart

More on each stage

Week 1-2

Some community users notice more energy within days. Stinging at the shot site and a mild warm flush are most common early on. Start at 25 mg (12.5 units) in weeks 1-2 to test how you react, then move to the store dose of 50 mg (25 units).

Week 2-4

Community users describe gradual gains in energy and focus over weeks 2-4, rather than the quick hit people report from IV drips.

Week 4-8

The store dose is a starting point. Some community users who want more step up to 100 mg (50 units) twice a week from week 5.

Week 8-12

Your course ends at 8-12 weeks. Pause before the next course, and use the break to judge how it has helped you.

Side effects

Most often stinging at the shot site, a warm flush, mild nausea, or trouble sleeping if taken late in the day. Stop and get medical help for chest pressure, a racing heart, or any sign of an allergic reaction.

Based on what people report in the community sources below. Results vary, and many responses are anecdotal.

• Raises NAD+ in the blood

  Human study

  In a small study of 8 healthy men, a 750 mg IV drip over 6 hours raised blood NAD+ by 398% by the end of the drip. This was an IV drip, not a shot under the skin.1

• Fuel for cell energy and DNA repair

  Animal/lab study

  Every cell needs NAD+ to turn food into usable energy (ATP). Enzymes that repair DNA (PARPs) and sirtuins, enzymes tied to aging, also use it up. NAD+ levels fall with age in rodents and humans.3

• Steadier energy and focus

  Community report

  Community users describe cleaner energy, better focus, and less afternoon crash, building gradually over 2-4 weeks with shots.1011

• NAD+ pills raise NAD+ levels

  Human study

  In human trials, oral NAD+ building blocks (NR and NMN) were generally safe and raised NAD+-related markers. A few found small gains in insulin sensitivity, energy use, or exercise capacity. These trials tested pills, not shots.4

What it has been studied for

• Age-related NAD+ decline (healthy aging), studied mainly with oral NR and NMN43Human study
• IV NAD+ drips in healthy adults: safety and blood levels in small pilot studies12Human study
• Head-to-head IV NAD+ versus IV NR in healthy adults (randomized, double-blind)5Clinical trial
• Energy, focus, and fatigue from home shots under the skin1011Community report

NAD+ is a helper molecule that every cell uses to make energy and to power repair work. When it is injected, most NAD+ does not slip straight into cells. Instead, enzymes (proteins that cut or build molecules) on the outside of cells cut it into smaller pieces. Another enzyme trims one of those pieces into a form cells can take in. Cells then use it to rebuild NAD+ inside. Leftover pieces leave the body in urine.

Peak

Not measured for shots under the skin. In the one IV study (750 mg dripped over 6 hours), blood NAD+ did not rise at all for the first 2 hours, then was 398% above starting levels when the drip ended.

Half-life

Not established in humans. No study has measured it for NAD+ shots or IV drips.

Cleared

Not measured for shots. In the IV study, the body took up or broke down NAD+ as fast as it was dripped in for the first 2 hours. Blood NAD+ was still raised 2 hours after the drip ended, while NAD+ and its breakdown product methylnicotinamide in urine had dropped 43% from their peak.

Half-life is how long it takes the body to remove half of a dose.1

2-3 times a week. Morning. Avoid late-day shots, which some users say keep them awake. 2-3 days a week with a rest day between shots (for example Monday, Wednesday, Friday). Units are for a 1,000 mg vial mixed with 5 mL water (200 mg per mL).

Step-up plan

When	Dose	Units
Weeks 1-2 (start low) Start here	25 mg	12.5 units
Week 3 on (store dose)	50 mg	25 units

• Lower end · what some users report early on

  50 mg subcutaneously, 2-3 times weekly

  Some community members report working up to 50 mg over the first couple of weeks, using it to gauge tolerance and the 'NAD flush' before stepping up. That is what they report, not a recommended starting dose.1110

• Most common · home-use standard

  100 mg subcutaneously, 2-3 times weekly

  The standard community subq protocol — reconstituted at 100 mg/mL and injected in the morning, 2-3 times weekly, as the home-use alternative to clinic-based delivery.11

• Higher end · advanced; flush-limited

  200 mg subcutaneously, twice weekly

  An advanced subq dose some run for a stronger energy ceiling: the full 200 mg at each of two weekly injections, limited by injection-site stinging and flush at faster delivery.11

• Community reports

  Start with the store plan: 25 mg in weeks 1-2, then 50 mg. Some users step up to 100 mg twice a week from week 5, for 8 weeks or more.10

Research protocols

• IV pilot study, 8 healthy men (plus 3 on saline)

  750 mg NAD+ in saline, dripped once over 6 hours (about 2 mg a minute). No adverse events were seen.1

• Clinic records, 6 adults on IV NAD+

  500 mg NAD+ in 500 mL saline, once a day for 4 days in a row; drips took about 97 minutes on average. All 6 reported moderate to severe stomach cramps, nausea, chest pressure, and a faster heart rate during the drip; these stopped as soon as it ended.2

• Randomized trial, 53 adults, IV NAD+ versus IV NR

  A single 500 mg IV dose of NAD+ (or NR, or saline) in 500 mL saline.5

• Related compound, not NAD+: ongoing trial of NR shots under the skin

  50 mg or 100 mg of NR (an NAD+ building block) once a day for 3 days, then 3 times a week (Monday, Wednesday, Friday) from day 10 to day 100. No results published yet.6

Whether direct subcutaneous NAD+ beats cheaper precursor supplements is actively debated and unresolved. Long-term safety of repeated high-dose NAD+ injection is not established, and immediate energy reports partly reflect placebo and setting.

Dosing guidance built from the cited research and community reports. It is not a prescription.

On

8-12 weeks

Break

A pause before the next course

A full course at the store pace takes 2 vials. A mixed vial keeps for up to 90 days.

Why the break helps

A course runs 8-12 weeks, then you pause before starting the next one. The pause lets you see how you feel without it. Some community users take oral NMN (500 mg a day) during the pause. The long-term safety of repeated NAD+ shots is not known: lab research has raised open questions about whether boosting NAD+ for years could feed inflammation or cancer growth. This has not been shown in people.

Common

• Stinging or burning where you inject, usually lasting 5-15 minutes

  What to do Push the plunger slowly and rotate sites. It normally fades on its own.

• Warmth or a mild flush

  What to do It usually passes within minutes. If it bothers you, drop to 25 mg (12.5 units) for a few shots.

• Nausea, stomach upset, or cramps

  What to do Try a lower dose and take it after a light breakfast. These were common with fast IV drips and are less often reported with shots.

• Trouble sleeping

  What to do Inject in the morning, never late in the day.

Stop and get help

• Chest pressure or tightness, a racing heart, or trouble breathing

  What to do Stop using it. Call emergency services (911 in the US) if it is severe or does not pass within a few minutes. All 6 people in one IV study had chest pressure and a faster heart rate during the drip.

• Hives, swelling of the face, lips, or throat, or wheezing

  What to do Possible allergic reaction. Stop and get emergency help right away.

• Redness that spreads, heat, pus, or fever around a shot site

  What to do Possible infection. Stop injecting there and see a doctor soon.

Do not use if

• You are pregnant or breastfeeding
• You have cancer or a history of cancer, unless your cancer doctor approves
• You have advanced liver disease
• You have had an allergic reaction to NAD+ or anything in the vial

Storage

Keep it

Keep the mixed vial in the fridge (2-8 °C), away from light and heat. Never leave it in a hot car.

How long

Use within 90 days of mixing. A mixed vial kept in the fridge holds its strength for 60-90 days, then slowly starts to lose potency. Wipe the rubber top with an alcohol swab before every draw.

Drawing your dose

Syringe: a 0.3 mL (30-unit) U-100 insulin syringe with half-unit marks, so small doses are easy to read. Doses above 30 units (up to 50 here) need a 0.5 mL (50-unit) syringe.

1. With this mix, every 1 unit line on a U-100 insulin syringe holds 2 mg. Draw to 12.5 units for 25 mg in weeks 1-2, then the 25-unit line for 50 mg, the store dose.
2. Look before you draw. Do not inject it if it is cloudy or has bits in it.
3. Stinging or burning where you inject is the most common complaint and usually lasts 5-15 minutes. Community users say pushing the plunger slowly and rotating sites helps.
4. Wipe the top before every draw. Hold the syringe at eye level, flick out air bubbles, and push the plunger back to the exact line.
5. Pinch a fold of skin, insert the needle at 45 to 90 degrees, push slowly, and wait a few seconds before pulling out. Use a new sterile syringe every time and never share one.

• SS-31

  Both aim at the mitochondria, the cell's power plants, from different angles: NAD+ is fuel for energy-making reactions, while SS-31 binds a fat (cardiolipin) in the inner mitochondrial membrane. In old mice, 8 weeks of SS-31 improved heart function and treadmill time. Community stacks pair NAD+ 100 mg 2-3 times a week with SS-31 500 mcg 5 days on, 2 off. The combination itself has not been studied.81112

• MOTS-c

  MOTS-c is a small peptide made from the mitochondria's own DNA that helps regulate metabolism. In mice it improved physical performance at young, middle, and old ages. Community users stack it with NAD+ as a mitochondrial support pair. The combination has not been studied.91112

Interactions

• Other NAD+ boosters: NMN, NR, nicotinamide, or niacin pills

  They feed the same pathway, and combining them with shots has not been studied. High-dose niacin can cause strong flushing and, at high doses, liver damage.

  What to do Do not add high-dose niacin. If you take NMN or NR, consider using it only during breaks from shots, as some community users do.

• Cancer, or any cancer treatment

  Doctors have raised a concern, not yet proven, that extra NAD+ could help cancer cells grow.

  What to do Do not use NAD+ without your cancer doctor's approval.

• Prescription medicines in general

  No drug-interaction studies exist for injected NAD+.

  What to do Tell your doctor and pharmacist you use it, especially if you take heart, blood-pressure, or diabetes medicines.

Videos

• The BEST Peptides for Mitochondrial Health (MOTS-c, NAD+, SS-31 Explained)Dr. Jones, DC · 2026

Sources

1. 1Grant et al., Front Aging Neurosci 2019: 6-hour IV NAD+ infusion pilotStudy
2. 2Reyna et al., Front Aging 2026: IV NAD+ vs NR tolerability (clinic records)Study
3. 3Covarrubias et al., Nat Rev Mol Cell Biol 2021: NAD+ metabolism and aging (review)Review
4. 4Freeberg et al., J Gerontol A 2023: NAD+-boosting supplements in humans (review)Review
5. 5ClinicalTrials.gov NCT06382688: IV NR vs IV NAD+ randomized trialClinical trial
6. 6ClinicalTrials.gov NCT07251608: subcutaneous and intramuscular NR injectionsClinical trial
7. 7Cleveland Clinic: NAD supplements, side effects and cautionsReference
8. 8Chiao et al., eLife 2020: SS-31 reverses heart aging in old miceStudy
9. 9Reynolds et al., Nat Commun 2021: MOTS-c and age-related physical decline (mice)Study
10. 10Peptide Protocol Wiki: NAD+ community protocolsCommunity
11. 11The Peptide Catalog: NAD+ dosing guide (subcutaneous)Community
12. 12Dr. Jones, DC (YouTube): The BEST Peptides for Mitochondrial Health (MOTS-c, NAD+, SS-31)Video

Where people discuss it

• r/NAD (subreddit)
• Peptide Protocol Wiki — NAD+ community (200 reports)
• The Peptide Catalog — NAD+ SubQ protocol

Some peptides, like semaglutide (Ozempic and Wegovy), are FDA-approved medicines. Most of the peptides people research are not. That label sounds like the FDA tested something and turned it down. Usually it means something else: nobody has paid for the studies the FDA needs to see. Here is why.

The FDA doesn’t test drugs. Companies do.

The FDA does not run its own drug tests. A company that wants to sell a new medicine has to test it first, and pay for it. It studies the drug in animals, then in people: first 20 to 100 volunteers, then a few hundred, then up to 3,000. Then it sends all the results to the FDA. FDA scientists review them and decide whether the benefits outweigh the risks.

So approval always starts with a company asking for it. If no company applies, the FDA has nothing to review, however promising the research looks.

Those studies cost about a billion dollars

A study in the medical journal JAMA estimated that bringing one new drug to market costs a typical company about $1.1 billion. That figure includes the money spent on drug ideas that failed along the way, because many drugs that start human testing never make it.

A patent is how a company earns that money back

A patent is a right the government gives an inventor. For up to 20 years from the day the inventor applies, nobody else may make or sell the invention without permission.

For a drug company, that right is what makes the billion-dollar bet worth it. While the patent lasts, the company is the only seller, so it can charge enough to pay back the studies and the failures. When the patent runs out, other companies can sell cheap copies, called generics, and the price drops.

The FDA adds a shorter shield of its own. For 5 years after a brand-new drug is approved, no copycat version can apply for approval. That helps, but it is much shorter than a patent can last.

Why most peptides can’t be patented

To get a patent, an invention has to be new, and it has to be something people made, not something found in nature. Most popular peptides fail one test or both.

They come from nature. Many are copies or small pieces of molecules your body already makes. KPV is a 3-building-block piece of the hormone that tans your skin. BPC-157 is copied from a protein in stomach juice. In 2013 the US Supreme Court ruled that something that exists in nature, like a human gene, cannot be patented just because someone found it and pulled it out.

They aren’t new anymore. Many were first described in research papers decades ago. Scientists were already testing KPV in the 1980s. Once something has been published, it no longer counts as new, so nobody can patent it now, and any patents from back then have long since run out.

Without a patent, a company that paid for the studies would soon face rivals selling the same peptide without having paid for any research. Few companies will spend a billion dollars on a product anyone can copy. So nobody goes first, and the large human studies never happen.

The workaround: change the molecule

Drug companies do make peptide medicines, but they change the peptide first. A changed molecule is a new invention, so it can be patented. Semaglutide is a lab-made version of GLP-1, a gut hormone your body releases after meals, changed so one shot lasts a week. Tesamorelin (Egrifta) is the body’s own growth-hormone signal with a small fatty chain added. Both went through the full studies, and both are FDA-approved.

The natural versions, and the many peptides nobody has changed and patented, stay where they are: studied in labs and animals, used by the biohacking community, and never put through large human trials.

What this means for you

When a peptide is “not FDA-approved,” it usually means no company has paid for the large human studies. It does not mean the FDA tested it and found it harmful.

It also does not mean it is proven safe or proven to work. Without those studies, nobody knows the best dose for sure, or what rare or long-term side effects it may have. And the FDA does not check research peptides for purity or strength the way it checks approved medicines. That is why this page labels every finding by the kind of study behind it, and lists who should not use it.

Sources for this section

1. 1FDA: How drugs are developed and approved (the FDA does not test drugs; companies submit the evidence)
2. 2FDA: The drug development process, step 3: clinical research (study sizes for each phase)
3. 3Wouters, McKee & Luyten, JAMA 2020, corrected 2022: median cost to bring a new drug to market, $1.14 billion
4. 4US patent law, 35 U.S.C. § 154: a patent lasts 20 years from the filing date
5. 5FDA: Frequently asked questions on patents and exclusivity (5-year new chemical entity exclusivity)
6. 6US Supreme Court, Association for Molecular Pathology v. Myriad Genetics (2013): naturally occurring genes cannot be patented