Restore & Recover
Supports recovery and tissue resilience.
BPC-157 + TB-500Optional: NAD+
Nutrient injection · 503A compounded
NAD+ injection, restoring cellular energy from the inside out.
Nicotinamide adenine dinucleotide (NAD+) sits at the center of how your cells produce energy, repair DNA, and regulate aging biology. NAD+ injection is one of the most-discussed therapies in longevity medicine, and one of the most frequently misrepresented. This page explains what the evidence actually shows, what to expect at Genesis Longevity in Colorado Springs, and who this therapy is and is not appropriate for.
What it is
Nicotinamide adenine dinucleotide (NAD+) is an essential coenzyme found in every living cell. It shuttles electrons in oxidative phosphorylation, the process your mitochondria use to generate ATP, and is required by sirtuins (proteins often called longevity enzymes) and by PARPs (which repair damaged DNA).
Endogenous NAD+ levels decline measurably with age, metabolic stress, and chronic illness. Injectable NAD+ (subcutaneous or intramuscular, compounded under 503A pharmacy regulations) aims to restore the NAD+/NADH ratio more directly than oral supplements, which face absorption limitations in the gut.
This is a compounded preparation. It is not an FDA-approved drug product. It requires a Good Faith Exam, a valid prescription, and ongoing provider supervision before and during use.
How it works
Sirtuin activation. Sirtuins (SIRT1 through SIRT7) are NAD+-dependent deacylases that regulate gene expression in response to cellular stress, promote mitochondrial biogenesis via PGC-1α and NRF1, and support stress-resilience pathways linked to longevity in animal models.
DNA repair via PARPs. Poly(ADP-ribose) polymerases consume NAD+ to tag and recruit repair proteins at DNA break sites. This process becomes less efficient as NAD+ declines with age.
Mitochondrial redox. NAD+ accepts electrons from metabolic reactions and transfers them to the electron transport chain. When the NAD+/NADH ratio falls, mitochondrial efficiency drops, manifesting clinically as reduced exercise capacity, fatigue, and slower recovery.
Most of this mechanistic work has been conducted in cell cultures and rodents. Human trials have more commonly studied oral precursors (NMN, NR) than injectable NAD+ directly. Extrapolation to clinical outcomes in humans requires appropriate caution.
Conditions and use cases
Who NAD+ injection may help.
- Age-related fatigue and reduced exercise tolerance, with no identifiable underlying medical cause.
- Cognitive sluggishness or brain fog without diagnosed neurologic disease. Effects develop gradually, not stimulant-like.
- Longevity and cellular health optimization, alongside lifestyle measures.
- Adjunct in addiction recovery (off-label, not a Genesis specialty program).
- Mitochondrial stress states, as adjunct support in research-level protocols.
- Not a treatment for diagnosed disease. Evidence for disease-modifying benefit in humans is not yet established.
Expected timeline
What patients commonly observe.
Week 0 to 2
Onset and tolerability
Possible mild improvement in subjective energy. Transient flushing and warmth post-injection are common.
Week 2 to 4
Cognitive and sleep signals
Patients commonly report sharper cognition and improved sleep quality. Effects are not stimulant-like.
Month 1 to 3
Sustained benefits
Sustained energy, mood, and exercise tolerance reported in observational data. Individual response is variable.
Month 3 to 6
Maintenance phase
Consistent dosing required to preserve benefit. No validated long-term outcome data exist in humans.
Stacks that include this therapy
NAD+ injection appears in these stacks.
Cellular Longevity
Designed to support cellular health and healthy aging.
MOTS-CEpitalonNAD+ Injection
Investment and access
Care plans, not menus.
Genesis Longevity therapies are dispensed only after a complimentary consultation and Good Faith Exam. Schedule yours to receive a personalized plan tailored to your biology and goals.
Side effects
What patients commonly report.
Reported side effects include flushing, warmth, and mild chest tightness during or shortly after injection (transient and common); nausea, headache, and dizziness; injection site pain and induration; and rare severe systemic reactions associated with endotoxin contamination from improperly compounded product.
Genesis sources NAD+ exclusively from regulated 503A compounders that use pharmaceutical-grade (USP) raw material. The FDA has issued recalls for contaminated NAD+ products from compounders that used non-sterile-grade ingredients.
Contraindications
Who should not use this therapy.
Show contraindications
Active or recent malignancy. NAD+ supports cellular metabolism that theoretically could aid cancer cell growth. Specialist clearance required.
Pregnancy and breastfeeding. Insufficient safety data.
Severe hepatic or renal impairment. NAD+ is metabolized hepatically and excreted renally.
Known hypersensitivity to NAD+ or compounding excipients. Significant cardiovascular disease or uncontrolled diabetes use requires additional caution.
Pairs well with
Therapies that complement this protocol.
- Research peptide
MOTS-C
Mitochondrial efficiency, metabolic flexibility, and endurance.
Weak evidence - Research peptide
Epitalon
Circadian rhythm regulation, telomere support, cellular longevity.
Very weak evidence - 503A compounded
Glutathione Injection
Antioxidant and detoxification support.
Moderate evidence
Frequently asked
Frequently asked questions about NAD+ injection.
Effects build gradually. Subtle changes in energy and mental clarity may appear in 1 to 2 weeks. Most consistent benefits reported by patients emerge after 4 to 6 weeks of regular dosing. NAD+ is not a stimulant. If you feel an instant energy surge, that is likely an injection-site or vasodilatory response.
No. NAD+ injection is a 503A compounded preparation, not an FDA-approved drug. The FDA has issued recalls for contaminated NAD+ products from compounders that used non-sterile-grade ingredients. At Genesis, we source exclusively from regulated, tested compounding pharmacies.
This requires specialist clearance. Active malignancy is a contraindication because NAD+ supports cellular metabolism that could theoretically aid cancer cell growth. Past cancer history without active disease may be manageable under specialist co-management.
Subcutaneous and intramuscular injections are typically used in maintenance protocols and are more convenient than 2 to 4 hour IV infusions. Both bypass the absorption limits of oral supplementation. Comparative outcome data in humans is limited.
Endogenous NAD+ returns toward baseline after stopping. Sustained benefit requires sustained dosing. Lifestyle factors such as exercise, caloric restraint, and sleep independently raise NAD+ and should accompany any protocol.
NMN and NR are oral NAD+ precursors. Oral absorption of NAD+ itself is poor; precursors are converted to NAD+ intracellularly. Injection bypasses GI absorption entirely. Whether this translates to meaningfully better tissue-level outcomes in humans is not yet established by comparative clinical trials.
Sirtuins are proteins that use NAD+ to regulate gene expression in response to stress. In animal models, enhancing sirtuin activity extends lifespan and improves metabolic health. Whether this translates directly to human longevity benefit remains an active research question.
Common compounded protocols use 50 to 300 mg subcutaneous or intramuscular, 2 to 3 times weekly during loading, transitioning to weekly or biweekly maintenance. All dosing is determined by your Genesis provider after a Good Faith Exam.
Sources
Citations & references
- [1]Covarrubias AJ et al. NAD+ metabolism and its roles in cellular processes during aging. Nat Rev Mol Cell Biol. PMC9512238.
- [2]Imai S, Guarente L. NAD+ and sirtuins in aging and disease. PMC4112140.
- [3]Cleveland Clinic Health Essentials, NAD supplements overview. Source
- [4]Empower Pharmacy, NAD+ injection compounding monograph. Source
- [5]NAD precursor human trial review. PMC9735188.
- [6]FDA, Use of ingredients suitable for sterile compounding. Source
- [7]Reiten OK et al. Preclinical and clinical evidence of NAD+ precursors. PMC7558103.
- [8]AboutNAD, FDA endotoxin recall analysis. Source
- [9]NAD therapeutics: bench to bedside review. PMC9495723.
Status & disclosures
- FDA status: not FDA-approved
- NAD+ injection is a 503A compounded preparation, not an FDA-approved drug. The FDA has documented recalls of contaminated NAD+ products from non-compliant compounders.
- 503A compounded preparation
- Compounded by licensed 503A pharmacies under U.S. FDA regulations. Genesis sources from regulated compounders that use pharmaceutical-grade (USP) NAD+ raw material.
- Educational use only
- Information on this page is for educational purposes and is not medical advice. Therapy requires a Good Faith Exam and provider consultation prior to initiation.
Next step
Talk to a Genesis provider about NAD+ injection.
Schedule a consultation. Physician-led, evidence-graded.
Or keep reading: See the Cellular Longevity stack