Supplies Needed

Plan based on an 8–16 week daily protocol with gradual titration as outlined above.

• Peptide Vials (NAD+, 500 mg each):
  • 8 weeks ≈ 11 vials (total 5,075 mg used)
  • 12 weeks ≈ 16 vials (total 7,875 mg used)
  • 16 weeks ≈ 22 vials (total 10,675 mg used)
• Insulin Syringes (U‑100, 1 mL):
  • Per week: 7 syringes (1/day)
  • 8 weeks: 56 syringes
  • 12 weeks: 84 syringes
  • 16 weeks: 112 syringes
• Bacteriostatic Water (10 mL bottles): Use 3.0 mL per vial for reconstitution.
  • 8 weeks (11 vials): 33 mL → 4 × 10 mL bottles
  • 12 weeks (16 vials): 48 mL → 5 × 10 mL bottles
  • 16 weeks (22 vials): 66 mL → 7 × 10 mL bottles
• Alcohol Swabs: One for the vial stopper + one for the injection site each day.
  • Per week: 14 swabs (2/day)
  • 8 weeks: 112 swabs → recommend 2 × 100‑count boxes
  • 12 weeks: 168 swabs → recommend 2 × 100‑count boxes
  • 16 weeks: 224 swabs → recommend 3 × 100‑count boxes

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Important Notes

Practical considerations for consistency, safety, and optimal results.

• Use new, sterile insulin syringes for each injection; dispose of used needles in a proper sharps container.
• Rotate injection sites systematically (abdomen at least 2 inches from navel, outer thighs, back of upper arms) to reduce soreness and prevent lipohypertrophy.
• Clean both the vial stopper and injection site with alcohol swabs; allow skin to air‑dry before injecting.
• Inject slowly over 5–10 seconds to minimize tissue irritation; wait a few seconds before withdrawing the needle.
• Document daily dose, injection site, and any observed effects to maintain consistency and track tolerance.
• If persistent redness or a lump develops at injection sites, apply over‑the‑counter hydrocortisone cream and rotate to a different location.
• Starting at the low end (50 mg) is recommended to assess individual tolerance before escalating dose^[4].

How This Works

NAD+ is a coenzyme central to redox reactions, energy metabolism (glycolysis, TCA cycle, oxidative phosphorylation), and cellular maintenance pathways including DNA repair and mitochondrial biogenesis^[1]. Cellular NAD+ levels decline with age and metabolic stress, which may contribute to reduced mitochondrial function and impaired cellular resilience^[8].

Clinical research on NAD+ therapy has primarily used intravenous infusions at high doses (500–1,000 mg) for applications such as addiction treatment and acute metabolic support^[2][9]. A pilot metabolic study demonstrated that a 750 mg NAD+ IV infusion over 6 hours was well‑tolerated in humans, with rapid metabolic clearance and no acute toxicity^[10]. However, IV administration requires clinical supervision and specialized equipment.

Subcutaneous (SC) or intramuscular (IM) injections at lower doses (tens to low hundreds of milligrams) are emerging as practical alternatives for maintenance therapy and wellness applications^[3][11]. Compounded NAD+ can be administered SC in small volumes, and SC self‑injection is convenient for ongoing use^[12]. Conservative protocols start around 50–100 mg per injection a few times per week; the present protocol uses daily SC administration with gradual titration to optimize individual tolerance and response.

Potential Benefits & Side Effects

Observations from preclinical models and clinical case reports.

Potential Benefits (Reported in Literature)

• May support cellular energy production and mitochondrial function through replenishment of NAD+ pools^[1][8].
• Human case reports and pilot studies suggest benefits at 100–300 mg/day ranges for cognitive support and metabolic health^[13].
• High‑dose IV protocols (500–1,500 mg daily for ~10 days) have been used in open‑label studies for substance use disorder, with reports of reduced cravings and improved mood in follow‑ups^[2][9].
• No severe adverse events have been reported in published NAD+/NADH trials; side effects are generally mild^[14].

Potential Side Effects

• High doses can produce adverse reactions such as insomnia, anxiety, or fatigue if escalated too quickly; gradual titration is advised^[4].
• Mild injection‑site reactions (redness, itching, soreness) may occur with subcutaneous administration; typically resolve with site rotation.
• Some individuals report transient headache or flushing; these effects are generally dose‑dependent.
• Doses exceeding ~200–300 mg/day should generally be reserved for supervised therapeutic use due to potential for metabolic byproduct accumulation^[15].

Lifestyle Factors

Complementary strategies to maximize NAD+ therapy outcomes.

• Nutrition: Consume a balanced diet rich in NAD+ precursors (niacin/vitamin B3, tryptophan) and support nutrients (B‑vitamins, magnesium). Consider foods that support methylation pathways.
• Exercise: Regular physical activity (both resistance training and aerobic exercise) naturally upregulates cellular NAD+ biosynthesis and enhances mitochondrial adaptations.
• Sleep: Prioritize 7–9 hours of quality sleep per night to support cellular repair processes and optimize circadian NAD+ metabolism.
• Stress Management: Chronic stress depletes NAD+ pools through activation of poly(ADP‑ribose) polymerases (PARPs); incorporate stress‑reduction practices like meditation or yoga.
• Avoid Excessive Alcohol: Alcohol metabolism consumes NAD+; moderate or eliminate alcohol intake during NAD+ protocols.

Injection Technique

General subcutaneous injection guidance based on CDC best‑practice resources and clinical literature^[16][17].

Preparation

• Wash hands thoroughly with soap and water.
• Clean the vial stopper with an alcohol swab and allow to air‑dry.
• Select injection site (abdomen at least 2 inches from navel, outer thigh, or back of upper arm) and clean with alcohol swab; allow skin to air‑dry completely before injecting.

Needle Selection

• Use a fine, short needle such as a 28–31 gauge insulin syringe.
• Needle length of 5/16 to 1/2 inch (8–12 mm) is sufficient to reach subcutaneous tissue in most adults^[16].
• Standard U‑100 insulin syringes (1 mL capacity) are appropriate for the volumes used in this protocol (0.30–0.60 mL per injection).

Injection Procedure

• Pinch a fold of skin between your thumb and forefinger to isolate subcutaneous tissue.
• Insert the needle at approximately a 45° angle into the pinched subcutaneous layer^[16][17]. (For ultrashort 4 mm needles, a 90° angle without pinching may be used, but for typical 8–12 mm needles, 45° with pinched skin is recommended.)
• Do not aspirate for subcutaneous injections^[16].
• Depress the plunger slowly and steadily to inject the NAD+ solution over 5–10 seconds. Injecting too rapidly may increase irritation.
• Wait a few seconds after full injection before withdrawing the needle at the same angle it was inserted.
• Apply a clean cotton swab or bandage with light pressure to the site; do not rub vigorously.
• Dispose of the used needle/syringe immediately in a proper sharps container.

Site Rotation

• Rotate injection sites systematically to prevent soreness, lipohypertrophy, or scar tissue buildup^[18].
• Alternate between left/right sides of the abdomen or different quadrants if injecting daily.
• The abdomen (at least 2 inches away from the navel) is a common site for subcutaneous NAD+ because it has a good layer of subcutaneous fat and tends to be less sensitive.
• Outer thigh and back of upper arm are alternative sites; choose areas with adequate subcutaneous tissue.

Volume Considerations

• NAD+ injections in this protocol range from 0.30 mL (50 mg dose) to 0.60 mL (100 mg dose).
• Subcutaneous tissue can comfortably absorb up to about 1.5 mL per injection; the volumes used here are well within this limit^[19].
• If higher individual doses are ever needed (above ~150 mg), consider splitting into two injections at different sites to enhance absorption and comfort.