Nicotinamide Adenine Dinucleotide (NAD+) is a coenzyme found in all living cells, and it plays a vital role in energy metabolism and proper cell functioning. It is particularly crucial for the optimal performance of mitochondria, the cellular power plants that turn food and oxygen into energy.1, 2 NAD+ is naturally made in the body from the amino acid tryptophan or vitamin B3 (also called niacin, the generic name for nicotinic acid, nicotinamide, and related derivatives).2, 3 NAD+ is continuously recycled within cells being interconverted to and from its reduced form (NADH) and phosphorylated forms (NADP and NADPH).3 Studies suggest that cells can also take up extracellular NAD+.4
NAD+ levels peak in newborns and steadily decrease with advancing age.5 The decline in mitochondrial function and NAD+ levels along with resulting oxidative damage is one theory of aging.1, 2 Evidence exists that age-related decline in NAD+ levels is propelled by growing levels of an enzyme that breaks down both NAD+ and its starting material.6 Other research suggests that inflammation and oxidative stress cause a reduction in NAD+ biosynthesis.7
Low NAD+ levels have been linked to several conditions associated with free radical damage, including diabetes,8 heart disease,7, 9 vascular dysfunction,10 ischemic brain injury,11 Alzheimer’s disease,12, 13 and vision loss.14
NAD+ infusions have been used in clinical practice for the treatment of addiction of acute and chronic symptoms of addiction to a variety of substances.15, 16, 17 Clinical trials have yet to be conducted, however, to evaluate the safety and efficacy of NAD+ treatment in addiction.
It is also postulated that NAD+ supplementation may assist with mitochondrial function, genome stability, neuroprotection, healthy aging, and longevity.1, 2, 3, 20 Numerous clinical trials have recently been completed (though not yet published) in evaluating the safety and efficacy of NAD+ treatment of human diseases and aging.
NAD+ is not commercially available at this time. Patients that would benefit from its administration may be prescribed compounded NAD+ Injection as determined by a health care provider. The most popular injectable formulation compounded at Galleria Medical Pharmacy is NAD+ 100 mg/mL Injectable Solution, though other strengths and formulations may be available upon request.
Store this medication at 36°F to 46°F (2°C to 8°C) and away from heat, moisture and light. Keep all medicine out of the reach of children. Throw away any unused medicine after the beyond use date. Do not flush unused medications or pour down a sink or drain.
- Cantó C, Menzies KJ, Auwerx J. NAD+ Metabolism and the Control of Energy Homeostasis: A Balancing Act between Mitochondria and the Nucleus. Cell Metab. 2015;22(1):31-53. doi:10.1016/j.cmet.2015.05.023
- Johnson S, Imai SI. NAD+ biosynthesis, aging, and disease. F1000Research. 2018;7. doi:10.12688/f1000research.12120.1
- Belenky P, Bogan KL, Brenner C. NAD+ metabolism in health and disease. Trends Biochem Sci. 2007;32(1):12-19. doi:10.1016/j.tibs.2006.11.006
- Billington RA, Travelli C, Ercolano E, et al. Characterization of NAD uptake in mammalian cells. J Biol Chem. 2008;283(10):6367-6374. doi:10.1074/jbc.M706204200
- Massudi H, Grant R, Braidy N, Guest J, Farnsworth B, Guillemin GJ. Age-Associated Changes In Oxidative Stress and NAD+ Metabolism In Human Tissue. Polymenis M, ed. PLoS One. 2012;7(7):e42357. doi:10.1371/journal.pone.0042357
- Camacho-Pereira J, Tarragó MG, Chini CCS, et al. CD38 Dictates Age-Related NAD Decline and Mitochondrial Dysfunction through an SIRT3-Dependent Mechanism. Cell Metab. 2016;23(6):1127-1139. doi:10.1016/j.cmet.2016.05.006
- Yoshino J, Mills KF, Yoon MJ, Imai SI. Nicotinamide mononucleotide, a key NAD + intermediate, treats the pathophysiology of diet- and age-induced diabetes in mice. Cell Metab. 2011;14(4):528-536. doi:10.1016/j.cmet.2011.08.014
- Wu J, Jin Z, Zheng H, Yan LJ. Sources and implications of NADH/NAD+ redox imbalance in diabetes and its complications. Diabetes, Metab Syndr Obes Targets Ther. 2016;9:145-153. doi:10.2147/DMSO.S106087
- Pillai JB, Isbatan A, Imai SI, Gupta MP. Poly(ADP-ribose) polymerase-1-dependent cardiac myocyte cell death during heart failure is mediated by NAD+ depletion and reduced Sir2α deacetylase activity. J Biol Chem. 2005;280(52):43121-43130. doi:10.1074/jbc.M506162200
- Csiszar A, Tarantini S, Yabluchanskiy A, et al. Role of endothelial NAD+ deficiency in age-related vascular dysfunction. Am J Physiol – Hear Circ Physiol. 2019;316(6):H1253-H1266. doi:10.1152/ajpheart.00039.2019
- Ying W, Xiong Z-G. Oxidative Stress and NAD+ in Ischemic Brain Injury: Current Advances and Future Perspectives. Curr Med Chem. 2010;17(20):2152-2158. doi:10.2174/092986710791299911
- Zhu X, Su B, Wang X, Smith MA, Perry G. Causes of oxidative stress in Alzheimer disease. Cell Mol Life Sci. 2007;64(17):2202-2210. doi:10.1007/s00018-007-7218-4
- Abeti R, Duchen MR. Activation of PARP by oxidative stress induced by β-amyloid: Implications for Alzheimer’s disease. Neurochem Res. 2012;37(11):2589-2596. doi:10.1007/s11064-012-0895-x
- Lin JB, Apte RS. NAD + and sirtuins in retinal degenerative diseases: A look at future therapies. Prog Retin Eye Res. 2018;67:118-129. doi:10.1016/j.preteyeres.2018.06.002
- O’Hollaren P. Diphosphopyridine nucleotide in the prevention, diagnosis and treatment of drug addiction. West J Surg Obstet Gynecol. May 1961.
- Mestayer PN. Addiction: The Dark Night of the Soul/ Nad+: The Light of Hope – Paula Norris Mestayer – Google Books. Balboa Press; 2019. https://books.google.com/books?id=t7qEDwAAQBAJ&lr=&source=gbs_navlinks_s. Accessed October 11, 2020.
- Braidy N, Villalva MD, van Eeden S. Sobriety and satiety: Is NAD+ the answer? Antioxidants. 2020;9(5). doi:10.3390/antiox9050425
Compounding Pharmacy Statement
This preparation is compounded with drug components whose suppliers are registered with the FDA. While Galleria Medical Pharmacy adheres to USP <797> guidelines and applicable state and federal regulations to meet the required quality standards, the statements made regarding this preparation have not been evaluated by the FDA for safety or clinical effectiveness. As such, this preparation is not intended to diagnose, treat, cure, or prevent any disease. For inquiries concerning this preparation, please contact (504) 267-9876.