Nicotinamide adenine dinucleotide (NAD) intravenous therapy has gained attention as a wellness intervention, with proponents claiming benefits ranging from enhanced energy to addiction support. NAD+ is a vital coenzyme involved in cellular energy production, DNA repair, and metabolic regulation. As NAD+ levels decline with age, some practitioners advocate IV supplementation to restore cellular function. However, robust clinical evidence supporting these claims remains limited. This article examines the proposed mechanisms, claimed benefits, current research evidence, safety considerations, and UK regulatory framework surrounding NAD IV therapy to help patients and healthcare professionals make informed decisions.

What Is NAD IV Therapy and How Does It Work?

Nicotinamide adenine dinucleotide (NAD) is a coenzyme found in all living cells, playing a crucial role in cellular energy production and metabolic processes. NAD exists in two forms: NAD+ (oxidised) and NADH (reduced). NAD+ is essential for mitochondrial function, DNA repair, and the regulation of circadian rhythms. As we age, cellular NAD+ levels naturally decline, which has led to interest in supplementation strategies.

NAD intravenous (IV) therapy involves the direct infusion of NAD+ or its precursors into the bloodstream, bypassing the digestive system. Proponents suggest this delivery method may achieve higher bioavailability compared to oral supplementation, though this hypothesis requires further research. The infusion typically takes between one and four hours, with duration varying based on dose, product formulation, and individual tolerance.

The proposed mechanism centres on potentially replenishing intracellular NAD+ stores, thereby supporting mitochondrial function and cellular energy metabolism. NAD+ serves as a substrate for several enzyme families, including sirtuins (involved in DNA repair and gene expression), poly(ADP-ribose) polymerases (PARPs, which facilitate DNA repair), and CD38 (an enzyme that degrades NAD+).

However, it is important to note that there is limited robust clinical evidence demonstrating that IV administration of NAD+ effectively raises intracellular levels in target tissues or produces clinically meaningful benefits. Extracellular NAD+ is rapidly metabolised in the bloodstream, and there are questions about whether intact NAD+ efficiently crosses cell membranes or the blood-brain barrier in humans. The relationship between plasma NAD+ concentrations and intracellular function remains an area of ongoing research.

Claimed Benefits of NAD IV Therapy

Advocates of NAD IV therapy promote a wide range of potential benefits, though many of these claims are based on theoretical mechanisms rather than rigorous clinical trials. Commonly cited claims include:

• Enhanced energy and reduced fatigue – by supporting mitochondrial ATP production

• Improved cognitive function and mental clarity – through neuroprotective effects and support of brain metabolism

• Anti-ageing effects – via activation of sirtuins and promotion of cellular repair mechanisms

• Support for addiction recovery – particularly in alcohol and opioid dependence, by reducing cravings and withdrawal symptoms

• Athletic performance and recovery – through improved muscle function and reduced oxidative stress

• Mood regulation – by influencing neurotransmitter synthesis and brain energy metabolism

Some practitioners also suggest NAD IV therapy may benefit individuals with chronic fatigue syndrome, fibromyalgia, neurodegenerative conditions, and metabolic disorders. The rationale often centres on the role of NAD+ in cellular stress responses and the observation that NAD+ levels decline with age and in certain disease states.

In the context of addiction treatment, NAD IV therapy has been promoted since the 1960s, with proponents claiming it helps restore brain chemistry disrupted by substance use. However, it is important to note that NICE guidelines for alcohol dependence (CG115) and drug misuse (CG51, CG52) do not recommend NAD therapy as part of evidence-based treatment pathways.

Similarly, NICE guidance for myalgic encephalomyelitis/chronic fatigue syndrome (NG206) and chronic pain including fibromyalgia (NG193) does not include NAD therapy among recommended interventions.

It is crucial to emphasise that many of these claimed benefits lack substantial clinical evidence from well-designed, peer-reviewed studies. Whilst the biological importance of NAD+ is well established, the therapeutic efficacy of IV supplementation for these specific indications has not been conclusively demonstrated through rigorous randomised controlled trials.

Evidence and Research on NAD IV Therapy

The scientific evidence supporting NAD IV therapy remains limited and preliminary. Whilst NAD+ biology is well characterised at the cellular level, translating this knowledge into proven clinical benefits through IV supplementation presents significant challenges.

Preclinical research in animal models has demonstrated that boosting NAD+ levels through various precursors (such as nicotinamide riboside or nicotinamide mononucleotide) can improve metabolic function, enhance mitochondrial activity, and extend lifespan in certain organisms. However, these findings do not necessarily translate to human clinical outcomes, and most studies have focused on oral precursors rather than direct NAD+ infusion.

Human clinical trials specifically examining NAD IV therapy are scarce. Most available evidence consists of case reports, small observational studies, or trials with significant methodological limitations. Literature searches reveal a lack of large-scale, double-blind, placebo-controlled trials that would be necessary to establish efficacy and safety profiles according to modern evidence-based medicine standards.

Regarding addiction treatment, whilst some small studies from the 1960s–1990s suggested potential benefits, these were often poorly controlled and have not been replicated in contemporary research settings. Current NICE guidance on substance misuse does not include NAD therapy as a recommended intervention.

For cognitive enhancement and anti-ageing claims, there is no established link between NAD IV therapy and measurable improvements in these domains in healthy individuals. Whilst oral NAD+ precursors have shown some promise in early-stage research for specific conditions, the evidence for IV NAD+ administration remains largely anecdotal.

The pharmacokinetics of IV NAD+ also raise questions. Research suggests that NAD+ administered intravenously may be rapidly degraded in the bloodstream by ectoenzymes such as CD38, and there are uncertainties about whether it efficiently crosses cell membranes or the blood-brain barrier in its intact form, potentially limiting its therapeutic potential.

It is worth noting that there is currently no NAD+ IV product with marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) or European Medicines Agency (EMA), meaning there is no approved Summary of Product Characteristics (SmPC) with established efficacy and safety data.

Safety Considerations and Potential Side Effects

Whilst NAD IV therapy is generally considered to have a relatively favourable safety profile in the short term, it is not without risks and potential adverse effects. These include both NAD-specific reactions and general risks associated with any IV therapy.

Common adverse effects include:

• Nausea and gastrointestinal discomfort – often dose-dependent and related to infusion speed

• Flushing and warmth – particularly in the chest and face

• Muscle cramping or discomfort – especially in the abdomen

• Headache and lightheadedness

• Anxiety or restlessness during infusion

• Injection site reactions – pain, redness, or phlebitis

These effects are typically mild to moderate and can often be managed by slowing the infusion rate. However, they may be distressing for some patients and can occasionally necessitate discontinuation of the treatment.

IV-specific risks include:

• Infection (including potential for bloodstream infections/sepsis)

• Thrombophlebitis (inflammation of a vein with blood clot formation)

• Infiltration or extravasation (fluid leaking into surrounding tissue)

• Air embolism (if air enters the bloodstream)

• Fluid overload (particularly in those with cardiac or renal conditions)

More serious concerns relate to the lack of long-term safety data. The effects of repeated, high-dose NAD+ infusions over extended periods have not been systematically studied.

Due to insufficient safety data, NAD IV therapy should generally be avoided in pregnancy, breastfeeding, and in those under 18 years of age unless part of a formal clinical study.

Seek immediate medical attention (call 999 or go to A&E) if you experience:

• Signs of severe allergic reaction (anaphylaxis): difficulty breathing, swelling of face/throat, severe rash

• Severe chest pain or pressure

• Severe shortness of breath

• Collapse or loss of consciousness

Patients should contact their GP if they experience persistent symptoms following NAD IV therapy, including ongoing headache, chest discomfort, palpitations, or any concerning symptoms. It is essential to inform healthcare providers about any complementary therapies being undertaken.

Suspected adverse reactions can be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Regulation and Availability of NAD IV Therapy in the UK

In the UK, NAD IV therapy exists within a specific regulatory framework. Under the Human Medicines Regulations 2012, any substance presented as having properties for treating or preventing disease in humans is classified as a medicinal product. NAD+ is not licensed as a medicine by the Medicines and Healthcare products Regulatory Agency (MHRA) for specific therapeutic indications.

NAD IV therapy is typically offered through private clinics and wellness centres rather than through the NHS. When presented for medicinal purposes, NAD+ can only legally be supplied as an unlicensed 'special' medicinal product against a prescription written by a doctor, dentist, nurse independent prescriber, or other authorised prescriber for a patient's special clinical needs. Patient Group Directions (PGDs) cannot be used for unlicensed medicines.

Unlicensed 'specials' should be sourced from manufacturers holding an MHRA 'Specials' licence, and detailed records must be maintained. It is prohibited to advertise unlicensed medicines to the public, and any marketing must comply with Advertising Standards Authority (ASA) and Committee of Advertising Practice (CAP) rules, which require health claims to be substantiated by robust evidence.

Clinics providing IV therapies may require registration with the Care Quality Commission (CQC) if they are providing a regulated activity such as 'treatment of disease, disorder or injury'. Healthcare professionals must adhere to their regulatory bodies' standards – the General Medical Council (GMC) guidance on prescribing unlicensed medicines and the Nursing and Midwifery Council (NMC) Code regarding evidence-based practice, informed consent, and competence.

Patients considering NAD IV therapy should:

• Verify the credentials and registration of the practitioner

• Ensure the clinic follows appropriate infection control and safety protocols

• Discuss the treatment with their GP, particularly if they have underlying health conditions

• Be wary of exaggerated claims and ensure realistic expectations

• Understand that this is not a substitute for evidence-based medical treatment

• Check that the treatment is being prescribed by an authorised prescriber

The cost of NAD IV therapy varies considerably but typically ranges from £250 to £800 per session, with some protocols recommending multiple sessions. Given the limited evidence base and lack of NHS provision, patients should carefully consider whether this represents value for money compared to evidence-based interventions recommended in NICE guidance for their specific condition.

Frequently Asked Questions