NAD IV therapy involves intravenous administration of nicotinamide adenine dinucleotide (NAD+), a coenzyme essential for cellular energy production. Whilst proponents claim benefits for energy, cognitive function, and ageing, NAD IV therapy side effects can range from mild infusion-related discomfort to potentially serious complications. Importantly, NAD+ for intravenous use is not licensed by the MHRA in the UK, lacks NICE recommendations, and is not routinely available through the NHS. The evidence base remains limited, with most research conducted in laboratory or animal models rather than robust human trials. Understanding potential side effects and safety concerns is essential for anyone considering this treatment.

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 IV therapy involves the intravenous administration of NAD+ (the oxidised form of NAD) directly into the bloodstream, bypassing the digestive system.

Proponents of NAD IV therapy claim it may support cellular repair, enhance energy levels, improve cognitive function, and potentially slow aspects of ageing. The treatment typically involves infusions with duration and dosage varying between providers, as there is no standardised or licensed regimen in the UK.

The proposed mechanism centres on NAD+'s role as a cofactor for enzymes involved in DNA repair, mitochondrial function, and cellular signalling pathways. When administered intravenously, NAD+ is largely metabolised extracellularly to precursors that enter cellular salvage pathways, rather than being taken up intact by cells. The body tightly regulates NAD+ levels through complex biosynthetic and salvage pathways.

Whilst NAD IV therapy has gained popularity in private wellness clinics, there is currently limited high-quality clinical evidence supporting many of the claimed benefits in humans. Most research has been conducted in laboratory settings or animal models, and robust randomised controlled trials in human populations remain scarce. It is important to note that NAD+ for intravenous use is not licensed as a medicine by the MHRA in the UK, has no marketing authorisation, and is not currently recommended by NICE or routinely available through the NHS.

Common Side Effects of NAD IV Therapy

Based on clinical reports and limited published data, reactions during NAD IV therapy appear to be primarily related to the infusion process itself. Individual responses vary considerably, with some patients experiencing minimal discomfort whilst others find the side effects challenging to tolerate.

During the infusion, patients may experience:

• Chest tightness or pressure – often described as a sensation of heaviness or constriction

• Abdominal discomfort – ranging from mild discomfort to more pronounced cramping

• Nausea – sometimes accompanied by a metallic taste

• Flushing or warmth – particularly in the face and upper body

• Headache – typically mild and transient

• Muscle cramping – especially in the legs or arms

The intensity of these symptoms often correlates with the infusion rate of NAD+. Many practitioners address this by slowing the infusion rate when symptoms occur, which typically provides relief within minutes.

Common IV administration-related effects may include:

• Pain, bruising or discomfort at the cannula site

• Infiltration or extravasation (fluid leaking into surrounding tissue)

• Thrombophlebitis (inflammation of the vein)

• Vasovagal reactions (feeling faint, dizzy, or nauseous)

• Fatigue or drowsiness following treatment

Most of these side effects resolve spontaneously within hours of completing the infusion. Patients should ensure they are adequately hydrated before and after treatment and should be monitored (blood pressure, heart rate) throughout the infusion. The infusion should be slowed or stopped if significant symptoms occur. Patients should inform the administering practitioner immediately if symptoms become severe or intolerable.

Serious Risks and Safety Concerns with NAD Infusions

Whilst severe adverse events from NAD IV therapy appear to be uncommon in published literature, the lack of comprehensive safety data and long-term studies means that serious risks cannot be fully characterised. Healthcare professionals and patients should be aware of potential serious complications.

Cardiovascular concerns represent an area of uncertainty. Theoretical risks that require monitoring include:

• Arrhythmias – alterations in heart rhythm, particularly in individuals with pre-existing cardiac conditions

• Hypotension – drops in blood pressure during or after infusion

• Tachycardia – rapid heart rate that may cause palpitations or chest discomfort

Allergic and hypersensitivity reactions can occur with any intravenous therapy. These may range from mild skin reactions to potentially life-threatening anaphylaxis. Any facility offering NAD IV therapy should have appropriate emergency equipment and trained personnel to manage severe allergic reactions, following Resuscitation Council UK guidance.

Infection risk is inherent to any intravenous therapy. Poor aseptic technique during preparation or administration can lead to local infection at the injection site or, more seriously, bloodstream infections (sepsis). Patients should ensure that treatments are administered in appropriate clinical settings by qualified healthcare professionals following strict infection control protocols.

Other serious IV therapy risks include:

• Fluid overload – particularly in patients with heart or kidney conditions

• Venous thrombosis – blood clot formation related to the IV line

• Air embolism – a rare but serious complication if air enters the bloodstream

Patients with pre-existing kidney or liver disease should exercise particular caution, as these organs play crucial roles in metabolism and clearance of substances. If you experience severe chest pain, difficulty breathing, severe allergic symptoms (swelling, rash, wheezing), or signs of infection (fever, rigors) following NAD IV therapy, call 999 or attend your nearest A&E department immediately.

Who Should Avoid NAD IV Therapy?

Due to the limited safety data available, NAD IV therapy is generally not recommended outside research settings for certain groups. Healthcare professionals should conduct thorough medical assessments before considering this treatment.

NAD IV therapy is not recommended for:

• Pregnancy and breastfeeding – there is insufficient evidence regarding safety for the developing foetus or nursing infant

• Known hypersensitivity to NAD+ or any components of the infusion solution

Groups requiring specialist assessment and careful consideration include those with:

• Cardiovascular disease – including arrhythmias, heart failure, recent myocardial infarction, or uncontrolled hypertension

• Kidney disease – impaired renal function may affect clearance of infused substances

• Liver disease – hepatic impairment can alter metabolism

• Active malignancy – theoretical concerns exist about NAD+'s role in cellular metabolism; oncologist input is advised

Additional considerations include:

• Age – limited safety data exists for NAD IV therapy in children and adolescents; this treatment is generally not recommended for individuals under 18 years of age. Elderly patients may be more susceptible to side effects and should be monitored closely if treatment is considered.

• Medications and medical conditions – people taking medicines affecting blood pressure or heart rhythm, or those with significant comorbidities, require medical review and monitoring as the clinical effects of IV infusions can be unpredictable in these groups.

Before considering NAD IV therapy, patients should consult their GP or relevant specialist to discuss their complete medical history, current medications, and whether this treatment is appropriate for their individual circumstances. This is particularly important as NAD IV therapy is not currently part of standard NHS care pathways and safety data remains limited.

UK Regulation and Evidence for NAD IV Treatment

NAD+ for intravenous use is an unlicensed medicine in the UK. It is not approved by the Medicines and Healthcare products Regulatory Agency (MHRA) for the conditions it is typically marketed to treat. This means it can only be supplied as a 'special' or as an imported unlicensed product, subject to specific regulatory requirements.

When NAD+ is used intravenously in the UK, it is prescribed under the 'unlicensed medicines' or 'specials' framework. This practice is legal when conducted by appropriately qualified healthcare professionals, but places additional responsibilities on the prescriber. According to GMC guidance, prescribers must be satisfied there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy, ensure patients are aware of its unlicensed status, and document the rationale for prescribing an unlicensed product.

NICE (National Institute for Health and Care Excellence) has not issued guidance recommending NAD IV therapy for any specific condition. The treatment is not included in standard NHS care pathways and is predominantly available through private clinics and wellness centres.

The evidence base for NAD IV therapy remains limited. Whilst preclinical studies and small-scale human trials have explored NAD+ supplementation, there is a paucity of large, well-designed randomised controlled trials demonstrating clear clinical benefits. Most existing research has focused on oral NAD+ precursors rather than intravenous NAD+ itself.

Quality and safety standards for NAD IV preparations should include:

• The clinic being registered with the Care Quality Commission (CQC) where regulated activities are undertaken

• Practitioners being appropriately qualified and registered with relevant professional bodies (GMC for doctors, NMC for nurses)

• NAD+ preparations being sourced from MHRA-licensed 'specials' manufacturers or importers following Good Manufacturing Practice (GMP)

• Appropriate emergency equipment and protocols being in place

Patients considering NAD IV therapy should be aware that costs are not covered by the NHS and can vary considerably between providers. Given the limited evidence base and unlicensed status for most claimed indications, individuals should approach marketing claims with appropriate scepticism and discuss the treatment thoroughly with their GP before proceeding. Any suspected adverse effects from NAD IV therapy should be reported to the MHRA through the Yellow Card Scheme (yellowcard.mhra.gov.uk), which monitors the safety of all medicines and medical devices used in the UK.

Frequently Asked Questions