NAD+ (nicotinamide adenine dinucleotide) is a molecule found naturally in every cell. It helps the body convert food into cellular energy, supports DNA repair, and plays a role in metabolism, recovery, brain function, and healthy aging.
GobyMeds may prescribe compounded NAD+ as either a subcutaneous injection or a nasal spray. Patients should use only the form, dose, and schedule prescribed by their provider.
What NAD+ does in the body
NAD+ helps cells produce ATP, the body’s usable energy. It also supports enzymes involved in DNA repair, inflammation control, gene regulation, and cellular stress response, including sirtuins and PARPs.
NAD+ levels can decline with age, stress, poor sleep, alcohol use, poor diet, inflammation, and environmental stress. Low NAD+ may contribute to fatigue, brain fog, slower recovery, metabolic changes, and visible signs of aging.
NAD+ therapy is intended to replenish NAD+ levels and support normal cellular function. It is not a stimulant like caffeine and should not be expected to create an immediate energy spike.
Potential benefits
Patients may use NAD+ therapy to support:
Steadier energy and reduced fatigue
Mental clarity, focus, memory, and mood support
Healthy metabolism, insulin sensitivity, blood sugar balance, and fat metabolism
Workout, stress, illness, or surgery recovery
Heart, blood vessel, liver, and metabolic health
Skin health, including hydration, tone, elasticity, collagen support, and DNA repair from UV/environmental damage
Long-term wellness and healthy aging
Results vary. Some patients notice subtle energy or clarity within days, but many notice more consistent benefits after 3–4 weeks. Larger changes in energy, recovery, mood, skin, and metabolic markers may take 2–3 months or longer. A 3-month minimum trial is often recommended to evaluate full benefit.
Available forms: injection vs nasal spray
NAD+ subcutaneous injection
Injection delivers NAD+ under the skin using a small insulin-style syringe. It is generally used for whole-body support, higher systemic absorption, longer-lasting effects, energy, recovery, metabolism, and anti-aging goals.Typical schedules may range from 1–3 times per week, depending on the prescription. Some sources reference 20–50 mg per injection as a starting range and up to 100 mg based on tolerance and goals, but patients should follow the exact dose written on their prescription in mL or units.
NAD+ nasal spray
Nasal spray is needle-free and may be preferred for convenience, daily use, or brain-focused support such as focus and mental clarity. It is absorbed through the nasal lining and may act faster for some patients.
Typical use may be once or twice daily, often in the morning or early afternoon. Some prescriptions may direct 1–2 sprays per nostril. Patients should follow their prescribed instructions and should not exceed the recommended amount.
Can patients use both?
Patients should use only the formulation prescribed to them. Some patients may ask about using injections and nasal spray together, but GobyMeds currently prescribes one NAD+ form at a time unless a provider gives different instructions.
How to use NAD+ nasal spray
Before use:
Wash your hands.
Gently blow your nose.
Remove the bottle from the refrigerator a few minutes before use so it can approach room temperature.
If using the bottle for the first time, prime the pump until a fine mist appears.
To use:
Shake the bottle gently.
Tilt your head slightly forward.
Insert the nozzle just inside one nostril while closing the other nostril with a finger.
Press the pump once and inhale gently through your nose.
Repeat in the other nostril if instructed.
Wipe the nozzle, replace the cap tightly, and store the bottle upright.
Avoid blowing your nose or sneezing for at least 2–3 minutes after use. Do not share nasal spray with anyone else.
How to use NAD+ subcutaneous injections
Before injecting, review the medication instructions and contact your provider or GobyMeds Customer Support if anything is unclear.
General steps:
Gather the NAD+ vial, syringe/needle, alcohol pads, and sharps container.
Wash your hands.
Choose an injection site such as the abdomen, thigh, or back of the upper arm.
Clean the site with an alcohol pad and let it dry.
Wipe the vial’s rubber stopper with an alcohol pad and let it dry.
Draw the prescribed amount into the syringe and remove air bubbles.
Pinch the cleaned skin.
Insert the needle at a 90-degree angle, or as directed by your provider.
Slowly push the plunger to inject.
Remove the needle, release the skin, and place the syringe in a sharps container.
Record the date, time, and dose.
Rotate injection sites to reduce irritation. Inject slowly, since injecting too quickly may cause flushing, tingling, or unusual sensations.
Storage, handling, and travel
Store both NAD+ injectable vials and nasal spray in the refrigerator between 36°F and 46°F (2°C and 8°C). Keep medication upright, tightly sealed, and protected from light. Do not freeze.
Before each dose, remove the vial or spray bottle from the refrigerator for a few minutes so it can reach a more comfortable temperature. Do not leave it out for extended periods.
Inspect injectable solution before use. It should be clear and colorless. Do not use it if it is cloudy, discolored, contains particles, expired, frozen, or exposed to extreme heat for an extended period. Contact the pharmacy, provider, or GobyMeds for guidance.
For travel, use an insulated cooler bag with cold packs. Do not place the vial or spray bottle directly against ice packs because freezing can damage the medication or spray mechanism. Keep medication away from heat, sunlight, moisture, children, and pets. Do not store it in a bathroom.
Ask the pharmacy about safe medication disposal or take-back options. Do not flush medication or dispose of sharps in household trash.
Side effects and injection-site reactions
NAD+ is generally well tolerated, but side effects can occur.
Possible side effects include:
Mild flushing, tingling, redness, nausea, dizziness, fatigue, or headache
Nasal dryness, irritation, or a mild bitter taste after nasal spray
Injection-site soreness, tenderness, redness, itching, warmth, swelling, rash, or a small temporary knot under the skin
Mild injection-site irritation can often be managed by rotating sites, using a cold compress, and using standard over-the-counter pain relievers or anti-inflammatory products if appropriate for the patient.
Contact your GobyMeds provider through the Patient Portal if you have persistent irritation, dizziness, severe flushing, symptoms that worsen instead of improve, blistering, severe pain, a widespread rash, hives, severe itching, fever of 100.4°F (38°C) or higher, muscle aches, or headache.
Call 911 or seek emergency care immediately for possible severe allergic reaction symptoms such as swelling of the lips, tongue, or throat; trouble breathing; wheezing; fast heartbeat; or feeling very weak or dizzy.
Who should avoid NAD+ or use extra caution
NAD+ may not be appropriate for everyone. Patients should tell their provider about all medical conditions, allergies, medications, vitamins, supplements, and prior reactions.
NAD+ should generally be avoided or used only with provider guidance in patients who are pregnant, breastfeeding, allergic to NAD+ or formulation ingredients, have severe liver or kidney disease, have active cancer or are undergoing chemotherapy, have chronic low blood pressure, have uncontrolled diabetes or unstable blood sugar, have chronic heavy alcohol use, or have certain heart conditions such as arrhythmias, angina, or congestive heart failure.
Patients with a history of cancer should discuss NAD+ with their oncologist before starting therapy.
Medication, supplement, and substance interactions
Patients should disclose all prescriptions, over-the-counter medications, vitamins, herbal products, and supplements before starting NAD+.
Important interaction considerations:
High-dose niacin, niacinamide, or vitamin B3 supplements may increase flushing or nausea. Typical multivitamin amounts are usually acceptable unless the provider says otherwise.
Blood pressure medications may have stronger effects because NAD+ may mildly lower blood pressure. Patients should report dizziness or lightheadedness.
Diabetes medications such as insulin, metformin, or glipizide may increase the risk of low blood sugar if NAD+ improves insulin sensitivity. Patients should monitor glucose as directed.
Chemotherapy or cancer treatments require oncologist/provider guidance.
Some antibiotics, especially fluoroquinolones such as ciprofloxacin or levofloxacin, may affect mitochondrial function and should be disclosed.
Alcohol may reduce NAD+ benefits, especially with chronic use.
CoQ10, resveratrol, caffeine products, and other energy/metabolic supplements may increase overstimulation, headaches, or jitteriness when combined.
Patients should not start, stop, or change NAD+ or other medication doses without provider guidance.
Compounded medication note
Compounded NAD+ is prepared by licensed compounding pharmacies based on an individual prescription. Compounded products are not reviewed or approved by the U.S. Food and Drug Administration for safety, effectiveness, or quality. GobyMeds works with licensed 503A and 503B compounding pharmacies that follow applicable quality standards.
Patients with questions should message their provider through the GobyMeds Patient Portal or contact GobyMeds Customer Support.