NAD Infusion in Humans: Current Evidence

Guideline-Based Recommendations

The American Academy of Physical Medicine and Rehabilitation does not recommend NAD patches due to lack of clinical evidence 1
FDA labeling for intravenous NAD lists only cosmetic uses, not therapeutic medical indications is not applicable, however, The American Academy of Physical Medicine and Rehabilitation does not recommend NAD patches due to lack of clinical evidence 1

Enteral nutrition should provide 18-40 mg per day of niacin in 1500 kcal (Grade A recommendation) 2
Parenteral nutrition should provide at least 40 mg of niacin per day (Grade B recommendation) 2
When niacin deficiency is suspected, higher doses may be required (Good Practice Point) 2
The oral/enteral route should be used whenever the gastrointestinal tract is functional 2

High doses of nicotinic acid can cause flushing, nausea, vomiting, liver toxicity, blurred vision, and impaired glucose tolerance 1
The upper intake level for nicotinic acid is only 10 mg/day due to flushing effects 1
Patch delivery systems may cause local skin reactions 1
NAD(P)H oxidase activity has been implicated in anthracycline-induced cardiotoxicity, raising concerns about NAD supplementation in certain contexts 3

For patients inquiring about NAD infusion, first-line approach: Recommend dietary sources of niacin (meat, poultry, fish, nuts, legumes) as suggested by the National Institutes of Health 1
If deficiency suspected: Measure blood or tissue NAD levels in the presence of pellagra symptoms (diarrhea, dermatitis, dementia) 2
If deficiency confirmed: Use oral nicotinic acid (15-20 mg/day) or nicotinamide (300 mg/day) for pellagra treatment 4
Avoid NAD infusion for therapeutic purposes outside of research protocols, given the lack of guideline support, poor pharmacokinetics, and absence of proven clinical benefit 1

The daily dietary reference intakes for niacin are 16 mg/day for males and 14 mg/day for females, according to the Clinical Nutrition guidelines 5
Risk factors for niacin deficiency include a corn-based diet, malnutrition, chronic alcoholism, and malabsorptive states, as noted in Clinical Nutrition 6

The upper intake level for free nicotinic acid is 10 mg/day due to flushing effects, and high doses can cause side effects such as nausea, vomiting, and liver toxicity, as reported in Clinical Nutrition 5
The upper intake level for nicotinamide is 12.5 mg/kg body weight/day, approximately 900 mg/day for adults, with no flushing effects observed and no adverse effects at doses up to 25 mg/kg body weight/day in prolonged studies, according to Clinical Nutrition 5, 6