NAD+ side effects depend on the route. Injections can cause redness, tenderness or burning where you inject; nasal sprays can irritate the nose; flushing, nausea and pressure are linked to fast IV infusions. FDA has received reports of severe reactions after injectable NAD+, tied to ingredient quality. Reliable frequency figures for home use are not established.
A pilot study of intravenous NAD+ measured metabolites in eight treated participants and three controls; it did not establish clinical benefits or a subcutaneous dosing schedule. Source: NAD+ intravenous pilot study
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme central to cellular energy metabolism, prescribed by a licensed US provider for general wellness after an individual evaluation. It’s a compounded medication, not an FDA-approved finished drug product. The overview of forms and care is on the NAD+ injections page.
| Route | Commonly reported effects | What to know |
|---|---|---|
| Subcutaneous injection (at home) | Redness, tenderness or a brief burning feeling where you inject; flushing, nausea, headache, tiredness | Rotate sites and follow your pharmacy’s instructions; FDA’s alert on injectable NAD+ ingredient quality applies here |
| Nasal spray | Mild nasal irritation, a brief burning feeling, headache, tiredness; less often dizziness, nausea or shortness of breath | Use the spray count on your label; see NAD+ nasal spray |
| Oral supplements and precursors (NR, NMN) | Depends on the product and dose; check the label and ask a pharmacist | Over-the-counter supplements are a different product from prescribed NAD+; see NAD+ supplements vs injections |
| IV infusion (clinic, for context) | Flushing, nausea and a feeling of pressure, often tied to infusion speed | Needs a trained, licensed person to place and watch the line |
Sources: FDA’s alert on ingredients for sterile compounding (linked below), a compounding pharmacy’s NAD+ injection information, and published NAD+ nasal spray instructions (read 2026-09-29). None of these gives a reliable frequency for a specific preparation.
Published pharmacy information lists redness, tenderness or a brief burning feeling where you inject. Flushing, nausea, headache and tiredness are also reported, often linked to dose or speed. FDA has received reports of severe chills, shaking, vomiting and fatigue after injectable NAD+, tied to ingredient quality. Reliable frequency figures for home injections are not established.
Chest pressure or pain should not be managed simply by slowing a home injection. Stop administration and seek urgent assessment if it is severe, new or accompanied by breathing difficulty. Source: FDA: ingredients for sterile compounding
These are generally temporary. As with any prescription medication, other effects are possible and individual experiences differ.
Some people do feel flushing, nausea, a sense of pressure or tiredness early on, and with NAD+ these effects are often tied to how much is given and how fast. That is one reason providers commonly start low and adjust. Feeling worse is a reason to contact your care team, not to push through.
NAD+ is a little different from many injectables: several of its most-reported effects are tied to how fast it’s delivered. Given too quickly, it’s associated with flushing, nausea, and pressure; slowed down, those tend to ease. That’s the main reason providers often start conservatively, supervise dosing, and explain technique — and why self-administering NAD+ without guidance is a bad idea. (See NAD+ injection dosage for how providers structure this.)
A licensed provider decides that after reviewing your history. Tell them first if you are pregnant, trying to conceive or breastfeeding, since safety there has not been established; if you have heart, kidney or liver disease or are in cancer treatment; or if you take other medications or supplements. Some of these may mean NAD+ is not right for you.
A bulleted list can’t tell you your risk. The likelihood and significance of any effect depend on your health history, medications, and other factors a provider weighs. That’s why NAD+ is prescription-required, individually screened, and monitored — you have a care team to contact and a provider who can adjust or stop treatment. For the FDA status and what to check before you start, read are NAD+ injections safe.
Pay attention to anything persistent, worsening, or unusual, and contact your care team if it occurs. For any severe or urgent symptom, seek emergency care immediately.
Have questions about whether NAD+ is right for you? Start a clinical evaluation with REMEVi — a licensed US provider reviews your history, explains the risks, and decides whether to prescribe, with bilingual care. Plan prices are on the NAD+ injection cost page.
Related reading: NAD+ injection dosage and NAD+ supplements vs injections.
This article is for general education and is not medical advice. NAD+ prescribed by REMEVi is a non-FDA-approved compounded medication that requires a prescription from a licensed provider after an individual evaluation.
FDA has received reports of severe chills, shaking, vomiting and fatigue after NAD+ injectable medicines, with some patients requiring medical care. It warns that food-grade ingredients are unsuitable for sterile compounding. Those reports do not establish a risk frequency for a particular preparation. Source: FDA: ingredients for sterile compounding
Published pharmacy information lists redness, tenderness or a brief burning feeling where you inject. Flushing, nausea, headache and tiredness are also reported, often linked to dose or speed. FDA has received reports of severe chills, shaking, vomiting and fatigue after injectable NAD+, tied to ingredient quality. Reliable frequency figures for home injections are not established.
Some people do feel flushing, nausea, a sense of pressure or tiredness early on, and with NAD+ these effects are often tied to how much is given and how fast. That is one reason providers commonly start low and adjust. Feeling worse is a reason to contact your care team, not to push through.
Published patient instructions for NAD+ nasal sprays list mild nasal irritation, a brief burning feeling, headache and tiredness as the most common effects, with dizziness, nausea or shortness of breath less often. Stop and contact your care team if an effect is severe or does not ease, and seek urgent care for any trouble breathing.
A licensed provider decides that after reviewing your history. Tell them first if you are pregnant, trying to conceive or breastfeeding, since safety there has not been established; if you have heart, kidney or liver disease or are in cancer treatment; or if you take other medications or supplements. Some of these may mean NAD+ is not right for you.
Contact your care team. In a provider-led program you have a clinician and coordinator to reach, and your provider can adjust the dose, slow the pace, or stop treatment if appropriate. For chest pain, trouble breathing, fainting or any other severe or urgent symptom, stop and seek emergency care right away.
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