NAD+ Injection

Active ingredients: NAD+
Dosage form: Injection
Route: Intramuscular injection, Subcutaneous injection, Intravenous
Care area: Dermatology
Drug class: Coenzyme / Cofactor
DEA schedule: Non-controlled
Sterile preparation: Yes

Compounded and dispensed by an NABP-accredited, LegitScript-certified pharmacy. Verify accreditation (opens in a new tab)

About compounded medications

All formulations are patient-specific prescriptions compounded by Lake Hills Pharmacy under FDA section 503A. Individual ingredients are FDA-approved; compounded products are not reviewed by the FDA for safety, effectiveness, or quality. For licensed healthcare providers only.

Available Dosage Strengths

Injection

200 mg/mL
Unit size: 5 mL vial, 10 mL

Clinical information

Product Overview

NAD+ Injection (Aqueous) is a sterile aqueous solution of nicotinamide adenine dinucleotide for intramuscular, subcutaneous or intravenous use. Lake Hills Pharmacy compounds it as a 503A pharmacy, pursuant to a patient-specific prescription.

NAD+ (nicotinamide adenine dinucleotide) is a bulk drug substance with no FDA-approved drug product. No FDA-labeled indication or dose exists for any route. NAD+ is an endogenous coenzyme in cellular redox reactions; prescribers use compounded NAD+ injections at their discretion.

Active Ingredients & Strengths

NAD+ 200 mg/mL, 5 mL vial (1,000 mg per vial).
NAD+ 200 mg/mL, 10 mL multi-dose vial (2,000 mg per vial).

Dosing & Administration

No FDA-labeled dose exists for this route; dosing is individualized by the prescriber. Dose, route and frequency are as prescribed.

Intravenous administration is given by a clinician in a supervised setting. Infusion-related symptoms are commonly related to the rate of administration.

Key Safety Information

Do not use in patients with hypersensitivity to NAD+ or any component.
Intravenous use: flushing, chest tightness or pressure, shortness of breath, nausea, abdominal cramping, headache, dizziness and anxiety can occur during infusion; slowing or stopping the infusion is the usual response.
Intramuscular and subcutaneous use: injection-site pain, redness, swelling and bruising can occur.
Safety in pregnancy and breastfeeding has not been established; use only if the prescriber judges it necessary.
No clinically established drug interactions are known; tell the prescriber about niacin, nicotinamide or other NAD+ precursor supplements.

Storage, Stability & BUD

Storage: refrigerate at 2°C to 8°C (36°F to 46°F) and protect from light, unless the label states otherwise.
Beyond-use date: per the prescription label.
USP default BUD (USP <797>, Category 2, no sterility testing): 1 day at room temperature, 4 days refrigerated or 45 days frozen when prepared from one or more nonsterile starting components; 4, 10 or 45 days when prepared only from sterile starting components. Longer USP dating applies after terminal sterilization or a passing sterility test.
Lake Hills may assign extended dating based on its own stability data.
If supplied as a preserved multiple-dose vial, follow the prescription label for in-use dating after first puncture.

Patient Counseling

Use this medication exactly as your prescriber directs. Do not change the amount or how often you use it without talking to your prescriber.

If you self-inject, use the technique your prescriber or clinic taught you, a new sterile needle each time, and rotate sites.
Tell the person giving an infusion right away if you feel chest tightness, shortness of breath, nausea or cramping.
Keep the vial refrigerated and discard it on the date shown on the label.

References

USP General Chapter <797> Pharmaceutical Compounding: Sterile Preparations.
The Merck Index: nicotinamide adenine dinucleotide.

Active ingredients

Nicotinamide Adenine Dinucleotide

Coenzyme / Cofactor

Overview

Nicotinamide adenine dinucleotide (NAD+) is an endogenous coenzyme present in all living cells. It is a bulk drug substance with no FDA-approved drug product, and no FDA-labeled indication or dose exists for any route. NAD+ is compounded into injectable and topical preparations pursuant to patient-specific prescriptions.

Indications & Uses

No FDA-labeled indication exists. Prescribers use compounded NAD+ by intravenous, intramuscular, subcutaneous and topical routes at their discretion.

Mechanism of Action

NAD+ and its reduced form NADH carry electrons in glycolysis, the citric acid cycle and oxidative phosphorylation. NAD+ is also a substrate for sirtuins, poly(ADP-ribose) polymerases and CD38, enzymes involved in DNA repair, gene regulation and cell signaling. Tissue NAD+ levels decline with age and some disease states; whether exogenously administered NAD+ raises intracellular NAD+ in humans has not been established.

Pharmacokinetics

Human pharmacokinetic data are limited. Extracellular NAD+ does not readily cross cell membranes and is rapidly broken down by ectoenzymes such as CD38 and CD73 to nicotinamide mononucleotide, nicotinamide riboside, nicotinamide and adenosine, which cells can take up and use to resynthesize NAD+. Nicotinamide is metabolized in the liver and excreted in urine. Topical absorption has not been characterized.

Contraindications

Hypersensitivity to NAD+ or any component of the preparation. No other contraindications are established.

Warnings & Precautions

Intravenous use: infusion-related reactions, including flushing, chest tightness, dyspnea, nausea, abdominal cramping, headache and anxiety, are common and are generally related to infusion rate; administer under clinical supervision.
Intramuscular and subcutaneous use: injection-site pain, erythema and swelling.
Safety data in pregnancy, lactation, children, and hepatic or renal impairment are not available.
Topical use: avoid broken skin, eyes and mucous membranes.

Drug Interactions

No clinically established drug interactions are known. Concurrent niacin, nicotinamide, nicotinamide riboside or other NAD+ precursor supplements add to total nicotinamide exposure.

Adverse Effects

Intravenous: flushing, chest pressure, shortness of breath, nausea, abdominal cramping, headache, lightheadedness and fatigue during or after infusion. Injection: local pain, redness, swelling and bruising. Topical: local irritation or itching.

Pregnancy & Lactation

No human data exist on exogenous NAD+ in pregnancy or lactation. Use is not recommended unless the prescriber judges it necessary; this is a precaution, not a labeled contraindication.

Monitoring

Intravenous use: vital signs and symptoms during infusion, with rate adjustment as needed. All routes: injection-site or skin reactions and any hypersensitivity.

References

The Merck Index: nicotinamide adenine dinucleotide.
USP General Chapter <797> Pharmaceutical Compounding: Sterile Preparations.
USP General Chapter <795> Pharmaceutical Compounding: Nonsterile Preparations.

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Are compounded medications FDA approved?

How do I get a prescription filled here?

You can have your doctor send prescriptions to us any time. We also transfer your medications from another pharmacy. Our pharmacy accepts all major insurance plans.

Can you ship this medication to my state?

It depends on the medication and on your state. Whether we can dispense or ship a medication to you depends on the laws and board of pharmacy rules of your state and on our licensure there. We confirm availability when we receive a prescription.

These answers cover the basics. For anything about a formula, a strength or a prescription, contact our pharmacists.

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12005 Bee Cave Rd, Suite 1-A, Austin, TX 78738