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Peptide library · Coenzyme

NAD+

Nicotinamide adenine dinucleotide, a coenzyme used by every living cell. It is not a peptide, and research on oral precursors or animal models does not establish outcomes for compounded NAD+ injections.

Last reviewed September 22, 2026

The short version

NAD+ is a coenzyme, not a peptide. Cells use it to move electrons during metabolism and as a substrate for enzymes involved in DNA repair and cellular signaling. The research spans cells, animals and human studies of related oral precursors such as NMN. Direct evidence for compounded injectable NAD+ is much thinner.

Injectable NAD+ is compounded and is not FDA-approved. Evidence for an oral precursor, reduced NADH or an animal infusion cannot establish the safety or effectiveness of an NAD+ prescription injection. A licensed provider evaluates the individual question.

What it is

NAD+ stands for nicotinamide adenine dinucleotide. It is a dinucleotide coenzyme made from a nicotinamide-containing nucleotide joined to an adenosine-containing nucleotide. The plus sign marks its oxidized form; NADH is the reduced form. Human cells make NAD+ through several pathways using dietary precursors, including forms of vitamin B3. Calling NAD+ a peptide is chemically incorrect.

NAD+ has the molecular formula C21H27N7O14P2, molecular weight 663.43 daltons and CAS number 53-84-9. NMN and nicotinamide riboside are precursors used to make NAD+; they are separate molecules, so studies of them must remain labeled as precursor studies.1

Where the research stands

The biology of NAD+ is well established, but the clinical question is narrower: whether raising it through a particular route changes a meaningful human outcome. A 2025 review found limited human efficacy evidence for precursor supplementation and sparse information about NAD+ changes in specific human tissues.2

How far the evidence has climbed

  1. Cell studiesYesExtensive metabolism and signaling biology
  2. Animal studiesYesMany models; route and molecule vary
  3. Small human pilotsLimitedMostly precursors or reduced NADH
  4. Controlled human trialsA fewOral precursors, not injectable NAD+
  5. FDA approvalNoNo approved injectable NAD+ drug

Here is what some of the most-cited studies looked at. Each names its species and molecule, because oral NMN in people is not injected NAD+.

  • Review2021

    NAD+ biology across species

    A review covering yeast, worms, mice and humans described NAD+ as a redox coenzyme and a substrate used by several enzyme families. It did not test compounded NAD+ injections.1

  • Mice2016

    Age-related decline in mice

    Mouse experiments linked greater CD38 activity with lower tissue NAD+ during aging. Knocking out CD38 changed that pattern in mice, not people.3

  • Rats2016

    Injected NAD+ in a heart model

    Rats with induced heart ischemia-reperfusion injury received intravenous NAD+, and researchers measured tissue damage and antioxidant markers. This acute rat model does not establish a human wellness outcome.4

  • Humans1994

    A small NADH comparison

    A double-blind study included nine people with Parkinson’s disease: five received intravenous NADH and four received saline. It measured clinical response and did not test an NAD+ injection.5

  • Humans2021

    Oral NMN in women

    A controlled study in prediabetic postmenopausal women tested oral NMN, a precursor rather than NAD+ itself, and measured muscle insulin signaling. It did not test an NAD+ injection.6

  • Review2025

    Human evidence remains limited

    A review assessed human precursor trials and tissue-specific NAD+ measurements during aging. It did not test compounded injectable NAD+.2

What the research can’t tell you

  • Different molecules are often grouped together

    NAD+, NADH, NMN and nicotinamide riboside are related but distinct. A result for one cannot automatically be assigned to another.

  • Route matters

    Oral precursor trials do not establish injectable NAD+ pharmacology. The cited research does not include a large controlled human trial of compounded NAD+ injections.2

  • Biomarkers are not outcomes

    Raising NAD+ in blood or changing a signaling marker does not by itself prove a meaningful clinical result. The relevant tissue can also matter.2

  • Long-term injection safety is unclear

    The research does not establish long-term safety for compounded injectable NAD+. Animal findings and small studies of related molecules cannot close that gap.

FDA status

Injectable NAD+ is not FDA-approved

Compounded NAD+ injections are not FDA-approved. FDA approval of a different product or evidence about a related molecule would not change that status.

FDA states that it does not verify a compounded drug’s safety, effectiveness or quality before the drug is marketed.7 That distinction remains even when a licensed provider writes the prescription.

Promise Peptides is currently taking waitlist sign-ups. Joining is not a medical request and no prescription comes from it.

A prescription route

Promise is currently accepting waitlist signups. Joining is not a treatment request and does not result in a prescription. If treatment visits open, any treatment request would require clinical review; prescribing and pharmacy fulfillment would remain separate decisions.

  1. Start on Promise’s NAD+ page

    It shows what the treatment involves and its current availability.

  2. Answer the NAD+ questionnaire

    A licensed provider reviews health history, medicines and goals, and can decline. Not everyone qualifies.

  3. Pharmacy review is a separate step

    A prescription does not guarantee preparation or dispensing. A pharmacy must separately determine whether it can fulfill the prescription under the applicable requirements.

A prescription does not make injectable NAD+ FDA-approved or convert evidence for oral precursors into evidence for an injection; it records an individualized clinical decision.

NAD+ at Promise

Read the treatment information and view the current waitlist.

Join the Promise waitlist

Peak may earn money when readers become Promise patients.

Joining does not guarantee future treatment availability. Availability would depend on the treatment, state, clinical review and separate pharmacy review.

Questions

Is NAD+ a peptide?

No. It is a dinucleotide coenzyme. Peptides are chains of amino acids, while NAD+ is built from two linked nucleotides.

Is NAD+ just vitamin B3?

No. Forms of vitamin B3 can serve as building blocks in NAD+ pathways, but NAD+ is a larger coenzyme with its own structure and cellular roles.1

Is an NAD+ injection FDA-approved?

No FDA-approved injectable NAD+ product is identified here. A compounded prescription is not FDA-approved and is not reviewed by FDA before marketing.7

Sources

  1. Covarrubias AJ, et al. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021. PubMed 33353981
  2. Vinten KT, et al. NAD+ precursor supplementation in human ageing: clinical evidence and challenges. Nat Metab. 2025. PubMed 41083806
  3. Camacho-Pereira J, et al. CD38 dictates age-related NAD decline and mitochondrial dysfunction through an SIRT3-dependent mechanism. Cell Metab. 2016;23:1127-1139. PubMed 27304511
  4. Zhang Y, et al. Exogenous NAD+ administration significantly protects against myocardial ischemia/reperfusion injury in rat model. Am J Transl Res. 2016. PubMed 27648125
  5. Dizdar N, et al. Treatment of Parkinson’s disease with NADH. Acta Neurol Scand. 1994;90:345-347. PubMed 7887134
  6. Yoshino M, et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science. 2021;372:1224-1229. PubMed 33888596
  7. U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers. Content current as of September 16, 2025.
  8. World Anti-Doping Agency. The 2026 Prohibited List (M2.2).