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NAD+ Precursors

70
evidence score
supplement
238 studies
NMNNRnicotinamide mononucleotide+4 more

NAD+ (nicotinamide adenine dinucleotide) precursors — primarily NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) — are orally bioavailable compounds that raise intracellular NAD+ levels. NAD+ declines ~50% between age 40–60, implicating it in aging-related metabolic dysfunction. NAD+ is the essential cofactor for sirtuins (SIRT1–7), PARP enzymes, and the mitochondrial electron transport chain. Multiple Phase I/II human trials confirm oral NMN and NR significantly increase blood NAD+ levels. NR (Tru Niagen) has the most published human data. Benefits demonstrated in humans include improved muscle function in older adults, improved exercise capacity, and metabolic parameters. The longevity narrative is largely extrapolated from animal data showing remarkable effects; human trials are younger. Safe and well-tolerated.

Evidence

Moderate evidence

Safety

Unknown safety profile

Clinical Status

Phase II

Last Sync

Feb 19, 2026

Last Reviewed

Not reviewed yet

Physician Notes

No oral NAD+ is bioavailable. Delivery hierarchy: IV >> SubQ >> NMN sublingual > NR oral. Loading protocol: 750mg IV x5 sessions over 10 days, then monthly maintenance. SubQ maintenance: 100mg 5 on/2 off.

FDA Status:Available via 503A compounding pharmacies for IV and SubQ formulations.

Monitoring

  • No standard labs for NAD+ levels
  • Clinical assessment: energy, cognition, recovery
  • Blood pressure during IV (can cause transient flushing/tachycardia)

Contraindications

  • Active cancer (theoretical concern with PARP/sirtuin activation)
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Dosing

Typical
500 mg
250 mgRange1000 mg
FrequencyOnce daily oral (morning)

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Pharmacology

Half-lifeNMN: ~2.5 hours. NR: ~2.7 hours for parent; metabolites longer.
OnsetBlood NAD+ elevation within hours; physiologic effects over weeks to months
DurationNAD+ elevation requires continued supplementation; returns to baseline within days
Routes
oral

Evidence Score

70
Level B — Moderate
238 studies indexed · 1 meta-analysis
Scoring Factors
Volume(24%)~48/100
Quality(24%)~44/100
Sample Size(12%)~93/100
Consistency(14%)~93/100
Replication(8%)~93/100
Recency(18%)~93/100

Scores estimated from study counts. Exact breakdown computed after research sync.

Evidence Levels
AScore ≥75 with at least 1 meta-analysis and 3+ RCTs
BScore ≥50 with at least 1 RCT or meta-analysis
CScore ≥25 — observational or animal evidence only
DScore <25 — very limited or preclinical data

Plain-English Snapshot

NAD+ Precursors is currently categorized as a supplement compound.

Evidence is moderate (70/100): promising signal from 238 indexed studies, but context and population still matter.

Safety scoring is incomplete. Start conservatively and monitor carefully.

Core mechanism

Orally bioavailable NAD+ precursors; NR converts to NMN then NAD+; NMN converts directly to NAD+; elevates NAD+ for sirtuin activation, PARP DNA repair, and mitochondrial biogenesis

Practical Context

Strongest current signals

  • Level B: Evaluation of Nicotinamide Riboside in Prevention of Small Nerve Fiber Axon Degeneration and Promotion of Nerve Regeneration.
  • Level B: The differential impact of three different NAD
  • Level C: Mitochondrial Health Through Nicotinamide Riboside and Berberine: Shared Pathways and Therapeutic Potential.

Compound Profile