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No. 043 · Longevity & Immune · Cellular Health

NAD+

Nicotinamide adenine dinucleotideNADNadideCoenzyme I

A Tier A · Controlled human trials how tiers work →
  • Not FDA approved
  • WADA — not listed
  • Not a peptide
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Fingerprint not a peptide
NAD+ (no defined sequence)

NAD+ is not a peptide, so it has no amino-acid sequence. This ring motif is decorative.

01

Evidence

  1. D In vitro
  2. C Animal
  3. B Human pilot
  4. A RCT
  5. S Approved

TIER A — At least one published randomized controlled trial in humans.

A randomized placebo-controlled trial of intravenous NAD+ in 180 patients with ischemic heart failure (2025), plus small pilot and pharmacokinetic studies. Most other trials test precursors (NR, NMN), which are different compounds.

Tiers rate the strength of published evidence — not effectiveness, safety, or a recommendation.

02

At a glance

Molecular weight
663.4 Da
Formula
C21H27N7O14P2
Routes studied
Intravenous, Oral, Subcutaneous Routes used in published research
FDA
Not approved
Other approvals
  • China — NAD+ for injection (“Coenzyme I for injection”), NMPA-registered
WADA
Not on the Prohibited List
03

Overview

Nicotinamide adenine dinucleotide, a coenzyme central to cellular energy production and sirtuin-mediated DNA repair. Declining NAD+ levels are a hallmark of biological aging.

Research status Extensive human and animal research on NAD+ biology; a randomized placebo-controlled trial of IV NAD+ in ischemic heart failure (2025); NR/NMN precursors tested in multiple clinical trials

04

Mechanism

NAD+ is an essential coenzyme that accepts electrons in glycolysis, the TCA cycle, and beta-oxidation, feeding them into the mitochondrial electron transport chain for ATP production. It also serves as a substrate for sirtuins (SIRT1-7), which deacetylate histones and proteins to regulate DNA repair, mitochondrial biogenesis, and inflammatory responses. NAD+ decline with age impairs these pathways.

05

Effects reported in research

Reported outcomes, not promises. Some come from controlled human trials; others may be from smaller or preclinical studies — check the studies below.

  • Restored cellular energy metabolism
  • Activated sirtuin-mediated DNA repair
  • Improved mitochondrial function
  • Enhanced mental clarity and reduced fatigue
06

Safety & unknowns

Endogenous coenzyme with well-characterized biology. IV NAD+ infusions can cause chest tightness, nausea, and cramping during rapid administration (rate-dependent). NR and NMN oral precursors are generally well-tolerated in clinical trials. Flushing possible with high-dose niacin (a different NAD+ precursor). Widely available as supplements.

Unknowns. Trial safety data apply to the populations, formulations and conditions studied.

Informational only — not medical advice. peptidemeta publishes no dosing, protocols, or sourcing. Talk to a qualified clinician about any treatment decision.

07

Studies [3]

  1. Clinical trial 2026

    Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial

    Yu X, Xu J, Cao J, et al. American Journal of Cardiovascular Drugs

    Single-center RCT in 180 patients with ischemic heart failure: 7 days of IV NAD+ added to standard therapy produced a greater improvement in ejection fraction at 1 month than placebo; differences in clinical events were not statistically significant.

    [pubmed] [doi]

  2. Review 2021

    NAD+ metabolism and its roles in cellular processes during ageing

    Covarrubias AJ, Perrone R, Grozio A, et al. Nature Reviews Molecular Cell Biology

    Review of NAD+ metabolism in ageing, covering its synthesis, consumption by enzymes such as sirtuins and PARPs, and strategies to restore NAD+ levels.

    [pubmed] [doi]

  3. Clinical trial 2018

    Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults

    Martens CR, Denman BA, Mazzo MR, et al. Nature Communications

    Randomized, double-blind, placebo-controlled crossover trial (2 × 6 weeks) in which the NAD+ precursor nicotinamide riboside was well tolerated and raised NAD+ metabolism; it tested the precursor, not NAD+ itself.

    [pubmed] [doi]

09

Status sources

Sources behind the tier, regulatory status, sequence and dates on this page.

10

Cite this entry

$ cite --format=apa

peptidemeta. (2026). NAD+. In peptidemeta: The peptide library, ranked by evidence. Retrieved November 8, 2026, from https://peptidemeta.com/p/nad-plus/

$ cite --format=bibtex 
@misc{peptidemeta-nad-plus,
  title = {NAD+},
  author = {{peptidemeta}},
  year = {2026},
  howpublished = {\url{https://peptidemeta.com/p/nad-plus/}},
  note = {Accessed 2026-11-08}
}

Accessed date reflects when you opened this page. Cite primary studies for scientific claims.

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