NAD+ IV Therapy: Clinical Applications and Protocols

Intravenous NAD+ therapy has emerged as a powerful tool in regenerative and functional medicine. By bypassing the digestive system, IV administration achieves rapid cellular NAD+ repletion with effects that many patients describe as transformative. This article provides clinical guidance for practitioners considering adding NAD+ IV therapy to their practice.

Indications for NAD+ IV Therapy

Clinical applications where NAD+ IV therapy has shown promise include:

• Addiction recovery: Originally developed for opiate and alcohol detoxification
• Chronic fatigue: Mitochondrial support for persistent fatigue states
• Neurodegenerative conditions: Adjunctive therapy for cognitive decline
• Longevity optimization: Periodic NAD+ restoration in wellness patients
• Athletic recovery: Enhanced recovery and performance
• Post-COVID syndrome: Emerging application for long COVID

Pre-Treatment Assessment

Before initiating NAD+ IV therapy, conduct:

• Medical history: Screen for contraindications
• Current medications: Check for interactions
• Baseline labs: CBC, CMP, inflammatory markers
• Blood pressure: NAD+ can cause hypotension
• Patient expectations: Set realistic goals

Contraindications

• Pregnancy and breastfeeding
• Active cancer (theoretical concern)
• Severe hypotension
• Uncontrolled cardiac arrhythmias
• Acute infection or sepsis

Protocol Development

Loading Protocol (Intensive)

For addiction recovery or severe depletion:

• Days 1-5: 500-1000mg NAD+ daily
• Infusion time: 4-8 hours (rate dependent on tolerance)
• Follow with maintenance protocol

Wellness Protocol (Standard)

For general longevity and optimization:

• 250-500mg NAD+ per session
• Infusion time: 2-4 hours
• Frequency: Weekly for 4-6 weeks, then monthly maintenance

Maintenance Protocol

For ongoing support:

• 250-500mg NAD+ monthly or quarterly
• Combined with oral precursors between infusions
• Adjust based on patient response and goals

Administration Guidelines

Infusion Setup

• Use normal saline as the carrier fluid
• Reconstitute NAD+ according to manufacturer guidelines
• Protect from light during infusion
• Use in-line filter as appropriate

Rate Titration

The infusion rate is critical for patient comfort:

• Starting rate: Begin at 1-2ml/min
• Titration: Increase slowly based on tolerance
• Target rate: Maximum 4-5ml/min for most patients
• Reduce rate if: Chest tightness, abdominal discomfort, or nausea occurs

Managing Side Effects

Common side effects and management:

• Chest tightness: Reduce rate; usually resolves in minutes
• Nausea: Slow infusion; consider anti-emetics
• Headache: Often related to rate; may need hydration
• Flushing: Common and self-limiting
• Fatigue post-infusion: Normal; encourage rest

Adjunctive Therapies

Consider combining NAD+ IV with:

• Glutathione: Enhances detoxification
• B vitamins: Support NAD+ metabolism
• Magnesium: Cofactor for many NAD+-dependent enzymes
• Amino acids: Particularly glycine and tryptophan
• Oral NMN/NR: Maintains levels between infusions

Monitoring and Follow-up

Track treatment response with:

• Subjective assessments: Energy, sleep, cognitive function
• Validated questionnaires: SF-36, PROMIS measures
• Biomarkers: Inflammatory markers, metabolic panels
• NAD+ levels: If testing available
• Functional assessments: Grip strength, cognitive testing

Case Examples

Case 1: Chronic Fatigue

55-year-old female with 3-year history of persistent fatigue. After ruling out other causes, initiated weekly NAD+ 500mg IV for 6 weeks. Patient reported significant energy improvement by week 3, sustained with monthly maintenance.

Case 2: Cognitive Optimization

62-year-old male executive seeking cognitive performance enhancement. Protocol: 4 weekly 250mg NAD+ infusions, then monthly maintenance. Reported improved mental clarity and reduced afternoon fatigue.

Conclusion

NAD+ IV therapy represents a valuable addition to the integrative medicine toolkit. Success requires proper patient selection, careful protocol development, and attentive management during infusions. As research continues to expand, NAD+ IV therapy is likely to become an increasingly important intervention in both longevity medicine and disease management.