Disclaimer: Compounded NAD+ is prepared by a licensed 503A compounding pharmacy and has not been reviewed or approved by the FDA. Compounded medications are not the same as commercially available FDA-approved products. This content reflects my perspective as a pharmaceutical executive and founder and is not medical advice. Consult one of our licensed providers for personalized clinical guidance.
A patient came to our program after spending the better part of a year doing IV NAD+ infusions at a wellness clinic. She was paying $400 a session, going once a month when she could afford it, then nothing for two or three months when she couldn’t. She shared with our team that the sessions helped — noticeably. She had started to resent a therapy that was working because she couldn’t afford to keep it going.
When our program introduced subcutaneous NAD+ injections at $139.99 for the first month, then $149 a month, she was skeptical — she had been told IV was the only legitimate delivery route. Three months later she reported the same mental clarity and energy consistency she had gotten from the IV sessions, maintained daily rather than spiking and crashing around appointments she could only afford sporadically. That outcome shaped everything about how we built this program.
What NAD+ Is — From a Biochemistry Standpoint
NAD+, or nicotinamide adenine dinucleotide, is a coenzyme present in every cell in the body. I want to explain the underlying science here as someone with a pharmaceutical background, not as clinical guidance.
NAD+ functions as an electron carrier in the mitochondrial electron transport chain — foundational to how cells convert nutrients into ATP. But it is also a consumed substrate for a class of enzymes that govern DNA repair, gene expression, and cellular stress response. Sirtuins (SIRT1 through SIRT7) require NAD+ as a cofactor for every catalytic cycle. SIRT1 regulates gene expression, inflammation, and stress resistance. SIRT3 governs mitochondrial biogenesis and antioxidant defenses within the organelle. PARPs consume NAD+ for DNA repair. CD38, a glycohydrolase involved in immune signaling, is another major consumer.
As we age, NAD+ levels fall. CD38 expression increases with aging and chronic inflammation, cleaving NAD+ continuously. PARPs run continuously in tissues under chronic oxidative stress. NAMPT — the rate-limiting enzyme in the salvage pathway that recycles nicotinamide back to NAD+ — declines in activity. The consumption side accelerates while the synthesis side weakens.
The human clinical evidence is real. Trammell and colleagues documented a 2.7-fold increase in blood NAD+ following a single 1,000 mg dose of NR in healthy human subjects (Trammell et al., Nat Commun 2016, PMID 27721479). Yoshino and colleagues found NMN supplementation produced a 38 percent increase in intramuscular NAD+ and a 25 percent improvement in muscle insulin sensitivity in prediabetic women (Yoshino et al., Science 2021, PMID 34108263). I want to be transparent: a significant portion of mechanistic data comes from animal studies, and large-scale RCTs in humans are still ongoing. The mechanism is well understood; the long-term clinical evidence in humans continues to develop.
For a detailed comparison of subcutaneous versus IV delivery and why consistency matters more than peak concentration, see Why I Recommend Subcutaneous NAD+ Over IV Therapy.
Why the Delivery Model Matters — An Operational Observation
The IV model priced NAD+ therapy out of reach for most people who would benefit from sustained use. Four hundred to six hundred dollars per session, four to ten sessions for a loading protocol, at a clinic that requires hours out of the day. Most patients can’t sustain that, and the benefit tracks consistency — not the magnitude of any single dose.
Subcutaneous NAD+ at home produces lower peak concentration than IV, but more sustained availability across days. For the sirtuin-dependent pathways that require ongoing NAD+ to function, consistent replenishment is more valuable than periodic flooding. What I observed operationally across our patient population — not as a clinical conclusion, but as a pattern — is that patients on consistent subcutaneous protocols described outcomes that matched or exceeded what they’d gotten from sporadic IV sessions they could only afford a few times a year.
What Patients in Our Program Have Reported
The most consistent report from our NAD+ patient population is mental clarity — not a stimulant effect, but a more durable cognitive sharpness that feels less effortful. Sustained energy without relying on caffeine or stimulants is the second theme. Faster physical recovery from training is the third. These are patient-reported observations from our program, not clinical trial results. Individual experiences vary, and our clinical team evaluates each patient’s situation individually.
Who This Is and Is Not For
Our clinical team adds NAD+ to protocols for patients dealing with cognitive fatigue, active patients seeking improved recovery, and patients who have responded well to IV NAD+ but cannot sustain that cost model. It is not positioned as a treatment for disease. Anyone expecting a cure-all will be disappointed — our providers say so directly before moving forward.
For a clinical comparison of IV versus injection delivery, see NAD+ IV Therapy vs Injections: What the Difference Actually Means.
FAQ
What are the reported benefits of NAD+ injections?
Patients in our program most commonly report improved mental clarity, more sustained energy, and faster recovery from physical activity. These are consistent with the known role of NAD+ in mitochondrial energy production and sirtuin activation. Compounded NAD+ has not been reviewed by the FDA. Individual results vary.
How does subcutaneous NAD+ compare to IV NAD+?
IV produces a higher acute peak; subcutaneous produces slower absorption and more consistent availability across days. For ongoing sirtuin activity — which requires NAD+ as a stoichiometric substrate in every catalytic cycle — consistency of replenishment matters more than the magnitude of a single dose.
How much do NAD+ injections cost?
At Precision Telemed, subcutaneous NAD+ injections are $139.99 your first month, then $149 a month. IV NAD+ at wellness clinics typically costs $400–600 per session.
Is the research on NAD+ established?
The mechanism of action is well understood, and human clinical data is growing. Larger long-term RCTs are still ongoing. I am transparent with patients that this is not a therapy with 30 years of phase III trial evidence — and our clinical team has that conversation before anyone starts.
References
- Trammell SA et al. Nicotinamide riboside is uniquely and orally bioavailable in healthy humans. Nat Commun. 2016;7:12948. PubMed
- Yoshino M et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science. 2021;372(6547):1224-1229. PubMed
If you want to talk through whether this is right for you, our providers are available online. Start at precisiontelemed.com.
This post reflects my personal perspective as a pharmaceutical executive and founder. It is not medical advice and does not establish a provider-patient relationship. Compounded medications have not been reviewed by the FDA and are not the same as commercially available FDA-approved products. Please consult one of our licensed providers for personalized clinical guidance.
About the Author: JP Rius is the founder of Precision Telemed with a background in pharmaceutical commercial sales, operations, and trade. Over the past two years, his clinical team has served more than 5,000 patients across weight loss, hormone therapy, peptide therapy, and longevity programs. His perspective is shaped by the commercial, regulatory, and operational side of telehealth medicine.