NAD+: where it stands with the FDA, and what it costs
The most-prescribed compound in online longevity programs. No FDA-approved drug contains NAD+; what clinics prescribe is compounded as injections, IV infusions or nasal sprays.
Prices by form:injections (370)nasal spray (161)cream (22)tablets (14)patches (9)troches (5)
- TGo to clinicLowest per month
NAD+ nasal spray
TomorrowsRx · from $23.14/mo
Go to clinicLowest at a clinic we link toNAD+ injection
Embody · $99/mo
Where NAD+ stands today
No FDA-approved drug contains NAD+. FDA lists NAD (and NADH) in 503A Category 1, the nominated substances it is still evaluating, where it says it does not intend to take action if the guidance's conditions are met (FDA-registered manufacturer, valid certificate of analysis, and the rest of 503A). That stands even though FDA's advisory committee voted 1-7 against listing NAD in May 2017 and FDA proposed in 2019 not to list it: no final rule has followed. For 503B outsourcing facilities FDA's documents conflict: its 503B list puts beta-NAD in Category 1, but a January 2026 warning letter told a 503B facility NAD+ is not eligible. FDA has also warned compounders (October 2024) against food-grade NAD+ for IV products, and several compounded NAD+ products have been recalled for sterility or endotoxin problems.
For pharmacies compounding one patient's prescription (section 503A)
Category 1 (Bulk Drug Substances Under Evaluation): FDA does not intend to take action against 503A compounding with it while it is evaluated, if the guidance's conditions are met. Not on the 503A bulks list (21 CFR 216.23).
“503A Category 1 – Bulk Drug Substances Under Evaluation ... Nicotinamide Adenine Dinucleotide (NAD) ... Nicotinamide Adenine Dinucleotide Disodium Reduced (NADH)”
What Category 1 means (FDA 503A page)
“FDA does not intend to take action against a compounder for compounding drugs using bulk drug substances listed in category 1, provided that the conditions described in the guidance document are met.”
A different salt form (the disodium salt trihydrate) sits in Category 3, outside the interim policy
“503A Category 3: Bulk Drug Substances Nominated Without Adequate Support ... Beta-Nicotinamide Adenine Dinucleotide Disodium Salt Trihydrate”
FDA proposed in 2019 NOT to put NAD or NADH on the 503A bulks list; no final rule has followed, so both stay in Category 1
“At its meeting on May 8, 2017, the PCAC voted not to include NAD on the list (Ref. 9). ... The proposed rule would not place NAD on the 503A Bulks List. ... The proposed rule would not place NADH on the 503A Bulks List.”
For outsourcing facilities (section 503B)
Contradictory in FDA's own documents. FDA's 503B nominations list (updated March 21, 2025) places "Beta-Nicotinamide Adenine Dinucleotide" in 503B Category 1, yet FDA's January 20, 2026 warning letter to a 503B outsourcing facility says NAD+ is not eligible for 503B compounding and not within the 503B interim (Category 1) policy. Not on the 503B bulks list. The disodium salt trihydrate is in 503B Category 3.
“503B Category 1: Bulk Drug Substances Under Evaluation ... Beta-Nicotinamide Adenine Dinucleotide”
What 503B Category 1 means
“FDA does not intend to take action against an outsourcing facility for compounding drugs using bulk drug substances identified in category 1 provided that the conditions described in the guidance document are met.”
FDA warning letter to GenoGenix LLC (503B), the later of the two FDA statements
“Drug products compounded using 5-Amino-1MQ and NAD+ are not eligible for the exemptions provided by section 503B, because 5-Amino-1MQ and NAD+ do not appear on the 503B bulks list and are not used to compound a drug that appears on the drug shortage list. ... These substances are also not eligible for the policy applicable to certain bulk drug substances described in the final guidance titled, Interim Policy on Compounding Using Bulk Drug Substances Under Section 503B of the Federal Food, Drug, and Cosmetic Act (Revision 1)”
The FDA's compounding advisory committee
8 May 2017: Should nicotinamide adenine dinucleotide (NAD) be placed on the 503A bulks list? Should NADH (nicotinamide adenine dinucleotide disodium reduced)? (uses FDA reviewed: fatigue in multiple sclerosis; chronic fatigue syndrome). Vote: NAD: Yes 1, No 7, Abstain 0. NADH: Yes 0, No 9, Abstain 0.. Committee advised against listing both. FDA proposed in September 2019 not to list NAD or NADH, but never finalized it, so both remain in 503A Category 1.
“1. FDA is proposing that nicotinamide adenine dinucleotide NOT be included on the 503A Bulks List. Should nicotinamide adenine dinucleotide be placed on the list? YES: 1 NO: 7 ABSTAIN: 0 ... The majority of the committee agreed that NAD should not be included on the 503A Bulks List. ... The committee unanimously agreed that NADH should not be included on the 503A list.”
FDA warnings, recalls and letters
1 February 2023: Recall of compounded NADH 10 mg/mL (report date 2023-02-01). Class II. (Pharmacy Innovations).
“NADH”
24 August 2023: Recall of NAD+ 200 mg/mL vials. Class II; initiated 2023-08-15, classified 2023-08-24. (TMC Acquisitions LLC dba Tailor Made Compounding).
“NAD+ 200mg/ml, 10ml vials, Tailor Made Compounding. ... Lack of Assurance of Sterility”
30 October 2024: FDA reminder to compounders: food-grade NAD+ sold by repackagers is being used to make IV products; FDA has adverse event reports consistent with endotoxin. (Compounders (FDA statement)).
“The agency is aware of compounders using food-grade nicotinamide adenine dinucleotide (NAD+) sold by repackagers to make intravenous products. ... FDA has received adverse event reports following use of NAD+ injectable drugs, including severe chills, shaking, vomiting and fatigue with some requiring medical treatment.”
20 June 2025: Recall of NAD+ 100 mg/mL pre-filled syringes. Class II; initiated 2025-05-21, classified 2025-06-20. (Thrive Health and Wellness, LLC dba Thrive Health Solutions, Englewood, CO).
“Nicotinamide adenine dinucleotide (NAD+): 100mg/mL, pre-filled syringe ... Lack of Assurance of Sterility”
21 October 2025: Class I recall of NAD+ for injection for elevated endotoxin (a companion Class II record, D-0065-2026, covers other NAD+ lots). Initiated 2025-07-30, classified 2025-10-21. (GenoGenix LLC, Boca Raton, FL (registered 503B outsourcing facility)).
“NAD+ (Nicotinamide adenine dinucleotide) for Injection ... Microbial Contamination of Sterile Products: elevated endotoxin levels”
20 January 2026: Warning letter: NAD+ is not eligible for 503B compounding (not on the 503B bulks list, and FDA says not within its 503B interim policy); one NAD+ lot sent three patients to the emergency room and FDA calls it adulterated. (GenoGenix LLC, Boca Raton, FL (registered 503B outsourcing facility)).
“Drug products compounded using 5-Amino-1MQ and NAD+ are not eligible for the exemptions provided by section 503B, because 5-Amino-1MQ and NAD+ do not appear on the 503B bulks list and are not used to compound a drug that appears on the drug shortage list. ... These substances are also not eligible for the policy applicable to certain bulk drug substances described in the final guidance titled, Interim Policy on Compounding Using Bulk Drug Substances Under Section 503B of the Federal Food, Drug, and Cosmetic Act (Revision 1) ... Accordingly, your firm’s compounded product containing NAD+ is adulterated under section 501(c) of the FDCA.”
9 February 2026: Warning letter: NAD+ the firm repackaged has no FDA-approved application (repackaged drugs are not eligible for the compounding exemptions). (Thrive Health and Wellness LLC dba Thrive Health Solutions, Englewood, CO (503A pharmacy)).
“You do not have any FDA-approved applications on file for the drug products that you repackage, such as NAD+ 50 mg/mL and MEGALean (Tirzepatide/Cyanocobalamin) Injections 10mg/20mg/mL.”
7 April 2026: Warning letter; NAD (1200 mg) and glutathione (2000 mg) injections cited for missing required label statements. (ProRx LLC (registered 503B outsourcing facility)).
“Some of your facility’s drug products, such as Nicotinamide Adenine Dinucleotide Injection 1200mg, Glutathione Injection 2000mg, and Tirzepatide Injection 45mg/2.5mL, did not include the following statement on the label: the statement “Not for Resale” (section 503B(a)(10)(A)(iii)(IX)).”
8 October 2026: Recall of NAD+ Injection 200 mg/mL, lot AP-202647. Class II; initiated 2026-09-24, classified 2026-10-08, in FDA's enforcement report of 2026-10-14. This is the only NAD+ recall in FDA's enforcement data since September 2026 (openFDA updated 2026-11-04); none is dated 22 Oct 2026. (Apothecary Pharma LLC, Cary, NC (registered 503B outsourcing facility)).
“Apothecary NAD+ Injection 200 mg/mL, 6 mL Sterile Multi-Dose Vial ... Lack of Assurance of Sterility”
For athletes who are tested
NAD+ itself is not named on the WADA list; IV infusions or injections over 100 mL per 12 hours are a prohibited method (M2.2) outside hospital care, whatever they contain (World Anti-Doping Agency, 2026 Prohibited List (in force 1 Jan 2026)).
“Intravenous infusions and/or injections of more than a total of 100 mL per 12-hour period except for those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations.”
Our reading
A 503A pharmacy may compound NAD+ (injection, IV, nasal) for a patient-specific prescription under FDA's Category 1 policy, but only from pharmaceutical-grade ingredient from an FDA-registered manufacturer with a valid certificate of analysis; food-grade NAD+ falls outside it. This is tolerance pending a rule FDA proposed against NAD, not approval, and FDA could finalize that rule. NAD+ from a 503B facility is the unsettled case: FDA's most recent statement (the January 2026 letter) treats it as ineligible.
Every source above was checked again on 14 November 2026.
What 421 clinics charge
- TomorrowsRxNAD+ nasal sprayfrom $23.14/mo
- Contour HealthNAD+ injection$60/mo
- myRNKNAD+ injection (1,500mg)from $69/mosupply not stated, counted as 4 weeks: ≈ $74 per 30 days
- Good Girl RxNAD+ creamfrom $75/mo
- Luma Health CoNAD+ (100mg)≈ $75/mo$175 for 70 days
What NAD+ is
- What it is
- Coenzyme (nicotinamide adenine dinucleotide)
- How it works
- A coenzyme every cell uses to move electrons in energy metabolism and as a substrate for enzymes such as sirtuins and PARPs. Levels fall with age in animal and human tissue studies.
- How it is given
- Subcutaneous or intramuscular injection; intravenous infusion; nasal spray
- Also called
- NAD, NAD+ injection, nicotinamide adenine dinucleotide
NAD+ side by side
About NAD+
Is NAD+ FDA-approved?
No. No FDA-approved drug contains NAD+. What clinics sell is compounded by a pharmacy for a prescription, and the FDA does not review compounded products before they are sold.
Is NAD+ legal in the US?
Whether a pharmacy may compound it for your prescription is what decides it. No FDA-approved drug contains NAD+. FDA lists NAD (and NADH) in 503A Category 1, the nominated substances it is still evaluating, where it says it does not intend to take action if the guidance's conditions are met (FDA-registered manufacturer, valid certificate of analysis, and the rest of 503A). That stands even though FDA's advisory committee voted 1-7 against listing NAD in May 2017 and FDA proposed in 2019 not to list it: no final rule has followed. For 503B outsourcing facilities FDA's documents conflict: its 503B list puts beta-NAD in Category 1, but a January 2026 warning letter told a 503B facility NAD+ is not eligible. FDA has also warned compounders (October 2024) against food-grade NAD+ for IV products, and several compounded NAD+ products have been recalled for sterility or endotoxin problems.
How much does NAD+ cost?
421 clinics publish a price. The lowest that compares per month is from $23.14/mo at TomorrowsRx, and the middle of 349 clinics' lowest monthly prices is about $169. What a month buys differs by clinic, so each price lists what it includes. every NAD+ price
What forms does NAD+ come in?
Clinics sell it as injection (370 prices), nasal spray (161 prices), other (70 prices), cream (22 prices), tablets (14 prices), patch (9 prices), troches (5 prices), capsules (3 prices).