NAD+ therapy restores levels of this coenzyme that drop ~50% between ages 40 and 60, supporting cellular energy, DNA repair, and mitochondrial function.
NAD+ therapy is a medical treatment that delivers nicotinamide adenine dinucleotide intravenously to restore declining cellular levels of this coenzyme, supporting energy production, DNA repair, and mitochondrial function.
Your body makes less NAD+ every year after 40, and that matters more than most people realize. NAD+ (nicotinamide adenine dinucleotide) is a coenzyme involved in over 500 enzymatic reactions — from converting food into cellular energy to repairing damaged DNA to activating sirtuins, the family of proteins that regulate aging at the genetic level.
According to Massudi et al. (2012, PMID: 22870241), human tissue NAD+ levels drop by approximately 50% between ages 40 and 60. That decline tracks closely with the familiar symptoms of aging: persistent fatigue, slower recovery, cognitive fog, and increased vulnerability to chronic disease.
NAD+ therapy aims to correct this deficit — usually through intravenous infusion, though oral precursors and subcutaneous injections are also available.
What NAD+ Does in Your Body (And Why the Decline Matters)
NAD+ isn't a single-purpose vitamin. It's a metabolic intermediary working across three processes simultaneously:
1. Cellular energy production (ATP)
Inside the mitochondria, NAD+ accepts electrons during the Krebs cycle and electron transport chain, driving ATP production — the energy currency of every cell. When NAD+ drops, ATP output falls with it. The result: fatigue, poor recovery, and reduced physical performance.
2. DNA repair
PARP enzymes (poly ADP-ribose polymerases) consume NAD+ each time they fix a DNA strand break. As we age, accumulated DNA damage increases PARP activity, which depletes NAD+ further — creating a vicious cycle of more damage and fewer resources to fix it. Yoshino et al. (Cell Metabolism, 2018, PMID: 29514064) identified this mechanism as central to cellular aging.
3. Sirtuin activation
Sirtuins (SIRT1-7) regulate gene expression, stress response, and cellular longevity. They require NAD+ as a substrate to function. When NAD+ levels fall, sirtuin activity declines — accelerating cellular senescence, increasing inflammation, and impairing autophagy (the cell's internal cleanup system).
These three functions are interconnected. NAD+ doesn't do one or the other — it does all three simultaneously, and when it's depleted, all three deteriorate together.
Routes of Administration: IV, Oral, Injectable
Not all methods of taking NAD+ are equally effective. The administration route determines how much actually reaches your cells.
Intravenous (IV) infusion
IV NAD+ is the most direct way to raise blood levels. A pilot study published in Frontiers in Aging (2026) compared IV NAD+ with IV NR in healthy adults and found that direct NAD+ infusion produces a rapid and significant increase in plasma levels, though with a relatively short half-life of approximately 6 hours. Sessions typically last 1-3 hours depending on dose (usually 250-500 mg per session). The infusion runs slowly because rapid delivery can cause nausea, facial flushing, or chest tightness.
Oral supplementation (NMN, NR)
Oral NAD+ precursors — nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR) — are the most accessible option. Igarashi et al. (NPJ Aging, 2022, PMID: 35927255) showed that chronic NMN supplementation raises blood NAD+ levels in healthy older men. A multicenter trial with 80 adults (Yi et al., 2023, PMID: 36482258) confirmed safety and dose-dependent NAD+ elevation with oral NMN at 300, 600, and 900 mg/day.
The trade-off: oral bioavailability is lower than IV, and some of the molecule degrades in the digestive tract. For maintenance goals, oral works well. For acute interventions (severe fatigue, post-viral recovery, intensive longevity protocols), IV delivers concentrations that oral supplementation cannot match.
Subcutaneous injection
Some clinics offer NAD+ via subcutaneous auto-injectors. This is a middle-ground option for bioavailability and convenience, though clinical evidence is more limited than for IV or oral routes.
NAD+ Administration Routes Compared
| Feature | IV | Oral (NMN/NR) | Subcutaneous |
|---|---|---|---|
| Bioavailability | High (100% in bloodstream) | Moderate (variable) | Intermediate |
| Onset of effect | Minutes | Days to weeks | Hours |
| Session duration | 1-3 hours | Daily, oral | 5-10 minutes |
| Typical dose | 250-500 mg | 250-1000 mg/day | 50-100 mg |
| Medical supervision | Required | Not required | Recommended |
| Approximate cost | €200-500/session | €40-120/month | €100-300/month |
| Best suited for | Acute intervention | Daily maintenance | Middle ground |
Who Benefits from NAD+ Therapy
NAD+ therapy isn't a treatment for a specific disease — it's a metabolic intervention that can help in several contexts:
Chronic fatigue and low energy: when ATP production is compromised by declining NAD+, restoring levels can improve perceived energy and physical capacity. Patients in longevity programs frequently report better energy and sleep quality after the first few sessions.
Post-viral recovery: after prolonged infections (including long COVID), some patients show residual mitochondrial dysfunction. NAD+ therapy has been explored as support for cellular energy recovery, though controlled clinical trials in this area remain limited.
Neurodegenerative conditions: preclinical studies show that NAD+ deficiency contributes to neuronal dysfunction in Alzheimer's and Parkinson's models. A pilot trial with NR in older adults with mild cognitive impairment (Brakedal et al., 2022, PMID: 37994989) found supplementation to be safe with preliminary signals of cognitive benefit, though larger studies are needed.
Longevity and anti-aging: within the framework of the 12 hallmarks of aging (López-Otín et al., Cell, 2023, PMID: 36599349), NAD+ decline connects directly to at least three: mitochondrial dysfunction, epigenetic alterations, and genomic instability. Restoring NAD+ doesn't "reverse" aging, but it addresses specific mechanisms that speed it up.
Athletic performance: athletes looking to improve post-training recovery and mitochondrial function use NAD+ as part of performance protocols. Kimura et al. (2024, PMID: 38789831) found that 12-week NMN supplementation in older adults maintained walking speed and improved sleep quality.
What to Expect During and After an IV Session
The experience is straightforward but requires patience.
Before: a medical assessment rules out contraindications. Basic vital signs are taken. No fasting is required, though good hydration is recommended.
During: you sit in a reclining chair with an IV line. The infusion runs slowly over 1-3 hours. Many patients read, work, or rest during the process. If the infusion rate is too high, you may experience facial flushing, mild nausea, or chest pressure — all resolved by slowing the drip.
After: effects aren't immediate or dramatic after the first session. Some patients report better mental clarity and energy within 24-48 hours. Cumulative benefits usually become noticeable from the third or fourth session onwards.
Typical protocol: 4-8 initial sessions (one or two per week), followed by maintenance sessions every 2-4 weeks based on individual response and patient goals.
Side effects: uncommon and generally mild. They include nausea during infusion (corrected by slowing the rate), transient facial flushing, mild discomfort at the injection site, and occasional mild headache. No serious adverse events have been reported in published clinical trials to date.
How We Use NAD+ Therapy at Progevita
At Progevita, NAD+ therapy isn't a standalone service you book and forget. It's one component within an integrated longevity protocol.
Our NAD+ drip ("Energy Boost") is administered intravenously under medical supervision within the Orthomolecular Medicine Unit. Sessions last approximately 30-40 minutes and integrate within our residential programs (Optimization Program from €1,350, Inflammaging from €1,470, Leadership Path from €1,640).
What makes our approach different:
We measure before we treat. We don't administer NAD+ by default. First, we evaluate biomarkers for oxidative stress (Oxytest), inflammation (suPAR), body composition, and metabolic profile to determine whether your mitochondrial deficit justifies the intervention.
We combine it with other treatments. NAD+ therapy pairs with ozone therapy (which activates complementary antioxidant pathways through Nrf2), plasmapheresis (which clears inflammatory proteins from plasma, creating conditions for NAD+ to work more effectively), and a personalized nutrition and exercise plan.
12-month follow-up. After your stay, you receive a maintenance plan that may include oral NAD+ precursor supplementation (NMN or NR) and follow-up sessions to evaluate whether your biomarkers have responded.
Progevita operates at the Balneario de Cofrentes, Valencia, with a team of over 50 medical professionals. We're not a hotel with a nurse setting up drips — we're a longevity clinic with advanced diagnostics, where every treatment responds to data, not trends.
Want to know if NAD+ therapy is right for you? Book your consultation at Progevita and start with the data.
Frequently Asked Questions About NAD+ Therapy
What exactly is NAD+ and why does it decline with age?
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme found in every living cell that participates in energy production, DNA repair, and sirtuin activation. Levels fall by approximately 50% between ages 40 and 60 (Massudi et al., 2012) due to increased consumption by repair enzymes (PARPs) and reduced endogenous synthesis.
How many IV NAD+ sessions are needed?
A typical initial protocol includes 4-8 sessions (one or two per week), followed by maintenance every 2-4 weeks. Response varies by individual and depends on baseline status, age, and goals.
Is IV NAD+ therapy safe?
Published clinical trials (Yi et al., 2023; Igarashi et al., 2022) report a favorable safety profile. The most common side effects are mild nausea and facial flushing during infusion, corrected by adjusting the drip rate. No serious adverse effects have been reported.
What's the difference between oral NMN and IV NAD+?
Oral NMN is a precursor that the body converts to NAD+. Bioavailability is lower and the effect is gradual (days to weeks). IV delivers NAD+ directly into the bloodstream, with faster effect but requires medical supervision. They're complementary: IV for acute intervention, oral for maintenance.
How much does NAD+ therapy cost?
Pricing varies by clinic and dose. At Progevita, the NAD+ drip is included within residential programs (from €1,350 for 4 nights, which includes accommodation, meals, medical consultations, diagnostics, and treatments). As an individual add-on, orthomolecular IV drips carry an additional cost based on the prescribed protocol.
Can NAD+ therapy be combined with other longevity treatments?
Yes, and it works better as part of a protocol. At Progevita we combine it with ozone therapy, plasmapheresis, advanced diagnostics, and a personalized 12-month plan covering exercise, nutrition, and sleep.
At what age should you consider NAD+ therapy?
There's no fixed minimum age, but the significant decline in NAD+ begins around age 40. From that point on, if you're experiencing fatigue, cognitive decline, or slow recovery, it makes sense to evaluate your biomarkers and consider intervention.
References
- Massudi H et al., "Age-associated changes in oxidative stress and NAD+ metabolism in human tissue", PLoS One, 2012 (PMID: 22870241)
- Yoshino J et al., "NAD+ Intermediates: The Biology and Therapeutic Potential of NMN and NR", Cell Metabolism, 2018 (PMID: 29514064)
- Rajman L et al., "Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence", Cell Metabolism, 2018 (PMID: 29514069)
- Igarashi M et al., "Chronic nicotinamide mononucleotide supplementation elevates blood NAD+ levels and alters muscle function in healthy older men", NPJ Aging, 2022 (PMID: 35927255)
- Yi L et al., "The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial", GeroScience, 2023 (PMID: 36482258)
- Brakedal B et al., "A randomized placebo-controlled trial of nicotinamide riboside in older adults with mild cognitive impairment", Alzheimers Dement, 2022 (PMID: 37994989)
- Kimura S et al., "Ingestion of β-nicotinamide mononucleotide increased blood NAD levels, maintained walking speed, and improved sleep quality in older adults", Aging Cell, 2024 (PMID: 38789831)
- López-Otín C et al., "Hallmarks of aging: An expanding universe", Cell, 2023 (PMID: 36599349)
- Campbell JM, "Supplementation with NAD+ and Its Precursors to Prevent Cognitive Decline across Disease Contexts", Nutrients, 2022 (PMID: 35512238)
This article is for informational purposes and does not replace medical consultation. Any NAD+ treatment should be prescribed and supervised by a qualified healthcare professional.