NAD⁺ Infusions: Hype or Real Anti-Aging Medicine?

Why NAD⁺ sounds interesting in the first place

NAD⁺ (nicotinamide adenine dinucleotide) is a molecule produced by the body and present in every cell. It performs central tasks in cell biology, including:

• Energy production in the mitochondria
• DNA repair and protection of genetic information
• Protection against oxidative stress
• Regulation of ageing processes at the cellular level

With increasing age, NAD⁺ levels decline in many tissues. At first glance this sounds like an ideal target for anti-ageing medicine: "If NAD⁺ is important and decreases with age, we simply top it up with an infusion."

But: just because a molecule is important does not mean that every infused form of it works.

Between a biochemically interesting substance and a safe, effective therapy there are often large gaps. This is exactly what the current data on NAD⁺ show.

What does the science say? – The evidence on NAD⁺ infusions

1. The most important human study: Grant et al., 2019

One of the few human studies on intravenous NAD⁺ comes from Grant et al., 2019 (Frontiers in Aging Neuroscience, PubMed ID: 31572171). In this pilot study, healthy volunteers received a 6-hour NAD⁺ infusion.

The results can be summarised in simple terms:

• NAD⁺ disappears very quickly from the blood.
• It is rapidly broken down and converted into various metabolites.
• Above all, breakdown products in plasma and urine increase.
• There is no evidence that infused NAD⁺ reaches the cells or the cell nucleus in any relevant amount.
• Clinical endpoints (e.g. improved performance, anti-ageing, symptom relief) are not demonstrated.

In other words:

The most important human study to date shows no clinical benefit – but mainly that NAD⁺ is rapidly broken down and excreted after infusion.

2. Current review: Endocrine Reviews 2023 (Bhasin et al.)

A major review in Endocrine Reviews (Bhasin et al., 2023, PubMed ID: 37364580) assesses the current state of research on NAD⁺ in the context of ageing and metabolism.

The key statements:

• NAD⁺ plays an important role in ageing processes and metabolic pathways.
• There are many animal and cell studies, but only a few small human studies.
• For NAD⁺ precursors (e.g. nicotinamide riboside, NMN) there are initial indications of changes in NAD⁺ metabolism – but without clear clinical effects in healthy people.
• For intravenous NAD⁺ infusions there are no robust data with hard clinical endpoints (e.g. anti-ageing, better skin, longer lifespan).
• There is no approval as a medicinal product for anti-ageing or aesthetic purposes.

The review reaches a clear assessment: NAD⁺ is biologically fascinating, but as a therapy – especially as an infusion – it is still far from evidence-based use.

3. Systematic review 2024 (Gindri et al.)

A systematic review by Gindri et al., 2024 (PubMed ID: 37971292) analysed studies on NAD⁺ and NADH in various clinical situations.

Important for everyday practice:

• Only 10 studies could be included.
• Most of them concern oral precursors, not infusions.
• There is no reliable evidence for anti-ageing effects or skin improvement in humans.
• The authors emphasise the very limited data and the need for high-quality controlled trials.

For NAD⁺ infusions in aesthetic or "longevity" medicine, the conclusion remains: the scientific basis is extremely thin.

Why NAD⁺ infusions can hardly work biologically

To understand why NAD⁺ infusions are so problematic, a simple look at the biochemistry helps:

• NAD⁺ is a large, charged molecule. Such molecules cross cell membranes poorly.
• The cell membrane acts like a door with access control – and for NAD⁺ it essentially stays closed.
• The Grant study showed that infused NAD⁺ is rapidly broken down and excreted.
• There is no evidence that intravenously administered NAD⁺ reaches mitochondria or cell nuclei in any relevant amount.

This removes the basis for the claim that an NAD⁺ infusion "rejuvenates cells from within" or visibly and lastingly improves the skin.

The theory sounds modern – the actual biology argues against it.

Marketing vs. medicine: where does the NAD⁺ hype come from?

The trend towards NAD⁺ infusions comes mainly from the USA. There, "IV bars", "longevity clinics" and biohacking studios offer infusion packages that often cost several hundred to over a thousand dollars per session.

The promises:

• more energy and performance
• better concentration
• anti-ageing from within
• better skin
• "detox" and cell regeneration

The terms sound scientific – mitochondria, longevity, cell protection – but behind them there is frequently no reliable clinical proof, mainly a strong marketing strategy.

The mechanism is comparable to other trends:

• A genuine biochemical link (e.g. NAD⁺ and ageing) is picked up.
• From this, a therapeutic promise is derived that is not scientifically proven.
• The procedure is marketed as "exclusive", "innovative" and "premium" – with a price to match.

What is missing is the proof that the approach really works in humans – rather than just sounding good.

Risks and side effects – from an emergency physician's perspective

NAD⁺ infusions are often presented as "the body's own substance" and "therefore harmless". That is misleading. In my work as an emergency physician, in the course of this year alone (2025) I attended three serious emergencies related to NAD⁺ infusions:

• Twice: pronounced tachycardia (pulse up to 180/min), flushing, shortness of breath, circulatory problems
• Once: a severe allergic reaction with pre-shock symptoms

What all cases had in common:

• Administration in settings such as non-medical practitioner offices, cosmetic studios or "aesthetic practices" without structured emergency management
• In some cases, preparations from abroad of unclear origin
• No continuous monitoring of circulation and breathing
• Uncertainty or overwhelm of the practitioners in the emergency situation

In addition, the generally known risks of infusion therapies must be considered:

• Vein irritation and thrombophlebitis
• Infections at the puncture site
• Misplaced cannula with tissue damage
• Systemic reactions up to allergic shock

An NAD⁺ infusion is not a wellness drink but an invasive procedure that would require a professional setting, genuine emergency competence and a clear medical indication – which currently does not exist.

The legal situation in Germany

In Germany, NAD⁺ has no marketing authorisation as a medicinal product for anti-ageing or lifestyle indications. Infusions are mostly used as off-label therapy with preparations that are sometimes sourced from abroad.

In practice this means:

• Non-medical practitioners (Heilpraktiker) and cosmeticians may not regularly administer NAD⁺ infusions.
• Physicians who use NAD⁺ without an approved indication operate in a legal grey area and bear full responsibility in the event of harm.
• The quality, purity and sterility of the preparations used are often not transparently verifiable.

For patients this is almost impossible to assess – in case of doubt, a "high-tech infusion" is suggested where in fact an unregulated off-label application without proven benefit takes place.

Why we do not offer NAD⁺ infusions – and what we do instead

In my practice, safety, evidence and long-term health come first – not quick business with the latest trend. Against this background I offer no NAD⁺ infusions, because:

• no convincing clinical efficacy has been demonstrated,
• the biological plausibility of intravenous administration is questionable,
• no approved preparation exists for this indication,
• real risks and emergencies are being observed,
• the quality and origin of the preparations are often unclear.

Instead, we rely on modern, evidence-based and safe concepts of preventive and anti-ageing medicine as well as aesthetic medicine, including for example:

• precise metabolic and lipid diagnostics (lipidology)
• holistic menopause and hormone medicine
• micronutrient therapy with approved, tested preparations
• skin longevity concepts with PRP, biostimulators and modern needling and energy-based procedures
• individual lifestyle and prevention strategies for heart, vessels, metabolism and skin

All of this is embedded in the practice philosophy "Harmony of Aesthetics": natural results, medical quality, honest advice – and a clear no to risky trends without added value.

Conclusion: NAD⁺ infusions – big promises, little substance

The current data clearly show:

• No reliable evidence for anti-ageing effects from NAD⁺ infusions
• No proof of relevant uptake into cells or cell nuclei
• No approval for this indication
• Real risks up to serious emergencies
• A lot of marketing, little medicine

For a serious general-medical, preventive and aesthetic practice, NAD⁺ infusions currently have no place.

If you want to do something for your skin, your energy and your long-term health, there are numerous proven, safe and well-studied options – from hormone and metabolic medicine to individual prevention and modern, gentle skin treatments.

I will be happy to advise you personally on which strategies make sense in your stage of life and with your medical history – scientifically sound, clearly explained and entirely in the spirit of a harmonious, natural aesthetic.