IV NAD+ drips are now a common wellness-clinic offering, marketed alongside oral NAD+ precursor supplements. The evidence bases for the two delivery methods are not the same, and neither is as mature as clinic marketing often suggests.
NAD+ levels decline with age. How best to restore them — and whether restoring them changes anything clinically — are two separate, both-unresolved questions.
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme involved in cellular energy metabolism and sirtuin activation, and its decline with age is well documented. Three approaches to restoring it have gained attention: oral NMN (nicotinamide mononucleotide), oral NR (nicotinamide riboside), and direct intravenous NAD+ infusion, increasingly offered at wellness and longevity clinics. None of the three is FDA-approved for any longevity indication; all are sold or offered outside the conventional drug approval pathway.
NMN and NR are both NAD+ precursors, metabolized through different pathways, both currently graded Emerging on Geroevidence. Published human data has focused on surrogate endpoints — insulin sensitivity for NMN (Yoshino 2021), aortic stiffness for NR (Martens 2020) — rather than hard clinical outcomes. This is a real, if early-stage, published human trial base.
Direct IV NAD+ infusion is a newer clinical offering than either oral precursor, and its published human longevity-outcome evidence base is, at present, thinner than NMN's or NR's — notably less than what currently exists for the oral precursors despite the more invasive delivery route and typically higher cost. A more invasive or expensive delivery method does not, on its own, imply stronger evidence; it implies a different evidence base that needs to be evaluated on its own terms, not assumed to be superior because it bypasses oral absorption.
All three approaches to NAD+ restoration remain in an early evidentiary stage. Oral NMN and NR have a modest but real published human trial base with surrogate-endpoint data; IV NAD+ infusion, despite its growing popularity as a wellness-clinic service, currently has less published evidence behind it, not more. Geroevidence will track NAD+ IV therapy as a distinct entry once sufficient published data exists to evaluate it on the same evidence ladder.