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NAD Precursors Monitoring Bundle: Lab Panels, Timelines, and Clinical Checkpoints for Prescribers

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At a glance

  • Regulatory status / oral dietary supplements; neither is FDA-approved [1]
  • Trial monitoring / blood counts, chemistry and urine were assessed in some studies [3][4]
  • Study duration / short; long-term safety data are lacking [2]
  • Labs used in trials / hematology, blood biochemistry, urinalysis [4][3]
  • Drug-interaction studies / none identified in a 2023 review [2]
  • Groups not studied / pregnancy, breastfeeding, children, cancer, kidney or liver disease [2]
  • Injectable NAD+ / compounded; no NAD+ drug is FDA-approved for aging or wellness [5]

Does anything specify monitoring?

NMN and NR are sold in the US as oral dietary supplements, and no NAD+ precursor product is FDA-approved for aging or any disease [1]. There is no prescribing label, so the only monitoring information comes from what the trials below checked.

What the trials checked

The trials reported no clinically relevant changes in the laboratory measures they assessed at the studied doses [3][6][4][7].

  • NMN 1,250 mg daily for up to 4 weeks in 31 healthy adults: no severe adverse events and no changes beyond physiological variation in hematology, biochemistry, urine or body composition [4].
  • NMN 250 mg daily for 12 weeks in 30 healthy adults: no laboratory abnormalities and no obvious adverse effects [3].
  • NMN 300, 600 or 900 mg daily for 60 days in 80 middle-aged adults: no safety issues [6].
  • In a 12-week trial of 40 sedentary men with obesity, those assigned to NR took 1,000 mg twice daily; there were no serious adverse events and safety blood tests were normal [7].
  • NR 1,500 mg twice daily for 4 weeks in 10 people with Parkinson's disease (10 others took placebo): no moderate or severe adverse events [8].

The available studies were short and had small sample sizes, which limits interpretation of long-term safety [2].

Blood chemistry and cancer concerns

Blood chemistry was among the laboratory measures these trials assessed, and they reported no clinically relevant changes at the doses tested [3][6][4][7].

Cancer risk with long-term NAD+ boosting remains a theoretical concern; human data addressing it are lacking [2].

Drug interactions and homocysteine

A 2023 review identified no human drug-interaction studies of NMN or NR [2].

In a four-week trial of 20 people with Parkinson's disease, 10 took NR 1,500 mg twice daily and 10 took placebo. NR recipients had a slight initial rise in serum homocysteine; the authors judged the methyl donor pool intact [8]. In that trial, an apparent symptom-score improvement was also associated with a shorter interval since the last levodopa dose, so the clinical result is confounded [8].

Blood NAD+ versus tissue NAD+

Oral NMN and NR raise NAD+ in blood [3][6][9]. A rise in blood NAD+ does not establish that muscle NAD+ also rose: in 12 older men, 21 days of NR did not raise muscle NAD+ or improve measured muscle function [10].

Injectable NAD+

Injectable or IV NAD+ is a compounded product, and no NAD+ drug is FDA-approved for aging or wellness [5]. The trials above used oral NMN or NR, so these findings do not apply to injected NAD+.

Frequently asked questions

What tests did the NMN and NR trials use?
Some trials checked blood counts, blood chemistry and urine during dosing periods of 4 to 12 weeks and reported no clinically relevant changes [4][7]. Neither supplement is an FDA-approved drug, so neither has a prescribing label with monitoring instructions [1].
Do NMN or NR interact with prescription drugs?
A 2023 review identified no human drug-interaction studies of NMN or NR [2]. In one trial of NR in Parkinson's disease, an apparent symptom-score improvement was confounded by a shorter interval since the last levodopa dose [8].
Is blood NAD+ testing useful for monitoring?
Whole-blood NAD+ rose in trials of NMN and NR [3][6][9], but in 12 older men NR 1 g daily for 21 days did not raise muscle NAD+ or change muscle function [10]. A rise in blood NAD+ does not establish that muscle NAD+ also rose.

References

  1. Official web page. Official web page
  2. Freeberg KA, Udovich CC, Martens CR, Seals DR, Craighead DH. Dietary Supplementation With NAD+-Boosting Compounds in Humans: Current Knowledge and Future Directions. J Gerontol A Biol Sci Med Sci. 2023;78(12):2435-2448. Dietary Supplementation With NAD+-Boosting Compounds in Humans: Current Knowledge and Future Directions
  3. Okabe K, Yaku K, Uchida Y, Fukamizu Y, Sato T, Sakurai T, et al. Oral Administration of Nicotinamide Mononucleotide Is Safe and Efficiently Increases Blood Nicotinamide Adenine Dinucleotide Levels in Healthy Subjects. Front Nutr. 2022;9:868640. Oral Administration of Nicotinamide Mononucleotide Is Safe and Efficiently Increases Blood Nicotinamide Adenine Dinucleotide Levels in Healthy Subjects
  4. Fukamizu Y, Uchida Y, Shigekawa A, Sato T, Kosaka H, Sakurai T. Safety evaluation of β-nicotinamide mononucleotide oral administration in healthy adult men and women. Sci Rep. 2022;12(1):14442. Safety evaluation of β-nicotinamide mononucleotide oral administration in healthy adult men and women
  5. Bulk Drug Substances Used in Compounding of the FD&C Act | FDA. Bulk Drug Substances Used in Compounding of the FD&C Act | FDA
  6. Yi L, Maier AB, Tao R, Lin Z, Vaidya A, Pendse S, 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;45(1):29-43. 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
  7. Dollerup OL, Christensen B, Svart M, Schmidt MS, Sulek K, Ringgaard S, et al. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects. Am J Clin Nutr. 2018;108(2):343-353. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects
  8. Berven H, Kverneng S, Sheard E, Søgnen M, Af Geijerstam SA, Haugarvoll K, et al. NR-SAFE: a randomized, double-blind safety trial of high dose nicotinamide riboside in Parkinson's disease. Nat Commun. 2023;14(1):7793. NR-SAFE: a randomized, double-blind safety trial of high dose nicotinamide riboside in Parkinson's disease
  9. Martens CR, Denman BA, Mazzo MR, Armstrong ML, Reisdorph N, McQueen MB, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9(1):1286. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults
  10. Elhassan YS, Kluckova K, Fletcher RS, Schmidt MS, Garten A, Doig CL, et al. Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome and Induces Transcriptomic and Anti-inflammatory Signatures. Cell Rep. 2019;28(7):1717-1728.e6. Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome and Induces Transcriptomic and Anti-inflammatory Signatures
Evidence overview for NAD Precursors Monitoring Bundle: Lab Panels, Timelines, and Clinical Checkpoints for Prescribers