HealthRX.com · Printable medication review sheet
NMN or NR medication check: which of your medicines this page flags
Tick the medicines you take from the classes this page discusses, then use the check table for the follow-up each one calls for. Take the sheet to the prescriber of your highest-concern medicine before starting NMN or NR, and again at the first follow-up.
The supplement
NMN or NR, product name
Milligrams per day
Start date
Which prescriber knows you take it?
Medicines this page flags (tick any you take)
The page rates the first two as the highest concern: do not start NMN or NR on them without your oncologist's approval.
- A PARP inhibitor: olaparib, niraparib, rucaparib or talazoparib
- Chemotherapy now or planned: cisplatin, carboplatin, cyclophosphamide or temozolomide
- Insulin, or a sulfonylurea such as glipizide or glimepiride
- Metformin
- Warfarin
- A direct oral anticoagulant: apixaban, rivaroxaban or edoxaban
- An antiplatelet: clopidogrel or ticagrelor
- Tacrolimus or cyclosporine
- Sirolimus or everolimus
- High-dose niacin for cholesterol, or another NAD+ precursor
- Two or more blood pressure medicines
Follow-up checks this page suggests
| If you take | Check | When | Date done | Result |
|---|---|---|---|---|
| Insulin or a sulfonylurea | Fasting glucose, more often than usual | First 4 to 6 weeks | ||
| Warfarin | INR | 2 weeks after starting or stopping NMN or NR | ||
| Apixaban, rivaroxaban or edoxaban | Unusual bruising, gum bleeding, slow-to-stop cuts | First month | ||
| Tacrolimus, cyclosporine, sirolimus or everolimus | Trough drug level | Within 2 weeks of any change | ||
| Several blood pressure medicines | Home blood pressure readings | 2 to 4 weeks after starting | ||
| Any of the above | Fasting glucose, HbA1c, liver tests, blood count | Before starting, and again at 8 weeks |
What the studies behind this page measured
- NMN 250 mg a day for 10 weeks in 13 women with prediabetes: muscle insulin sensitivity rose 25%, but fasting glucose and blood pressure did not change.[1]
- NR 500 mg twice a day for 6 weeks: systolic pressure averaged 3.9 mmHg lower than on placebo, a difference that was not statistically significant.[2]
- In test tubes, nicotinamide inhibited the drug-metabolizing enzymes CYP2D6, CYP3A4 and CYP2E1 at millimolar levels (Ki 13 to 19 mM), which the authors tie to very high therapeutic nicotinamide doses (blood levels up to 15 mM); NMN and NR were not tested.[3]
Questions for your prescriber
- Do any of my medicines make NMN or NR a bad idea right now?
- I am having chemotherapy or take a PARP inhibitor: does my oncologist agree to any NAD+ precursor?
- Which blood tests should we do before I start, and when do we repeat them?
- If my glucose readings fall, which of my diabetes medicines would you adjust?
- Should I stop NMN or NR before surgery, and how far ahead?
Sources for the facts on this sheet
- Yoshino M, Yoshino J, Kayser BD, et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science 2021. PMID 33888596. https://pubmed.ncbi.nlm.nih.gov/33888596/
- Martens CR, Denman BA, Mazzo MR, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun 2018. PMID 29599478. https://pubmed.ncbi.nlm.nih.gov/29599478/
- Gaudineau C, Auclair K. Inhibition of human P450 enzymes by nicotinic acid and nicotinamide. Biochem Biophys Res Commun 2004. PMID 15081432. https://pubmed.ncbi.nlm.nih.gov/15081432/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.