Not a peptide
NAD+ precursors (NR, NMN, NAD+)
Vitamin B3 compounds sold beside peptides. They are not peptides, and their rules and risks are different.
Not a peptide
Short page. This is a short page. A full page with the complete evidence review is planned for version 1.1. The grades and regulatory status below are complete and sourced.
At a glance
- Is it an approved medicine?
- No. It is not a peptide, and it is not an approved medicine in the EU.
- Has it been tested in people?
- Yes. Many trials, mostly of pills. The biggest one, in 410 people with Parkinson's, found no benefit.7,6,12
- Is it allowed in sport?
- Unclear. Not named on the anti-doping list. Drips over 100 mL in 12 hours are banned.16,26,17 Regulatory status
- What is the biggest risk?
- Drips and shots can carry germs. Long-term effects are unknown. More about the risks
Status checked on . The details and sources are further down this page.
Stop and get help if you notice
- Hot, red, swollen skin where the needle went30
- Fever or chills after a drip or injection53,12
- Swollen face or throat, or trouble breathing54
If it is severe, call your local emergency number.
All warning signs, further down this page Warning signs for any peptide
The 30-second version
About 5 minutes for the short version; 11 with every detail open.
- These are not peptides. NR and NMN are forms of vitamin B3 that the body turns into NAD+.
- NR and NMN are sold as pills. NAD+ is also given as drips and injections.
- In the EU, NR may be sold in food supplements. NMN may not, yet.
- Pills raise NAD+ in blood. A large trial in Parkinson's disease found no benefit.
- Drips and injections add the risks of any injection. Their benefit is unproven.
Fact sheet
- Class
- Not a peptide
- What they are
- Vitamin B3 compounds, not peptides
- How they are sold
- Capsules; NAD+ also as drips or injections
- EU food status
- NR allowed in supplements; NMN not yet
- Largest trial
- 410 people with Parkinson's: no benefit
- Status in the EU
- Not authorised
- Tested in people
- Yes
Label facts, not dosing advice. Sources are in the sections below.
Each section starts with the short answer. The rest is folded under “In detail”.
Evidence profile
Four separate questions. Not a score.
- Human clinical evidence How far has it been tested in people?
- Phase III (large controlled trials) (step 5 of 6)
- Preclinical volume How much laboratory and animal research exists?
- Extensive (step 3 of 3)
- Source independence How many independent groups produced it?
- Broadly replicated (step 3 of 3)
- Safety characterisation How well do we know the harms in humans?
- Partial (step 2 of 3)
In detail: Why these grades: the reason for each step , about 1 minute to read
- Human clinical evidence
- Phase 3. NOPARK, a randomised, placebo-controlled trial of nicotinamide riboside in 410 people with early Parkinson disease, was published in October 2026, and dozens of smaller randomised trials of NR and NMN exist. For NAD+ drips the evidence is a handful of small studies.
- Preclinical volume
- Extensive. On 23 October 2026 PubMed held 2,036 non-review records on nicotinamide riboside or NMN, 1,091 of them mentioning rats or mice.
- Source independence
- Broadly replicated. Human trials come from many independent university groups in Europe, North America and Asia; some use product supplied by makers, and some authors hold patents.
- Safety characterisation
- Partial. Oral NR and NMN were well tolerated in trials of weeks to a year, and EFSA judged both safe as supplements for adults within set limits. Long-term use, high intakes and drips are much less studied.
We never add these up. A compound can have a large animal literature from one laboratory and no human data at all — that is a specific situation, and a single number would hide it. How we grade evidence
In detail: The molecule: amino-acid sequence and technical details , about 1 minute to read
- Full name
- Nicotinamide riboside (NR), nicotinamide mononucleotide (NMN) and NAD+ (nicotinamide adenine dinucleotide)
- Also called
- NR, NMN, NAD+, NAD, nicotinamide riboside chloride, beta-NMN, nadide
- Class
- Not a peptide
- Body systems
- Metabolism, Cells and mitochondria, Brain and nerves
What it actually is
What are NAD+ precursors?
| NR (nicotinamide riboside) | NMN (nicotinamide mononucleotide) | NAD+ itself | |
|---|---|---|---|
| Allowed in EU food supplements? | Yes Authorised as a novel food since 2020.1 | No EFSA judged it safe for adults in 2026, but it is not yet authorised.2,3 | Unknown Not on the EU list of authorised novel foods; we found no EU decision on it.3 |
| An approved medicine in the EU? | No No.4 | No No.4 | No No.4,5 |
| Tested in people? | Yes Many trials, including one large one.6,7 | Yes Small trials.8 | Yes A few small studies of drips.9,10 |
They are on this site because they are sold beside peptides: in the US, NAD+ was put forward for pharmacy compounding and sits on the same FDA list as GHK-Cu, and clinics offer NAD+ drips as “longevity” treatments.11,12
In detail: Why the category confusion matters , about 1 minute to read
A peptide is a chain of amino acids. NR is a vitamin B3 ring joined to a sugar, NMN is NR with a phosphate group, and NAD+ joins NMN to a second unit that carries adenine; none contains an amino acid.13
The category decides which checks a product has had. In the EU, NR as a food supplement was assessed by EFSA for swallowing, within limits, for adults.14,1 Under EU law, food is something meant to be swallowed, so a product meant for injection or a drip is not a food.15 A supplement assessment therefore says nothing about whether an injection is sterile or safe. In sport, a drip of more than 100 mL in 12 hours is banned even if its contents are allowed.16,17
Proposed mechanism
How do they work?
Each step is labelled with how well the link from the previous step is established.
-
Pills raise NAD+ in the blood
In a crossover trial in healthy middle-aged and older adults (30 randomised, 24 finished), six weeks of NR raised NAD+ and related molecules in blood cells compared with placebo.
-
NAD+ helps cells make energy and repair themselves
NAD+ is a helper molecule for energy-making and some repair enzymes. In rodents, ageing and obesity lower how much NAD+ the body makes; that is the idea behind the precursors.
-
Better health in people: mostly not shown
One small NMN trial improved muscle insulin sensitivity; other trials did not improve insulin sensitivity, and the largest trial, in Parkinson disease, found no benefit.
In detail: What each step rests on , about 1 minute to read
What the evidence actually shows
Do they work?
In the largest trial, people did slightly worse than on placebo
+2.72 points
worse on a Parkinson's score after a year than on placebo; a small gap
Who took part NOPARK: 410 people with early Parkinson disease, NR by mouth for 52 weeks Source Brakedal et al. (2026)6 Evidence Human trials
The body's use of insulin did not get better
40
men with obesity took NR or placebo for 12 weeks
Who took part Dollerup 2018: randomised, double-blind trial Source Dollerup et al. (2018)19 Evidence Human trials
Muscles used insulin better in one small trial
25
women with prediabetes took NMN or placebo for 10 weeks
Who took part Yoshino 2021: randomised, double-blind trial Source Yoshino et al. (2021)8 Evidence Human trials
A small early trial in Parkinson’s disease looked promising; the large trial that followed did not confirm it.20,6
In detail: Every study in one table , about 3 minutes to read
8 studies: 7 in humans, 1 in animals, 0 in cells, 0 reviews or other.
| Study | Species | n | Design | Funding | Research group | What it found | What it did not show |
|---|---|---|---|---|---|---|---|
| Dollerup et al. 2018 19 | Humans | 40 | Randomised controlled trial (controlled, blinded) | Not disclosed | Independent group | In 40 men with obesity and insulin resistance, 12 weeks of NR did not improve insulin sensitivity, blood sugar control, energy use or body composition; no serious side effects due to NR. | Men only; 12 weeks; a high intake. |
| Martens et al. 2018 18 | Humans | 30 | Randomised controlled trial (controlled, blinded) | Mixed | Mixed | In 30 healthy middle-aged and older adults (24 completed), six weeks of NR was well tolerated and raised NAD+ metabolism in blood cells; effects on blood pressure were only hinted at. | Small and short; blood measures, not health outcomes. The NR maker supplied the pills and part of the funding. |
| Grant et al. 2019 9 | Humans | 11 | Pharmacokinetic study (controlled) | Mixed | Mixed | In 11 healthy men, NAD+ given by drip over 6 hours disappeared from the blood almost at once for the first 2 hours; no adverse events were seen. | Tiny; one drip; co-funded by a company whose director runs a clinic that gives NAD+ drips. |
| Yoshino et al. 2021 8 | Humans | 25 | Randomised controlled trial (controlled, blinded) | Government | Mixed | In 25 women with prediabetes after menopause, 10 weeks of NMN raised the muscles' response to insulin compared with placebo. | Small; one sex and one age group; some authors hold NMN patents or receive licence fees. |
| Brakedal et al. 2022 20 | Humans | 30 | Phase I trial (controlled, blinded) | Not disclosed | Mixed | In 30 people newly diagnosed with Parkinson disease, 30 days of NR raised NAD in the brain and was linked to a mild clinical improvement. | A small, short phase 1 trial; the larger trial that followed did not confirm a benefit. |
| Nakazzi et al. 2026 29 | Mixed | not reported | Animal experiment (controlled) | Not disclosed | Independent group | In pancreatic cancer cells and mice, NMN and nicotinamide helped cancer cells resist chemotherapy and supported tumour growth. | Cells and mice only; shows a possible risk for people with active cancer, not a proven one. |
| Brakedal et al. 2026 6 | Humans | 410 | Phase III trial (controlled, blinded) | Government | Mixed | In 410 people with early Parkinson disease, a year of NR did not help: the rating score worsened slightly more than with placebo (2.72 points), and non-motor symptoms worsened more; serious adverse events were 8.3% against 14.1% on placebo. | One disease; the difference was below what the trial counted as clinically important. The maker supplied NR and placebo. |
| Yu et al. 2026 10 | Humans | 180 | Randomised controlled trial (controlled) | Not disclosed | Independent group | In 180 adults with heart failure after heart attacks, 7 days of NAD+ drips on top of standard care gave a slightly higher pumping strength at one month (45.4% against 42.4%). | One centre; blinding not stated; the 6-month outcome difference was not significant. |
For NAD+ drips, a 2026 review found mostly small series, few placebo-controlled trials, and conflicting results, and called the drips experimental.12 One single-centre trial in 180 people with heart failure reported slightly better pumping after a week of drips; it needs repeating.10
Regulatory status
Are they legal?
| Netherlands and the EU | United States | |
|---|---|---|
| Approved as a medicine? | No None.4,5 | No None.21 |
| NR allowed in foods or supplements? | Yes In food supplements, since 2020.1 | Yes The FDA had no questions about its use in foods (2016).22 |
| NMN allowed in supplements? | No Not yet authorised.3 | Yes The FDA said in 2025 that it is not excluded from supplements; a new-ingredient notice is still needed.23 |
| Drips allowed in sport? | No Not over 100 mL in 12 hours.16 | No The same worldwide rule.17 |
In detail: Status in each country, and in sport , about 2 minutes to read
| Jurisdiction | Status | Note | Checked |
|---|---|---|---|
| European Union | Not authorised | No medicine. NR chloride is an authorised novel food for supplements (2020). NMN had a positive EFSA opinion in May 2026 but no EU authorisation yet. 4,1,2,3 | |
| Netherlands | Not authorised | No medicine in the CBG database. EU novel-food rules apply; an injection is not a food under EU law. 5,55 | |
| United States | Not authorised | Not an FDA-approved drug. NMN is not excluded from dietary supplements (FDA, 2025). NAD+ is under FDA evaluation for pharmacy compounding. 21,23,22,11 | |
| Sport (WADA) | Unclear (not named) | Unclear: none is named on the List. Separately, IV drips over 100 mL in 12 hours are banned whatever they contain. 16,26,17 |
All statuses were checked on 23 October 2026. In the EU, only novel foods on the EU list may be sold.1 EFSA gave a positive opinion on NMN in May 2026, but EFSA only advises; the Commission had not added NMN to the list by its 10 August 2026 version, and we found no later act.2,3 NMN also has an EU orphan designation as a possible medicine for sickle cell disease.24
In the US, the FDA had said in October 2022 that NMN could not be a supplement, because it had been studied as a drug. On 29 September 2025 it reversed this: NMN was sold as a supplement from 2017, before the drug studies. It remains a new dietary ingredient that needs notification before sale.23 NAD+ is in category 1 for pharmacy compounding: while the FDA evaluates it, the agency does not intend to act against pharmacies that compound it under set conditions.11,25
In sport, none of the three is named on the 2026 or 2027 List. Drips or injections of more than 100 mL in 12 hours are banned unless received in hospital care or with an exemption.16,26,17
Risk profile
What are the risks?
| Possible harm | Shown in people? |
|---|---|
| Serious side effects from pills in trials | No Not more common than on placebo in the largest trial.6 |
| Harm from high intakes over years | Unknown EFSA noted possible ways high intakes could harm, and said the safe upper limit may need a new review.27 |
| Helping an existing cancer grow | Unknown Seen in mice and cancer cells.28,29 |
| Infection or reactions from drips and injections | Unknown Procedural risks; not studied for NAD+.12,30 |
In detail: Why these risks are theorised , about 1 minute to read
Cancer cells also need NAD+. In mice with a breast cancer, NR led to more cancer spread to the brain; in pancreatic cancer cells and mice, NMN helped tumours resist chemotherapy.28,29 These are animal findings, not proof in people. EFSA’s safety conclusion for NMN does not cover pregnant or breastfeeding women; for NR, EFSA accepted only a lower intake for them. A 90-day rat study of NMN showed effects on reproductive organs.14,2 In Parkinson disease, a year of NR was slightly worse than placebo.6 See product risk.
If someone is going to do this anyway
This section exists to reduce harm. It gives no doses, schedules or sourcing advice, and it is not a recommendation to use this compound.
How can someone lower the risk?
If your product did not come from a pharmacy: check before you use it
These checks can show that something is wrong. None of them can show that a product is good or free of germs.31,32,33
Tick each box when you have checked it.
-
For NAD+ precursors
Check whether it is meant to be swallowed or injected. In the EU, food law covers only what is swallowed.15
-
A lab report proves little if:
- its batch number is not the one on your vial;
- it does not name the lab, or has no date or signature;
- it shows only purity (HPLC), with no test of what it is, such as mass spectrometry;
- it has no test for germs (sterility) or for toxins from germs (endotoxin).
Even a full report covers only one sample. A report from the seller comes from someone who gains if it looks good. It cannot show that your vial is clean.40,41,42,43,44
When to stop and get help
Stop-now warning signs
Call your local emergency number now
- Confusion or slurred speech, very fast breathing, or pale, blue or blotchy skin, often with fever or shivering These can be signs of sepsis: the body's reaction to an infection has started to damage its own organs.
- Fainting and not waking up within a minute, or fainting with chest pain, a racing heart or a fit This can be a dangerous heart rhythm or a severe allergic reaction.
- Pain at the injection spot that is much worse than it looks, or dark, purple or grey patches or blisters there This can be a rare, fast-spreading infection of the deep layers under the skin (necrotising fasciitis).
- Swelling of the lips, tongue or throat, trouble breathing or swallowing, wheezing, a hoarse voice, or feeling faint, soon after an injection This can be a severe allergic reaction (anaphylaxis), which is life-threatening and gets worse very quickly.
Get medical help today
- Fever, shivering or feeling very ill in the days after an injection Germs from the needle, the skin or the product may have reached your blood. If you also have a fast heartbeat or fast breathing, call your local emergency number.
- Redness, heat, swelling or pain around the injection spot that keeps growing or getting worse This can be a skin infection (cellulitis), which needs antibiotics before it spreads.
- Red lines that run from the injection spot towards the armpit or groin The infection may be spreading along the lymph vessels, and from there into the blood. If you also have a fever with a fast heartbeat or fast breathing, call your local emergency number.
- A painful, warm lump that fills with pus This is probably an abscess: it often needs draining by a doctor, so do not squeeze it.
- You were pricked by a needle that someone else had used Blood on a used needle can pass on HIV and hepatitis B or C, and preventive treatment works best within hours.
Stop and contact a doctor
- You fainted, but woke up quickly and now feel well Fainting is often harmless, but a doctor should check the cause.
- A new mole, or a mole that changes size, shape or colour, itches or bleeds A changing mole can be skin cancer, and tanning peptides such as melanotan II have been linked to new and changing moles in case reports.
- A lump at an injection spot that does not go away, or keeps growing A doctor should check whether it is an abscess, a reaction to the product or something else.
- An itchy, raised rash, or puffy eyes or lips, while breathing stays normal Your body may be reacting to the product, and using it again can bring the reaction back.
In detail: Checks that make sense, and who should be careful , about 1 minute to read
A doctor can help you decide what fits you (see talking to your doctor):
- Cancer treatment: tell your cancer team, because in mice and cancer cells these compounds helped tumours.29,28
- Pregnancy or breastfeeding: EFSA’s safety conclusion for NMN does not cover you, and for NR it accepted only a lower intake.2,14
- Parkinson’s disease: in the largest trial, NR did slightly worse than placebo.6
- Sport: a drip of more than 100 mL in 12 hours breaks anti-doping rules.16,17
For injections, see sterile technique.
Sources
Every claim on this page links to one of these sources. Scholarly sources link to their DOI; regulatory sources to the regulator's own page.
In detail: All 55 sources, numbered as in the text , about 10 minutes to read
- (2020). Commission Implementing Regulation (EU) 2020/16 of 10 January 2020 authorising the placing on the market of nicotinamide riboside chloride as a novel food under Regulation (EU) 2015/2283 and amending Implementing Regulation (EU) 2017/2470. Official Journal of the European Union, L 7, 13.1.2020, p. 6. Law eur-lex.europa.eu (opens an external site) — accessed 23 October 2026 ↩
- (2026). Safety of beta-nicotinamide mononucleotide (β-NMN) pursuant the regulation (EU) 2015/2283 and the bioavailability of nicotinamide from this source in the context of Directive 2002/46/EC. EFSA Journal 24:e10007. Regulator doi:10.2903/j.efsa.2026.10007 (opens an external site) ↩
- (2026). Commission Implementing Regulation (EU) 2017/2470 establishing the Union list of novel foods, consolidated text of 10 August 2026. EUR-Lex, CELEX 02017R2470-20260810. Law eur-lex.europa.eu (opens an external site) — accessed 23 October 2026 ↩
- (2026). Medicines data download (JSON report of all EPARs: authorised, refused, withdrawn and suspended medicines). Dataset ema.europa.eu (opens an external site) — accessed 20 October 2026 ↩
- (2026). Geneesmiddeleninformatiebank (database of medicines authorised in the Netherlands). Regulator geneesmiddeleninformatiebank.nl (opens an external site) — accessed 20 October 2026 ↩
- (2026). Nicotinamide Riboside for Patients With Early-Stage Parkinson Disease: The NOPARK Randomized Clinical Trial. JAMA. Clinical trial doi:10.1001/jama.2026.18828 (opens an external site) ↩
- (2026). PubMed searches for nicotinamide riboside and nicotinamide mononucleotide, 23 October 2026. PubMed. Dataset pubmed.ncbi.nlm.nih.gov (opens an external site) — accessed 23 October 2026 ↩
- (2021). Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science 372:1224-1229. Clinical trial doi:10.1126/science.abe9985 (opens an external site) ↩
- (2019). A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD. Frontiers in Aging Neuroscience 11:257. Research article doi:10.3389/fnagi.2019.00257 (opens an external site) ↩
- (2026). Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial. American Journal of Cardiovascular Drugs 26:97-106. Clinical trial doi:10.1007/s40256-025-00764-7 (opens an external site) ↩
- (2026). Bulk Drug Substances Nominated for Use in Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act (categories 1–3), updated 14 May 2026. Regulator fda.gov (opens an external site) — accessed 20 October 2026 ↩
- (2026). Intravenous longevity therapy: a critical review of evidence, mechanisms, and clinical utility. Acta Dermatovenerologica Alpina, Pannonica et Adriatica 35:39-43. Review PMID 41915584 (opens an external site) ↩
- (2026). PubChem Compound Summaries: CID 5892 (NAD+, nadide), CID 439924 (nicotinamide riboside), CID 14180 (nicotinamide mononucleotide). PubChem. Dataset pubchem.ncbi.nlm.nih.gov (opens an external site) — accessed 23 October 2026 ↩
- (2019). Safety of nicotinamide riboside chloride as a novel food pursuant to Regulation (EU) 2015/2283 and bioavailability of nicotinamide from this source, in the context of Directive 2002/46/EC. EFSA Journal 17:e05775. Regulator doi:10.2903/j.efsa.2019.5775 (opens an external site) ↩
- (2002). Regulation (EC) No 178/2002 laying down the general principles and requirements of food law, Article 2 (definition of food). Official Journal of the European Communities, L 31. Law eur-lex.europa.eu (opens an external site) — accessed 23 October 2026 ↩
- (2025). World Anti-Doping Code International Standard: Prohibited List 2026. Regulator wada-ama.org (opens an external site) — accessed 20 October 2026 ↩
- (2026). IV Infusions: Explanatory Note. Web page usada.org (opens an external site) — accessed 23 October 2026 ↩
- (2018). Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD(+) in healthy middle-aged and older adults. Nature Communications 9:1286. Clinical trial doi:10.1038/s41467-018-03421-7 (opens an external site) ↩
- (2018). A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects. The American Journal of Clinical Nutrition 108:343-353. Clinical trial doi:10.1093/ajcn/nqy132 (opens an external site) ↩
- (2022). The NADPARK study: A randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease. Cell Metabolism 34:396-407.e6. Clinical trial doi:10.1016/j.cmet.2022.02.001 (opens an external site) ↩
- (2026). openFDA Drugs@FDA queries, 23 October 2026: prezatide, GHK, copper tripeptide, AOD-9604, AOD9604, hexarelin, examorelin, nicotinamide riboside, nicotinamide mononucleotide, nadide, nicotinamide adenine dinucleotide, elamipretide. openFDA. Dataset api.fda.gov (opens an external site) — accessed 23 October 2026 ↩
- (2016). GRAS Notice Inventory: GRN No. 635, nicotinamide riboside chloride (ChromaDex, Inc.). Regulator hfpappexternal.fda.gov (opens an external site) — accessed 23 October 2026 ↩
- (2025). Response to citizen petition FDA-2023-P-0872 (Natural Products Association and Alliance for Natural Health USA) on the regulatory status of beta-nicotinamide mononucleotide (NMN): petition granted in part and denied in part. Regulations.gov, document FDA-2023-P-0872-2754. Regulator regulations.gov (opens an external site) — accessed 23 October 2026 ↩
- (2026). Orphan designations data download (JSON report of all EU orphan designations). Dataset ema.europa.eu (opens an external site) — accessed 20 October 2026 ↩
- (2026). Bulk Drug Substances Used in Compounding Under Section 503A of the FD&C Act. Regulator fda.gov (opens an external site) — accessed 20 October 2026 ↩
- (2026). World Anti-Doping Code International Standard: Prohibited List 2027 (in effect 1 January 2027). Regulator wada-ama.org (opens an external site) — accessed 20 October 2026 ↩
- (2021). Extension of use of nicotinamide riboside chloride as a novel food pursuant to Regulation (EU) 2015/2283. EFSA Journal 19:e06843. Regulator doi:10.2903/j.efsa.2021.6843 (opens an external site) ↩
- (2023). A bioluminescent-based probe for in vivo non-invasive monitoring of nicotinamide riboside uptake reveals a link between metastasis and NAD(+) metabolism. Biosensors and Bioelectronics 220:114826. Research article doi:10.1016/j.bios.2022.114826 (opens an external site) ↩
- (2026). Vitamin B3 derivatives support pancreatic cancer cell survival and chemotherapy resistance. Cancer Letters 645:218334. Research article doi:10.1016/j.canlet.2026.218334 (opens an external site) ↩
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- (2001). Directive 2001/83/EC on the Community code relating to medicinal products for human use (consolidated text). Official Journal of the European Communities, L 311. Law eur-lex.europa.eu (opens an external site) — accessed 20 October 2026 ↩
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