The short version of this quarter's NAD+ news: the research got a little clearer, and the rules stayed put. NAD+ (nicotinamide adenine dinucleotide, a helper molecule every cell uses to turn food into energy) kept turning up in studies where blood levels rose but memory, fatigue and sleep didn't budge. No NAD+ injection has ever been FDA-approved, and FDA still lists NAD among the compounding ingredients it has under evaluation. The grimmest headline came from a Bronx wellness business, where a woman died after an NAD+ IV.
As of September 23, 2026, the day this article was written, nothing this quarter changed NAD+'s regulatory status. Each item below carries its own date and source, newest first.
Changelog
September 21 — A death after a Bronx NAD+ IV was ruled a homicide. Police confirmed the city medical examiner's ruling in the death of a woman who lost consciousness during an NAD+ IV at a wellness business and died on July 19, News 12 reported. The operator told investigators he was not licensed to practice medicine in New York, and he faces charges including manslaughter. Charges are allegations, not findings. Our report on the Bronx case covers what is and isn't known.
September 16 — Animal safety data for injected NAD+. A toxicology study injected NAD+ into the muscle of four animal species. After four weeks of daily injections in rats, the authors found no adverse effect at the top dose tested, and injection-site changes reversed. In dogs, the two higher single doses raised heart rate and lowered blood pressure (Gu et al., Biomedicine & Pharmacotherapy, 2026). Animal doses don't translate to people, but the heart-rate signal echoes small human IV reports on the NAD+ side-effects page.
September 8 — Supplements and fatigue, pooled. A network meta-analysis (a method that compares several treatments across many trials at once) combined 27 studies of about 1,600 adults taking NAD+ precursors such as NR and NMN. None significantly improved how tired people felt or how well they slept. NMN showed a signal for endurance, not strength (Gao et al., Frontiers in Nutrition, 2026).
July 30 — An oral NAD+ trial with a catch. Sixty adults aged 45 to 75 took an oral NAD+ formulation or a placebo for five days. NAD+ inside blood cells rose 53% compared with placebo, while NAD+ in plasma (the liquid part of blood) didn't move, and no wellbeing or clinical measure held up statistically (Kornilov et al., GeroScience, 2026). Several authors disclose stock or options in a company whose chief executive co-wrote the paper.
July 27 — FDA closed out a warning letter that named NAD+. In February, FDA had told a Colorado repackager that its sterile work was done under insanitary conditions and that products such as an NAD+ 50 mg/mL injection were unapproved new drugs. The July 27 close-out letter says the firm appears to have "adequately addressed the violations." A close-out ends that file. It doesn't change NAD+'s approval status.
July 21 — NR raised NAD+ but not memory scores. In a 12-week trial of 42 older adults with amnestic mild cognitive impairment (memory trouble beyond normal aging, short of dementia), oral NR doubled blood NAD+ but did not improve cognition, the main outcome, or total brain blood flow (Martens et al., Alzheimer's & Dementia, 2026).
June 16 — Under the tongue versus swallowed. In a crossover trial, 14 healthy men took NMN both ways. Blood NMN and NAD+ over the first hour were no different; only two breakdown products rose faster under the tongue (Wakabayashi et al., Scientific Reports, 2026). All three authors work for Meiji, the Japanese food company whose lab ran it. It tested NMN, not NAD+, so it can't speak for sublingual NAD+ strips.
NAD+ FDA status in 2026
No NAD+ injection or infusion has ever been FDA-approved. Oral NAD+, NR and NMN are sold as dietary supplements, and FDA "does not have the authority to approve dietary supplements before they are marketed" (FDA).
Compounding runs on separate rules. Under section 503A (the federal rules for pharmacies preparing a prescription for one patient), NAD sits in FDA's category 1, "Bulk Drug Substances Under Evaluation": nominated for the list of ingredients pharmacies may compound with, and not yet decided. FDA says it does "not intend to take action against a compounder" using a category 1 substance when its guidance's conditions are met (FDA).
As of September 23, 2026, the day this article was written, FDA's posted list was the version "Updated May 14, 2026" (FDA list). NAD+ wasn't on the agenda of FDA's July 23–24 compounding advisory committee, which took up seven peptides (FDA meeting page).
Promise offers NAD+ by prescription as a compounded injectable only, after a licensed provider reviews your request; it is not FDA-approved. That is a regulatory fact, not a verdict: a licensed provider may still prescribe a compounded formulation, and that decision is between you and your doctor.
What the latest NAD+ news adds up to
Side by side, the quarter's studies agree. Oral NR and oral NAD+ raised NAD+ measured in blood, NR doubling it. What hasn't followed, in this quarter's trials, is a clear change in how people think, feel or sleep. Nearly all the human data involved swallowed supplements; evidence on injected NAD+ is still thin, and the NAD+ dosage page walks through what exists.
None of that proves NAD+ does nothing. It means the question that matters, whether raising the number helps anyone, is still open.
NAD+ isn't the only molecule studied for cellular energy. MOTS-c is a different thing entirely: a short peptide encoded in mitochondrial DNA (the small genome inside the cell's energy-making structures), and one of the seven substances FDA's advisory committee discussed in July. Its evidence is separate, and the MOTS-c research overview covers it.
Why the ingredient matters as much as the molecule
The safety story around NAD+ injections keeps coming back to the vial. In October 2024, FDA reminded compounders that food-grade NAD+ is not suitable for sterile drugs "without appropriate processing," after reports of "severe chills, shaking, vomiting and fatigue" consistent with endotoxin (bacterial fragments that can cause fever and shock even without live bacteria). On August 27, 2026, FDA issued the same kind of reminder about supplement-grade glutathione, after reports involving at least 30 patients.
That's where a prescribed route differs from a vial bought online: a named prescriber, a licensed U.S. pharmacy that labels the lot, and a way to report a problem. Fair questions for any provider: which pharmacy compounds it, what the label shows, and who you call if a dose makes you feel unwell. How compounded medications are made explains the pharmacy side.
What a provider considers now
The quarter adds detail to a familiar review, and active cancer is the clearest example. In a 2026 lab-and-mouse study, NAD+ precursors helped pancreatic cancer cells survive chemotherapy, and NMN and nicotinamide supported tumor growth in mice (Nakazzi et al., Cancer Letters, 2026). That was precursors and mice, not injections and people, but it's the kind of finding a prescriber weighs. Heart history, other medications, pregnancy or breastfeeding (where there's no data at all) and what you hope NAD+ will do are on the list too.
Promise's NAD+ page lists only a compounded injectable: a 100 mg/mL × 10 mL vial (1,000 mg). A licensed provider reviews every request, decides whether NAD+ fits and sets the protocol; not everyone qualifies.
What to watch next
As of October 17, 2026, the October 8 NOPARK phase 3 publication reports no clinical benefit from oral nicotinamide riboside in 410 people with early Parkinson's disease, with a modest difference favoring placebo; it tested an oral NAD+ precursor, not NAD+ injections (trial summary). Three other developments could fill the next quarterly update. A 156-person, 24-week trial of oral NMN in diabetic kidney disease published its design in July (Chandra et al., Kidney International Reports, 2026); its results would be one of the larger NAD+ readouts yet. A small April preprint with injected NAD+ arms hasn't yet appeared in a journal. And FDA's category list is where any change in compounding status would show first.
