How to dose NAD+

According to reports, subcutaneous NAD+ dosing in current research practice follows a sequence made up of five steps:

1. Setting the dose dial on the pre-filled multi-dose pen, which is marked at 20, 30, 40 and 50 mg and goes up to 200 mg a day, which fixes the dose directly in milligrams and which contains 1000 mg in total [2].
2. Choosing one of the two valid schedules, the intermittent one or the daily one, both of which are described further down.
3. Slow administration into the subcutaneous tissue of the abdomen, with the severity of the flush scored on a scale that runs from 0 to 4.
4. Titrating upwards only if the previous flush was scored at ≤2, and always within the range of the schedule that has been chosen.
5. Maintenance on the chosen schedule, with the pen stored at 2–8 °C and protected from light [3].

As of 2026, no peer-reviewed human pharmacokinetic curve has been published for subcutaneous NAD+. All of the figures given below rest on the standard operating procedures of clinics and on mechanistic reasoning, and not on direct comparative studies.

NAD+ dosing: the essentials

• There are two valid schedules, and they are alternatives to one another. Intermittent: 10–50 mg two or three times a week for the first 4 weeks, and then 20–80 mg two or three times a week. Daily: 10–20 mg a day, 5 days a week, and then it goes up to 20–30 mg a day.
• The dose dial fixes the dose directly in milligrams and comes marked at 20, 30, 40 and 50 mg, up to 200 mg a day. Doses below or in between the printed marks can also be set, 10 mg included. There are no volumes to calculate.
• The injection speed (30–60 seconds per dose) is the single most controllable variable for reducing the severity of the flush.
• The NAD+ flush is a prostaglandin-mediated vasodilation response, not an allergic reaction, and it subsides within 15–30 minutes.
• Change the injection sites every week, moving them by at least 2 cm, in order to avoid lipohypertrophy and cumulative irritation.
• Recording the severity of the flush and the duration of the injection every day serves to detect individual tolerability thresholds before escalating.

What NAD+ is and why dose precision matters

NAD+ (nicotinamide adenine dinucleotide) is a coenzyme that is present in every one of the cells of mammals. It drives the production of ATP, sirtuin signalling and PARP-mediated DNA repair [4]. Tissue concentrations of NAD+ decline measurably with age in preclinical and human samples, a pattern that Rajman et al. summarised in Cell Metabolism (2018) [5]. That age-associated decline is the mechanistic premise that underpins all of the research with exogenous NAD+.

Subcutaneous administration is used in research settings because oral NAD+ and its precursors (NMN, nicotinamide mononucleotide; NR, nicotinamide riboside) are subject to marked first-pass metabolism and to degradation by the gut flora, which in preclinical pharmacokinetic work gives rise to a lower and more variable plasma exposure than parenteral administration does [4]. As of 2026, no direct human comparisons of bioavailability between oral precursors and subcutaneous NAD+ have been published. Researchers choose the route of administration for mechanistic reasons, and not because of any pharmacokinetic superiority that has been confirmed.

Precision matters because the dose-response margin between a tolerable flush (grade 0–2) and an unpleasant one (3–4) is a narrow one. The NAD+ 1000 mg pen contains 1000 mg of active substance and the dose dial fixes the dose in milligrams, with marks at 20, 30, 40 and 50 mg and up to 200 mg a day: accuracy depends on reading the figure on the dial correctly, not on any prior calculation. The pen that is discussed here is handled strictly as a research compound. Anyone carrying over the subcutaneous injection technique and site rotation from neighbouring peptide protocols should nevertheless titrate again from the lowest of the doses listed below.

The subcutaneous NAD+ injection protocol at a glance

The subcutaneous NAD+ protocol that this guide uses allows two schedules, and the two are equally valid. The intermittent schedule gives 10–50 mg two or three times a week for the first 4 weeks and then 20–80 mg two or three times a week. The daily schedule gives 10–20 mg a day, 5 days a week, and then goes up to 20–30 mg a day. They are alternatives: one of them is chosen and kept to, and the two are not mixed within the same cycle [1]. All of the doses are given at the same time of day in order to standardise the assessment of tolerability [3]. The higher single doses appear almost exclusively in the context of intravenous infusions and fall outside subcutaneous pen protocols [3].

The severity of the flush scales with the dose, so the higher steps of either schedule demand more discipline over the pace of administration than the first ones do.

Four operating parameters apply to both of the schedules:

1. Administering within a fixed daily time slot (±60 minutes) reportedly keeps the severity of the flush comparable from one day to the next.
2. During the first week the same abdominal quadrant is used, and afterwards the sites are rotated according to the subcutaneous injection technique and site rotation protocol.
3. The current step is held for 7 full days before escalating, even if the flush score is 0.
4. The dose dial on the NAD+ 1000 mg pen is set directly to the dose in milligrams: 20, 30, 40 and 50 mg, and up to 200 mg a day.

Understanding the NAD+ flush response

The NAD+ flush is a prostaglandin-mediated cutaneous vasodilation response, not an allergic reaction. It subsides of its own accord within 15–30 minutes of subcutaneous administration. A rapid rise in circulating NAD+ and in its metabolites triggers the release of prostaglandins D2 and E2 by the Langerhans cells and the keratinocytes of the skin, which produces the same vasodilatory cascade that Benyó et al. described in the Journal of Clinical Investigation (2005) for the niacin flush [6]. That mechanistic work from 2005 remains the foundational reference on the subject. No work from 2020–2026 has refuted the prostaglandin model for the flush reactions of the nicotinamide class.

The onset typically occurs 5–10 minutes after the injection has been given. The flush reaches its peak at around 10–15 minutes and subsides by 30 minutes. The symptoms to expect are warmth in the face, the neck and the upper chest, diffuse erythema ranging from pink to red, tingling and mild itching. What distinguishes a pharmacodynamic flush from a hypersensitivity reaction is the absence of urticaria (raised weals), wheezing, swelling of the lips or tongue and of any systemic symptom such as dizziness, tachycardia beyond a slight awareness of the heartbeat, or nausea that persists beyond the flush window. Persistent or systemic symptoms call for stopping and for a clinical review, and not for titrating.

The severity of the flush scales with the dose and with the speed of the injection. That is precisely why the protocol holds each step for 7 days and escalates the dial of the NAD+ 1000 mg pen in defined increments, rather than jumping straight to the ceiling of the schedule.

Body Pharm flush severity scale (researcher self-assessment)

The protocols score the most intense moment of the flush, not the average, within the 20 minutes that follow the administration:

1. Grade 0: no perceptible warmth, no erythema, no tingling.
2. Grade 1: mild warmth in the face or the upper chest; no visible reddening; no change in behaviour.
3. Grade 2: visible erythema on the face and neck plus tingling or mild itching; tolerable while sitting down.
4. Grade 3: considerable discomfort, marked erythema, intense itching or stinging. The protocols describe pausing halfway through the administration and giving the remainder more slowly, or holding the next dose at the current step.
5. Grade 4: any systemic feature (urticaria, wheezing, swelling, presyncope). The protocols provide for stopping and for a medical assessment; that is not a flush.

The score is recorded together with the time to onset and the duration of the injection in a dosing log, with the same discipline in the choice of abdominal site that the subcutaneous injection technique and site rotation guide describes.

How injection speed reduces the severity of the NAD+ flush

The speed of injection is, at any NAD+ dose, the most controllable variable for reducing the severity of the flush. Pressing the plunger of the pen slowly, over 30–60 seconds for the whole of the dose, dampens the local uptake by the tissue, smooths out the systemic rise in NAD+ and reduces the prostaglandin D2-mediated cutaneous vasodilation that is responsible for the flush.

The mechanism at work is pharmacokinetic, not pharmacological. A rapid bolus of under 10 seconds generates a sharper maximum concentration (Cmax) coming out of the abdominal depot. An administration spread over 30–60 seconds distributes the absorption across a wider window and lowers the peak value. As of 2026, no specific randomised controlled trial has quantified injection speed against flush severity for subcutaneous NAD+. The published data on speed-dependent flushing exist only in the case of intravenous infusions. The subcutaneous relationship between speed and flush is mechanistically grounded and observed in practice, but it has not been confirmed by studies.

In Body Pharm's protocol review notes, researchers who self-assessed on the flush severity scale consistently recorded grade 1 reactions when the duration of the injection exceeded 30 seconds. The same dose, injected in under 10 seconds, produced grade 2–3 reactions with the NAD+ 1000 mg pen. The effect becomes relevant from doses of 20 mg upwards. Below that threshold, the speed of injection has little influence, because the absolute prostaglandin load is already low.

Reported parameters for slow administration

The protocols for any subcutaneous NAD+ dose describe the following sequence with the pre-filled pen, at an abdominal site rotated according to the subcutaneous injection technique and site rotation guide:

1. Bring the pen to room temperature. The usual practice is to take it out of the refrigerator and let it reach room temperature before injecting; according to reports, a cold solution stings more and leads to the plunger being pressed faster.
2. Skin fold. A 2–3 cm fold is lifted at a minimum of 5 cm lateral to the navel, in order to separate the subcutaneous tissue from the muscle.
3. Needle angle. A 45° puncture through the lifted fold up to the hub is described; a 90° angle is considered acceptable with a short needle if there is enough fatty tissue.
4. Administration speed. The plunger is pressed over 30–60 seconds, counting the seconds out loud or with a stopwatch. The protocols state that, if a grade 2 or higher flush begins during the administration, a 10-second pause is taken before continuing more slowly.
5. Withdrawal. The needle is held in place for 5 seconds after the plunger has been pressed fully and is then withdrawn at the angle of entry; dry pressure is then applied, without rubbing.

The recorded duration of the injection, paired with the flush score across the 7-day step, reportedly reveals each researcher's individual speed threshold.

NAD+ titration protocol

Titrating consists of nothing more than changing the figure on the dial, not of preparing anything different: each step is read directly in milligrams. Titration allows each researcher to determine their own personal flush threshold before settling on the chosen schedule [3]. The data sheet that accompanies each NAD+ 1000 mg pen should be checked before starting.

The intermittent schedule

The intermittent schedule gives 10–50 mg two or three times a week for the first 4 weeks and then 20–80 mg two or three times a week. No human subcutaneous pharmacokinetic curve published as of 2026 fixes the size of the step or the interval between increases within those windows, so this guide does not propose any: escalation proceeds only for as long as the flush score stays at grade ≤2 and the site reactions are negligible. Skipping steps shortens the window available for prostaglandin adaptation and reliably increases the severity of the flush at the next step.

The daily schedule

The daily schedule gives 10–20 mg a day, 5 days a week, and then goes up to 20–30 mg a day. Within those windows, the starting point is always the low end. Each step is held for 7 full days, and escalation takes place only if the flush stays at grade ≤2 and the site reactions are negligible. The first few doses also serve to fine-tune the depth of the fold, the 45° puncture and the 30–60-second plunger pace that was established in the previous section.

The intravenous NAD+ regimens of 500–1000 mg, used in addiction and mitochondrial contexts, are not pharmacokinetically comparable and should not determine the subcutaneous dose ceilings [3].

Handling and storage of the NAD+ 1000 mg pen

The NAD+ 1000 mg pen is supplied pre-filled and ready to use. There is nothing to prepare, nothing to dilute and no volumes to calculate: the dose dial fixes the dose directly in milligrams, it comes marked at 20, 30, 40 and 50 mg and goes up to 200 mg a day, and the cartridge contains 1000 mg in total [2]. Doses below or in between the printed marks can also be set, 10 mg included. The internal concentration is a manufacturing detail, and it plays no part at all in the dosing.

Storage and oxidation control

Store it at 2–8 °C, protected from light. Unopened, the shelf life is 24 months. Once it has been pierced for the first time, it is used within 12 months. If no refrigerator is available, it remains stable at room temperature for a maximum of 30 days, without going above 30 °C. Bring the pen to room temperature before injecting. Do not freeze it.

NAD+ oxidises very easily. The solution should be somewhere between pale yellow and clear. Discard any pen whose solution has taken on a yellowish-brown tint, has become cloudy or has developed particles. Bringing the pen to room temperature before administering reduces the sting and favours the slow plunger pace that the subcutaneous injection technique and site rotation guide deals with.

Choosing and rotating the injection site

The three subcutaneous sites with the most palpable fatty tissue and the least irritation reported in current subcutaneous NAD+ practice are the abdomen (2–5 cm lateral to the navel), the outer thigh and the flank (hip area) [3]. All three allow subcutaneous administration at an angle of 45–90°, depending on the depth of tissue at each site [3].

Change the site on a fixed weekly cycle, and not on an improvised basis. A workable rotation for a week with three injections: Monday left abdomen, Wednesday right flank, Friday outer thigh, and the following week mirrored. Never use exactly the same puncture point within a seven-day period. Move each new injection at least 2 cm away from the previous mark, in order to limit lipohypertrophy and the cumulative histamine-mediated irritation [3].

Mild local erythema, a pink halo of 2–4 cm and transient warmth in the weal are typical with NAD+ and usually subside within 60–120 minutes [3]. Induration that persists for more than 24 hours, reddening that spreads outwards, or a palpable nodule all warrant resting that site and reviewing the technique.

Quick reference for site and rotation

• Sites: abdomen and flank; the outer thigh in leaner research subjects [3].
• Angle: 45° into the skin fold; 90° with a short needle and enough fatty tissue.
• Rotation: a shift of at least 2 cm; never the same site on consecutive days.
• Avoid: scar tissue, stretch marks, visible vessels and the 2 cm zone around the navel.

The same rotation logic applies to the whole of the protocol covered by the subcutaneous injection technique and site rotation guide.

NAD+ dosing: Frequently Asked Questions for researchers

Can NAD+ be dosed twice a day? Both of the schedules in this guide involve just a single administration per dosing day: 10–50 mg and then 20–80 mg two or three times a week, or else 10–20 mg and then 20–30 mg a day. No comparative study from 2023–2026 compares once-daily with twice-daily subcutaneous NAD+ in humans [3]. Splitting a daily dose into two injections to soften the peak of the flush is a tolerability-guided heuristic, not an evidence-based improvement.

What if the flush is intense from the very first doses? The protocols describe going down one step on the dial and extending that plateau for a further 5–7 days, and not titrating upwards again until the severity of the flush has stabilised at the lower dose. Putting up with intense discomfort offers no documented pharmacokinetic advantage, and it increases the risk of the vasovagal symptoms described in the practice literature on intravenous NAD+ [3].

Is there a maximum subcutaneous dose? The highest dose covered by the schedules in this guide is 80 mg two or three times a week on the intermittent schedule, and 30 mg a day on the daily one. The dial on the pen goes up to 200 mg a day, but this guide does not publish any schedule above those windows. Single doses of 250–1000 mg appear only in the context of intravenous infusions [3]. No peer-reviewed human subcutaneous pharmacokinetic curve published as of 2026 justifies exceeding them.

How long should a research cycle last? The published clinic protocols last for 4–12 weeks, normally with a washout phase of 2–4 weeks before the cycle is repeated [3]. Cycles of more than 12 weeks of continuous subcutaneous NAD+ are poorly characterised in the 2020–2026 literature.

Can NAD+ be combined with other peptides? Combination with other compounds falls outside the scope of this protocol. The broader longevity peptides category covers the compatible compounds. The subcutaneous injection technique and site rotation guide applies the same method of administration. The NAD+ 1000 mg pen remains the reference product for the doses above.

Research notice and safe handling

All Body Pharm products, including the NAD+ 1000 mg pen, are supplied exclusively for research and analytical purposes and are not intended for human consumption. This guide summarises dosing patterns that are described in the clinical practice literature [3], and it does not constitute medical advice. Researchers should:

1. Comply with the regulations applicable to the acquisition and handling of research peptides [3].
2. Follow the standards of subcutaneous injection technique and site rotation when planning laboratory protocols.
3. Consult the full index of peptide guides for neighbouring research protocols and dosing references.

Next steps

Research protocols usually start out at the low end of the chosen schedule, always at the same time of day, noting the severity of the flush and the duration of the injection every day in a dedicated log. Once 7 days with consistent grade 0–1 reactions have been completed, the protocols go up one step on the dial and keep to the same discipline of record-keeping. This approach reportedly identifies the personal tolerability threshold before the ceiling of the schedule is reached. If at any point the severity of the flush goes beyond grade 2, or systemic symptoms appear, it is advisable to pause the escalation, review the administration technique against the slow-administration parameters above and consult the FAQ section before continuing.

Sources

1. Body Pharm dosing protocol for the NAD+ 1000 pen (intermittent schedule and daily schedule) (supplier specification, reviewed in October 2026). Supplier research protocol, not a peer-reviewed study.
2. Body Pharm product specification: pre-filled multi-dose pen, 3 ml cartridge, dial in milligrams, storage at 2–8 °C, 24 months unopened and 12 months from the first puncture, up to 30 days below 30 °C without a refrigerator. Supplier specification, not a study.
3. Clinic and supplier practice literature on subcutaneous and intravenous NAD+ (2023–2025), with no published controlled trial. Cited as a practice convention, not as evidence.
4. Covarrubias AJ, et al. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021. pubmed.ncbi.nlm.nih.gov/33353981
5. Rajman L, Chwalek K, Sinclair DA. Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence. Cell Metab. 2018;27(3):529-547. pubmed.ncbi.nlm.nih.gov/29514064
6. Benyó Z, et al. GPR109A (PUMA-G/HM74A) mediates nicotinic acid-induced flushing. J Clin Invest. 2005;115(12):3634-40. pubmed.ncbi.nlm.nih.gov/16322797