1. THE BIOCHEMISTRY BEHIND NAD⁺ DRIP

NAD⁺ (Nicotinamide Adenine Dinucleotide) is a central metabolic coenzyme that serves as a key electron carrier in redox reactions. It exists in two forms: oxidized (NAD⁺) and reduced (NADH). While both are essential for cellular energetics, the NAD⁺/NADH ratio governs the cell’s oxidative state, mitochondrial function, and sirtuin activity.

1. Activation of Sirtuins – The NAD⁺-Dependent Deacetylases

Sirtuins (SIRT1–SIRT7) are NAD⁺-dependent enzymes that deacetylate transcription factors and metabolic enzymes, regulating:
- Mitochondrial biogenesis (via PGC-1α)
- Autophagy & apoptosis
- Inflammation suppression (via NF-κB inhibition)
- DNA repair (via PARP1 modulation)
- Circadian rhythm & cellular senescence

Sirtuin activity is entirely dependent on NAD⁺ as a co-substrate. Without sufficient NAD⁺, sirtuins become inactive, blunting metabolic adaptation, longevity pathways, and cellular resilience to stress.

II. WHY INTRAVENOUS NAD⁺?

Oral or sublingual NAD⁺ is poorly bioavailable and quickly metabolized to nicotinamide or NADH. Furthermore:
- Oral NAD⁺ is rapidly reduced to NADH, shifting the redox balance away from the desired oxidized state.
- IV NAD⁺ bypasses digestion, ensuring delivery of the active oxidized form directly to the bloodstream, and preserves a high NAD⁺/NADH ratio, critical for sirtuin activation and mitochondrial signaling.

If the clinical goal is only to increase NADH or total NAD pool, then oral supplementation with niacin and riboflavin (e.g., Bi-vitamin powder: Riboflavin:Niacin::1:4) is cost-effective and logical—it raises NAD⁺, NADH, FAD, and FMN levels. However, the therapeutic value of IV NAD⁺ lies in rapidly elevating the NAD⁺/NADH ratio in systemic circulation and tissues.

III. NAD⁺ INFUSION PROTOCOL (500 mg)

Preparation:
- NAD⁺ dosage: 500 mg pure NAD⁺ (pharmaceutical grade)
- Dilution: Dilute in 500 mL Normal Saline (0.9% NaCl)
- Infusion Time: Infuse slowly over 2–4 hours (initially at 30–40 mL/hr)

Administration:
- Use a standard IV drip set with roller clamp or infusion pump.
- Begin with slow rate (first 15–30 mins at ~20 mL/hr), monitor patient response.
- Gradually increase rate as tolerated; do not exceed 120 mL/hr.
- Monitor for chest tightness, flushing, anxiety, or nausea—pause or slow down if these occur.
- Always have the patient in a reclined, calm environment.

IV. CONTRAINDICATIONS & PRECAUTIONS

Contraindications:
- Hypersensitivity to NAD⁺ or excipients
- Unstable cardiovascular conditions
- Severe anxiety or panic disorders (risk of transient activation)
- Recent stroke or seizure disorder

Precautions:
- Always assess baseline vitals and hydration status
- Avoid bolus or rapid infusion (can cause intense parasympathetic activation)
- Consider pre-medication in anxious patients with B-complex or low-dose magnesium

V. SUMMARY OF BENEFITS

- Enhanced mitochondrial efficiency
- Upregulation of sirtuin signaling
- Improved cellular redox status
- Reduced chronic inflammation
- Enhanced neuroplasticity and cognitive support
- Adjunct in addiction recovery, chronic fatigue, neurodegeneration

DISCLAIMER:

This document is for informational purposes only and is intended for use by trained medical professionals. NAD⁺ infusion must be administered under qualified supervision after appropriate patient evaluation. The author and SOMA Wellness Clinic are not liable for misuse or unsupervised application. Always follow local medical guidelines and regulatory frameworks.