Designing a NAD+ Protocol for Your Medical Practice

A well-designed NAD+ protocol does three things: it produces good patient outcomes, it creates a repeatable clinical workflow, and it generates sustainable practice revenue. Getting all three right requires thinking through patient selection, dosing, monitoring, and the patient experience.

This post is a practical guide to building a NAD+ subcutaneous injection protocol for your practice.

Not every patient is a good candidate for NAD+ therapy. Defining your target patient population helps you market effectively and set appropriate expectations.

Ideal NAD+ candidates:

Fatigue and energy optimization: Patients with chronic fatigue, low energy, or reduced vitality who have had other causes ruled out. This is the largest and most accessible patient segment.

Cognitive function: Patients with subjective cognitive concerns — brain fog, reduced focus, memory concerns — who want to optimize cognitive performance. This segment is growing rapidly.

Athletic performance and recovery: Active patients who want to optimize performance and recovery. This segment tends to be younger and more engaged.

Metabolic health: Patients with metabolic syndrome, prediabetes, or obesity who are interested in supporting cellular health alongside other interventions (including GLP-1 therapy).

Anti-aging and longevity: Patients who are proactively investing in their long-term health. This segment is often willing to pay premium prices for premium services.

Patients already on GLP-1 therapy: NAD+ is a natural add-on for GLP-1 patients. The combination addresses both weight management and cellular health.

Before starting NAD+ therapy, conduct an appropriate evaluation:

History:

• Chief complaint and goals for NAD+ therapy
• Current medications (check for interactions)
• Relevant medical history
• Allergies

Physical examination: Basic vital signs at minimum.

Laboratory evaluation (consider):

• Basic metabolic panel (baseline renal and hepatic function)
• CBC (baseline)
• Thyroid function (if fatigue is the primary complaint)
• HbA1c (if metabolic health is a concern)

Contraindications to assess:

• Active malignancy (NAD+'s role in cellular proliferation raises theoretical concerns)
• Pregnancy or breastfeeding
• Known hypersensitivity to NAD+ or components of the formulation

Most NAD+ protocols include a loading phase with higher frequency dosing to rapidly elevate NAD+ levels:

Option A (aggressive loading):

• Daily injections for 5–7 days
• 500–1,000 mg per injection depending on concentration

Option B (moderate loading):

• Every other day for 2 weeks
• 500 mg per injection

Option C (gentle loading):

• 3 times per week for 2 weeks
• 500 mg per injection

The loading phase choice depends on patient goals, tolerance, and practice workflow.

After loading, transition to a maintenance protocol:

Standard maintenance: 2–3 injections per week Reduced maintenance: 1–2 injections per week (for patients who achieve good response) Intensive maintenance: Daily injections (for patients with significant deficiency or high goals)

We supply NAD+ at two concentrations:

• 500 mg/mL: Standard concentration; 1 mL injection = 500 mg
• 1,000 mg/mL: Higher concentration; 0.5 mL injection = 500 mg (smaller volume for patients who prefer it)

Sub-Q injection sites: abdomen, thigh, upper arm. Rotate sites to minimize injection site reactions.

Injection speed: Inject slowly (over 30–60 seconds) to minimize discomfort.

Temperature: Allow the medication to reach room temperature before injection.

Patients need to understand:

What to expect: Most patients report subjective improvements in energy and clarity within 1–2 weeks of starting the loading phase. Objective improvements in metabolic markers may take longer.

How to inject: If patients are self-injecting at home, provide thorough injection training and written instructions.

Storage: NAD+ sub-q injections require refrigeration. Provide clear storage instructions.

Side effects: Injection site reactions (redness, mild pain) are the most common side effect. Flushing, nausea, and headache can occur, particularly with higher doses.

Long-term commitment: NAD+ therapy is most effective as an ongoing protocol, not a one-time treatment.

Follow-up schedule:

• 2-week check-in (phone or in-person): Assess tolerability, answer questions
• 4-week visit: Assess response, adjust protocol if needed
• 3-month visit: Comprehensive assessment, repeat labs if indicated
• Ongoing: Every 3–6 months

What to assess at follow-up:

• Subjective response (energy, cognition, recovery)
• Tolerability (injection site reactions, systemic side effects)
• Adherence to protocol
• Any new medications or health changes

NAD+ therapy can be structured several ways:

Per-injection pricing: Charge per injection. Simple but creates variable revenue.

Monthly membership: Fixed monthly fee for a defined number of injections. Creates predictable recurring revenue.

Protocol packages: Sell loading phase + maintenance phase as a package. Encourages commitment.

Add-on to GLP-1 program: Bundle NAD+ with GLP-1 therapy at a package price. Increases average revenue per patient.

Request portal access for NAD+ supply →

This content is for informational and educational purposes only. It does not constitute medical advice. Prescribers should use clinical judgment when developing patient protocols.