NICOTINAMIDE ADENINE DINUCLEOTIDE (NAD+) COMPOUND

What is this medicine?

Nicotinamide Adenine Dinucleotide is a coenzyme signaling molecule.

The precursor to NAD+ is Niacin (Vitamin B3).

▪ It may have neuroprotective properties related to aging.

▪ It may have a role in energy metabolism.

▪ It may also be used for other conditions as determined by your doctor.

Compounded Drug Forms: nasal spray, troche, injectable

What should I tell my health care provider before I take this medicine?

▪ Allergy to NAD+ or Niacin

▪ History of liver disease

▪ Pregnant or breastfeeding

What should the product look like?

Upon visual inspection, the medication should appear clear to amber/yellow in color with no visible particles.

How should I use this medicine?

Follow the package directions provided by the pharmacy and by your prescriber. Your dosage is based on your medical condition and response to therapy. Follow the dosing schedule provided carefully.

Injectable medications should be given subcutaneously or intramuscularly as indicated by your healthcare provider. See recommended administration guide for further instruction.

    ▪ For Injectable - This medication should be given by subcutaneous injection. A subcutaneous injection

(SQ) delivers medicine into the fatty layer between skin and muscle, and is used to deliver a small quantity of certain kinds of medications.

            o Rotating your injection site is recommended. Commonly used injection sites include: the outer area of the upper arm, the abdomen (avoiding a 2-inch circle around the navel), or the front of the thigh.

            o Wash hands and sanitize the injection site with alcohol prior to administration. Do not use the solution if it becomes cloudy, has particles, or changes color. Dispose of used needles in a

Sharps container. Do not use past the beyond use date indicated on the prescription label.

            o Discard 28 days after initial puncture.

    ▪ Nasal sprays may need to be primed. Blow nose gently to clear any mucus from nasal passages and wash hands. Hold the bottle with thumb at the bottom and the nozzle between two fingers (use left hand for right nostril and vice versa). Tilt head forward slightly and close nostril not receiving medication. Insert the tip of the nozzle gently into nostril roughly ¼ to ½ inch inward. Point spray toward ear, away from nasal septum at center. Sniff deeply while pushing down on nozzle once. Breathe out through the mouth. Repeat with other nostril if dosing suggests, waiting 10 seconds between sprays.

    ▪ Sublingual formulations should be placed under the tongue or between the cheek and gums and held in place until fully dissolved. Avoid swallowing saliva to ensure best absorption into the blood stream. Avoid eating or drinking 15 minutes before or after taking sublingual dosage forms.

What should I watch for while using this medicine?

    ▪ Signs of an allergic reaction: hives blistering, swelling of the mouth, face, lips tongue, throat, trouble breathing.

    ▪ Regular check-ups with your provider are recommended.

What side effects or adverse drug reactions may I notice from receiving this medicine?

Possible side effects that may occur and may go away as your body gets used to the medication include:

▪ Fatigue

▪ Headache

▪ Flushing

▪ Itching

▪ Sweating

▪ Dizziness

▪ Nausea, vomiting and/or diarrhea

▪ Shortness of Breath

▪ Injection site reactions

What serious events prompt immediate attention?

Contact your doctor immediately or seek medical attention if you experience:

▪ Maculopapular rash

▪ Pruritis

▪ Liver problems

▪ Signs of high blood sugar, such as confusion, feeling sleepy, unusual thirst or hunger, urinating more often than usual, flushing, fast breathing, or breath that has a fruity odor

You may experience side effects not listed. Contact your doctor with questions.

An allergic reaction to this medication is unlikely but seek medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and/or trouble breathing.

Where should I keep my medicine?

▪ Follow the storage recommendations found on your prescription label.

▪ Store troches at room temperature between 59 and 86 degrees F, unless otherwise specified on the

packaging.

▪ Store nasal spray and injectable NAD+ in the refrigerator at a temperature of 36 to 46 degrees F,

unless otherwise specified on the packaging.

▪ Protect from light.

Additional Information:

▪ Do not share this medication with others.

▪ Keep out of reach of children and pets.

▪ If an overdose is suspected contact your local poison control center at 1-800-222-1222 or go to the nearest emergency room.

If you have any questions concerning this or any of your medications, a pharmacist is available during normal business hours to answer your questions.

You may report side effects to the FDA at 1-800-FDA-1088.

Do not flush down a toilet or pour down a drain. Check with your pharmacist if you have questions about the best way to dispose of medications. There may be a drug take-back program in your area.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medication or any other medication. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe,

effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does not include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. For questions about the source of any of the information provided herein, pharmacists at Belmar Pharma Solutions are

available. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of this medicine.

References:

1. Niacin. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: . Accessed June 2023.

2. Rajman L, Chwalek K, Sinclair DA. Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence. Cell Metab. 2018;27(3):529-547. doi:10.1016/j.cmet.2018.02.011