What Medications Should You Avoid When Using NAD+

Nicotinamide adenine dinucleotide (NAD+) plays a crucial role in energy production, cell repair and overall cellular health. It has gained popularity through therapies, supplements and injections designed to boost vitality, cognitive function and longevity. Because NAD+ is so deeply involved in many biological processes, it may interact with certain medications. Understanding these potential interactions is essential for anyone using NAD+ alongside prescribed treatments.

The insights provided in this article are from Vivere's Head of Nutrition, Yusra Serdaroglu Aydin, a registered dietitian with expertise in nutrition, food engineering and culinary arts. Her evidence-based approach focuses on personalised nutrition and the human microbiome, helping individuals make informed decisions about their wellbeing.

“NAD+ can interact with several medications, including treatments for diabetes, blood pressure, cancer, blood clotting and depression, so professional guidance is essential before combining NAD+ with any prescription drug”.

Here are the five biggest takeaways from this article about medications you should avoid when using NAD+:

• NAD+ supports cellular energy and repair, but may alter how some medications work in the body.

• People taking diabetes, blood pressure or cancer medications should seek medical advice before using NAD+ supplements or infusions.

• NAD+ can affect blood-thinning treatments, potentially increasing or reducing their effectiveness.

• Combining NAD+ with antidepressants or melatonin may impact mood regulation and sleep cycles.

• Always consult a healthcare professional before adding NAD+ to any treatment plan, especially if you take multiple medications.

People with diabetes who use insulin or oral glucose-lowering medications should be cautious when using NAD+ supplements. Research shows that NAD+ plays a role in glucose metabolism and insulin sensitivity, meaning it could potentially alter blood sugar control. NAD+ supplementation might enhance insulin activity, which could lead to hypoglycaemia if not properly monitored.

Studies suggest that NAD+ influences mitochondrial function and cellular energy pathways, both of which are vital in regulating how the body processes glucose [1]. If you use NAD+ while on diabetes medication, your blood sugar levels should be closely monitored and adjusted under medical supervision.

In the UK, licensed medications for managing diabetes include Mounjaro, Metformin and Ozempic.

NAD+ supplements have been associated with improved vascular health and better endothelial function, which affects how blood vessels relax and contract. However, if you already take medication to manage high or low blood pressure, NAD+ could influence how these perform. Studies have found that NAD+ can promote vasodilation, potentially lowering blood pressure further when combined with existing treatments [2] [3].

People using ACE inhibitors or beta-blockers should consult with a doctor before using NAD+ to avoid dizziness, fainting or hypotension.

NAD+ is involved in DNA repair and cellular energy production, both of which are key to how cancer cells grow and respond to treatment. Although NAD+ supports healthy cells, it may also promote the survival of cancerous ones in certain contexts. 

Some studies show that elevated NAD+ levels can help tumour cells resist chemotherapy or radiotherapy, while others suggest potential benefits in supporting recovery and reducing fatigue [4] [5] [6] [7] [8].

This makes it vital for anyone undergoing cancer treatment to discuss NAD+ use with their oncology team. 

Blood thinners and other anticoagulants are sensitive to changes in metabolism. NAD+ may influence how the liver processes these drugs, potentially affecting their ability to prevent blood clots. Some evidence suggests that NAD+ can alter enzyme activity related to clotting, which might either increase bleeding risk or reduce the drug’s intended effect [9].

If you take blood thinners, your healthcare provider may recommend regular monitoring and dosage adjustments when starting or stopping NAD+ supplementation.

NAD+ is essential for neurotransmitter synthesis and mitochondrial function, both of which influence mood and brain performance. However, when used alongside antidepressants such as SSRIs or SNRIs, NAD+ may modify serotonin or dopamine activity, potentially intensifying or reducing the effects of these medications [10].

While some research points to NAD+’s potential benefits in supporting brain function, combining it with prescription antidepressants should be done carefully and only under medical supervision.

Both NAD+ and melatonin influence the body’s circadian rhythm. NAD+ levels naturally fluctuate with the sleep-wake cycle, and taking supplements at the wrong time of day could interfere with melatonin’s sleep-promoting effects. Studies show that NAD+ can alter mitochondrial energy levels, which may make you feel more alert, while melatonin prepares the body for rest.

If taken together without timing or dosage guidance, this may lead to disrupted sleep or daytime fatigue. To avoid this, it’s advisable to take NAD+ earlier in the day and melatonin only in the evening, following professional advice.

“NAD+ is a powerful molecule that supports many vital processes, from energy metabolism to DNA repair. However, because of its broad range of effects, it can interact with several types of medication, including treatments for diabetes, blood pressure, cancer, clotting disorders and mood regulation. Understanding these interactions helps ensure both safety and effectiveness when integrating NAD+ into your health plan”.

Vivere helps you take control of your health with personalised insights from state-of-the-art gut microbiome testing, nutritional guidance, science-backed supplements, NAD injections and expert support. Sign up today and start living better, for longer.

[1] The therapeutic perspective of NAD+ precursors in age-related diseases - ScienceDirect

[2] Effects of NAD+ precursors on blood pressure, C‐reactive protein concentration and carotid intima‐media thickness: A meta‐analysis of randomized controlled trials - Wiley

[3] Nicotinamide Riboside Supplementation for Treating Elevated Systolic Blood Pressure and Arterial Stiffness in Midlife and Older Adults - Frontiers

[4] NAD Metabolism in Cancer Therapeutics - Frontiers

[5] Biological Functions and Therapeutic Potential of NAD + Metabolism in Gynecological Cancers - MDPI

[6] Nicotinamide adenine dinucleotide and the sirtuins caution: Pro-cancer functions - Wiley

[7] Inhibitors of NAD+ Production in Cancer Treatment: State of the Art and Perspectives - MDPI

[8] Role of NAD+ in regulating cellular and metabolic signaling pathways - ScienceDirect

[9] Critically Elevated INR in a Patient on Warfarin After Increase in Extended-Release Niacin Dose - Amy Christopher, 2011 - Sage

[10] Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake - ScienceDirect