NAD dosing is the part of this therapy with the least published consensus and the most variation between clinics. Ask five practitioners and you will get five schedules — daily, every other day, load-then-maintain, or a fixed weekly drip.
What follows is one experienced clinician's actual protocol, stated plainly, with the reasoning behind it and the places where the evidence genuinely runs out.
Why NAD IV Dosing Varies So Much
There is no FDA-approved indication for NAD in longevity or wellness, and therefore no labelled dose to anchor to. Practitioners are working from clinical experience, small trials and the addiction-medicine literature, and they have arrived at different places.
Dr. Chris Croley, Empire's Chief Medical Officer, is candid that the number is not the settled part: “I don't think doses are that defined.”
The more useful question, and the one that actually drives his protocol, is what you are treating. A chronic neurological condition, withdrawal support and general fatigue are not the same clinical problem and should not share a schedule.
The Case for Loading
Croley's practice favors a front-loaded series rather than an even drip.
“I love an IV load, especially if there's a chronic condition that we're trying to combat,” he says. “I've had patients with dementia, early diagnosis Alzheimer's, and I think for some of those things to load and do them on some kind of maintenance before they get really severe, helps regulate sleep-wake cycle.”
The logic is that a chronic depletion is unlikely to respond to an occasional single infusion, and that establishing a level first, then maintaining it, is more plausible than hoping to build one gradually.
NAD IV Dosage: The Loading Protocol
For the loading indications above, Croley describes a specific and unusually concrete schedule:
- Dose: approximately 750 to 1,000 mg per IV infusion
- Infusion time: around six hours
- Frequency: at least six infusions within the first two weeks, roughly three days a week across those two weeks
- Then: “we start backing off on that” — tapering to maintenance
Two features of that schedule deserve attention, because they are where clinics most often deviate.
The six-hour infusion is not padding. NAD infused quickly is poorly tolerated — chest tightness, nausea, cramping and a general sense of unwellness are well recognised at speed. The rate is the tolerability control. A clinic promising a high-dose NAD drip in ninety minutes is describing a different patient experience than the one above.
The taper is part of the protocol. Loading without a maintenance plan is a course with no follow-through, and the patient's baseline is where they started.
Withdrawal and Substance Use: Where the Evidence Is Strongest
The best-supported use of NAD is not aesthetic.
Croley describes a referral pathway: “We've had patients that we have treated for withdrawal and substance abuse in conjunction with the psychotherapists who refer to us, and they get them on a weaning schedule of Suboxone or methadone. And when they get to their lower doses, they come in and we do a series of infusions, and I think we have much better success when we load.”
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Note the structure: NAD sits inside a supervised programme, alongside a taper managed by someone else, at a defined point in that taper. It is an adjunct within addiction medicine, not a standalone detox product, and a clinic offering it outside that structure is doing something materially different.
Dosing the Other Indications
Outside loading indications, the schedule follows the goal — and the goal is often the problem.
“When we start getting into some of the other things, that depends on what we're trying to do,” Croley says. “We're saying anti-aging. What is the endpoint that we're looking for?”
That is the correct challenge to put to any wellness NAD plan. Loading toward a measurable target is a protocol. Infusing indefinitely toward “anti-aging” is a subscription. Before setting a schedule, name the endpoint you would use to judge whether it worked — energy, sleep, a symptom scale, a functional measure — and set the review date at the same time.
Oral, Sublingual and Maintenance Between Infusions
Because six-hour infusions are impractical to repeat indefinitely, maintenance usually moves to another route. NMN and NR are precursors better suited to oral administration than NAD itself, whose oral bioavailability remains genuinely unsettled — the molecular detail is covered in what NAD is and why it is not a peptide.
Croley uses a combined NMN and NAD oral strip when travelling and IV when at home — a reasonable, openly pragmatic split rather than a claim that the two routes are equivalent.
What Belongs in Your Protocol Document
- The indication, written down. Loading for a chronic condition, adjunct in a supervised withdrawal programme, or wellness — they are different protocols.
- Dose and infusion time together. A dose without a rate is an incomplete instruction and the rate is what patients feel.
- The taper. What maintenance looks like, and when it starts.
- The endpoint and the review date. What you are measuring and when you will decide whether to continue.
- What you do when it is not tolerated. Slow the rate first.
- Consent that reflects the regulatory position. NAD is not FDA approved for these indications.
Empire teaches infusion protocols, tolerability management and the wider category in IV nutrition therapy and across the anti-aging and regenerative medicine academy. Technique and protocol are learned under supervision; this article is educational and is not a substitute for training.
Frequently Asked Questions
What is a typical NAD IV dosage?
In the loading protocol described by Empire's Chief Medical Officer, approximately 750 to 1,000 mg per infusion, given over about six hours, at least six times within the first two weeks before tapering to maintenance. There is no FDA-approved labelled dose for NAD in these indications, and protocols vary substantially between practitioners.
Why does an NAD infusion take so long?
Rate drives tolerability. Infused quickly, NAD commonly produces chest tightness, nausea and cramping. Extending the infusion is how those effects are managed, which is why a high-dose infusion is measured in hours rather than minutes.
How often should NAD be given?
It depends on the indication. A loading schedule for a chronic condition or withdrawal support is front-loaded and then tapered. For general wellness use there is no established frequency, and the more useful discipline is defining the endpoint you intend to measure before choosing a schedule.
Is NAD IV better than oral NMN?
They serve different purposes. IV delivers high doses reliably but is slow and impractical to repeat often. Oral NMN is a precursor better suited to oral administration and is commonly used for maintenance. They are not interchangeable and the evidence for one does not transfer to the other.
Is NAD approved for addiction treatment?
NAD is not an FDA-approved drug for addiction. It has been used as an adjunct within supervised programmes alongside medically managed tapering, and substance use is the area where the supporting literature is strongest relative to other uses.
Disclaimer
This article is educational and intended for licensed clinicians. It is not medical advice and does not establish a clinician-patient relationship. NAD is not FDA approved to treat, cure or prevent any disease, and the protocol described reflects the clinical practice of the faculty member quoted rather than a published standard or a recommendation for any individual patient. Dosing decisions must be made by a qualified clinician who has examined the patient and who is responsible for the indication, the route and the monitoring.
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