# How to Inject NAD+: A Step-by-Step Subcutaneous Guide **By TelosRX Editorial Team** ยท 2026-10-07 **How to inject NAD+: use a small insulin syringe, clean a fatty site like the abdomen, pinch the skin, and inject slowly under it. Only follow a provider's prescribed dose. [TelosRX](https://telosrx.com) walks through each step safely.** Self-injecting sounds intimidating. In practice, a subcutaneous shot (an injection into the fat just under your skin) is one of the simplest routes there is. This guide explains how to inject NAD+ step by step. It also covers supplies, mistakes to avoid, and when a needle-free option may suit you better. ## Before You Start: Is Injectable NAD+ Right for You? NAD+ (nicotinamide adenine dinucleotide) is a coenzyme your cells use to make energy and repair DNA. Levels tend to fall with age, which drives interest in replacing it. A few facts frame everything below: - **Compounded NAD+ is not FDA-approved.** It is prepared by pharmacies under federal compounding rules. - **A prescription is required.** Starting is subject to medical approval by a licensed provider. - **Human data are early.** A small 2019 pilot study found that during a slow IV infusion, NAD+ was cleared from plasma for at least the first 2 hours. You can read that [NAD+ infusion pilot study on PubMed Central](https://pmc.ncbi.nlm.nih.gov/articles/PMC6751327/). Providers typically ask about pregnancy, cancer history, and liver, kidney, or heart conditions before prescribing. Our [NAD+ explainer](https://www.telosrx.com/blogs/hormone-longevity/what-is-nad) covers the basics if you're new to it. ## What You'll Need Your pharmacy or provider will specify exact supplies. A typical home kit includes: - Your prescribed NAD+ vial, with its pharmacy label - Insulin-style syringes with short, fine needles - Alcohol swabs - Bacteriostatic water, only if your vial needs mixing - An FDA-cleared sharps container - A dose log (paper or phone) ## Step 1: Confirm Your Prescription and Instructions Read the pharmacy label before anything else. Check the drug name, strength, beyond-use date, and your prescribed dose. If the label and your instructions don't match, stop. Contact your provider or pharmacy before injecting. Your dose and schedule are always set by your prescriber. ## Step 2: Wash Up and Set Up a Clean Space Wash your hands with soap and water for at least 20 seconds. Clear a flat surface and lay out your supplies. Wipe the vial's rubber stopper with an alcohol swab. Let it air-dry. Blowing on it defeats the purpose. ## Step 3: Mix the Vial Only if Directed Some compounded NAD+ arrives as a freeze-dried powder. Others come ready to use. Only reconstitute (mix with liquid) if your pharmacy's directions say so. If mixing is required, add the specified diluent slowly down the vial wall. Swirl gently. Don't shake, which can create foam and bubbles. ## Step 4: Draw Up Your Prescribed Dose Pull the plunger back to the dose mark first. That draws air into the syringe. 1. Insert the needle through the stopper and push the air in. 2. Flip the vial upside down. 3. Pull the plunger slowly to your prescribed mark. 4. Tap out any large bubbles and push them back into the vial. 5. Recheck the dose at eye level. ## Step 5: Choose and Clean an Injection Site Subcutaneous injections go into fatty tissue. Common sites include: - **Abdomen:** at least two inches from the belly button - **Front of the thigh:** the outer, upper area - **Back of the upper arm:** often easier with help Swab the site in a small circle and let it dry. Avoid bruised, scarred, or irritated skin. ## Step 6: Pinch, Inject Slowly, and Release Gently pinch an inch of skin. Insert the needle in one smooth motion, typically at a 45- to 90-degree angle depending on needle length and body type. Push the plunger slowly. NAD+ can sting, and many people find a slower push more comfortable. Release the pinch, then withdraw the needle at the same angle. Press lightly with a clean swab if needed. Don't rub the area. ## Step 7: Dispose of the Needle Safely Drop the used syringe straight into your sharps container. Never recap a used needle. Don't toss loose needles in household trash. The FDA's [guide to safely using sharps at home](https://www.fda.gov/medical-devices/consumer-products/safely-using-sharps-needles-and-syringes-home-work-and-travel) explains disposal options by state. ## Step 8: Rotate Sites, Store, and Log Rotate injection sites each time. Repeated shots in one spot can cause lumps or irritation. Store the vial exactly as your pharmacy label directs. Many mixed vials are refrigerated and discarded after a set number of days. Log the date, dose, site, and how you felt afterward. That record helps your provider adjust your plan. **Not keen on needles?** TelosRX offers a [needle-free NAD+ nasal spray](https://www.telosrx.com/pages/nad-nasal-spray), subject to medical approval by a licensed provider. Compare routes in our [NAD+ nasal spray vs. injections guide](https://www.telosrx.com/blogs/hormone-longevity/nad-nasal-spray-vs-injections). ## Common NAD+ Injection Mistakes Mistake Why it's a problem Better approach Pushing the plunger fast More stinging and flushing Inject slowly and steadily Shaking the vial Creates bubbles and foam Swirl gently Same site every time Lumps and irritation Rotate sites each injection Recapping used needles Needle-stick injuries Drop straight into a sharps container Changing your own dose Unpredictable side effects Ask your provider first Ignoring storage directions Potency and sterility loss Follow the pharmacy label exactly ## Side Effects to Watch For Most reported reactions are mild and short-lived. Common ones include: - Redness, stinging, or a small lump at the site - Flushing or warmth - Nausea or headache - Lightheadedness Seek urgent care for hives, swelling of the face or throat, chest pain, or trouble breathing. Report persistent side effects to your provider. See our full list of [NAD+ side effects](https://www.telosrx.com/blogs/hormone-longevity/nad-side-effects). ## Frequently Asked Questions ### Where is the best place to inject NAD+? Subcutaneous NAD+ is usually injected into fatty tissue on the abdomen, the front of the thigh, or the back of the upper arm. The abdomen is often easiest for self-injection. Stay at least two inches from the belly button and rotate sites each time to reduce irritation. Follow any site guidance from your provider. ### Why does NAD+ burn when injected? Stinging is one of the most commonly reported NAD+ injection reactions. It often eases with a slower push and a fully room-temperature vial if your pharmacy allows it. Rotating sites also helps. If burning is severe, lasts for hours, or comes with spreading redness or swelling, contact your provider. ### How often should you inject NAD+? There is no single standard schedule for NAD+ injections, and published protocols vary. Frequency and dose are set by your prescriber based on your goals, health history, and tolerance. Never increase your dose or frequency on your own. Keep a log so your provider can make informed adjustments. ### Is it better to inject NAD+ or use a nasal spray? Each route has trade-offs. Injections deliver NAD+ under the skin, while nasal sprays avoid needles and sharps disposal. Human comparison data are limited for both. The right choice depends on your comfort with needles, your health history, and your provider's recommendation. Both compounded forms are not FDA-approved. ### Can I inject NAD+ intramuscularly instead? Some protocols use intramuscular injection, but the route is a prescribing decision. Intramuscular shots use longer needles and different sites. Only use the route, needle, and dose listed on your prescription and pharmacy label. If you're unsure, ask your provider or pharmacist before injecting. ### What should I do if I miss an NAD+ injection? Check your provider's instructions first, since they vary by protocol. In general, don't double up to make up for a missed dose. Resume your regular schedule and note the missed dose in your log. If you miss several doses in a row, contact your provider before restarting. _TelosRX is LegitScript-certified. Compounded medications are not FDA-approved and are prepared under federal compounding regulations. Approval is subject to evaluation by a licensed provider; approval is not guaranteed. Individual results vary. TelosRX operates as an online-first, asynchronous telehealth service._ Start your private evaluation at [TelosRX](https://telosrx.com). **Tags:** cellular energy, guide, longevity, NAD+, NAD+ injection, subcutaneous injection --- > Source: [Telos RX](https://www.telosrx.com/blogs/hormone-longevity/how-to-inject-nad-subcutaneous-guide)