Nicotinamide adenine dinucleotide — NAD+ — is a coenzyme found in every living cell in the human body, and its role in cellular energy metabolism, DNA repair, and neurological function has made it one of the most studied molecules in longevity and neuroscience research over the past two decades. NAD+ levels decline naturally with age and are further depleted by chronic stress, alcohol use, substance use, and inflammatory conditions — a convergence of factors that affects a significant portion of the patients we see at Infuse RVA in South Chesterfield. Our team offers IV NAD+ therapy as part of a comprehensive approach to mental health and neurological recovery, and we want patients across the greater Richmond area to understand what the science actually supports — and what it does not.
How NAD+ Works in the Body
NAD+ functions as a cofactor for hundreds of enzymatic reactions in the body, most critically in the mitochondria, where it is essential for converting food into cellular energy through the process of oxidative phosphorylation. Beyond energy production, NAD+ activates a class of enzymes called sirtuins, which are involved in DNA repair, inflammation regulation, and cellular stress response. It also plays a role in the function of poly(ADP-ribose) polymerases (PARPs), which are critical for genomic stability. The interconnection of these systems means that NAD+ depletion has downstream effects that extend well beyond fatigue — affecting cognitive function, emotional regulation, cellular repair capacity, and the brain’s ability to respond to stress.
Why IV NAD+ Delivery Matters
At Infuse RVA, our team administers NAD+ intravenously, which allows for significantly higher plasma concentrations than oral NAD+ precursors such as NMN or NR can achieve through standard supplementation. While oral precursors have a legitimate role in maintenance-level support, the clinical context in which we use IV NAD+ therapy involves patients with meaningful functional impairment — chronic fatigue, cognitive fog, recovery from substance dependence, or depleted neurological resources following prolonged psychiatric illness — where the speed and magnitude of NAD+ repletion matters. IV delivery also allows our team to monitor the patient’s response and adjust the infusion rate to manage common side effects such as flushing, nausea, or chest tightness, which are typically related to infusion speed rather than the molecule itself.
Who Is NAD+ Therapy For?
The patient population for whom NAD+ therapy has the most established clinical rationale at Infuse RVA includes individuals in recovery from alcohol or opioid dependence, patients with chronic fatigue and brain fog that has persisted despite conventional treatment, and patients undergoing neurological recovery following periods of prolonged stress, depression, or substance depletion. The mechanism in addiction recovery is particularly compelling: chronic alcohol and opioid use significantly deplete NAD+ stores in the brain, and this depletion contributes to the dysphoric, low-energy state that characterizes early recovery and drives relapse. Repletion of NAD+ through IV therapy has been used clinically in addiction medicine for decades, and our team applies that framework with patients who are working to rebuild neurological function alongside other behavioral and psychiatric support.
Our approach to NAD+ therapy does not exist independently of our broader clinical practice. Many patients receiving NAD+ therapy at Infuse RVA are doing so as a complement to IV ketamine infusions, SPRAVATO® treatment, or vitamin therapy — because we recognize that the neurological conditions driving their symptoms have multiple contributing factors that deserve a multi-pronged approach. A patient whose depression has not responded fully to IV ketamine may have depleted NAD+ levels contributing to residual fatigue and cognitive impairment; addressing that depletion can support the full therapeutic picture. This is not speculative — it reflects the clinical reasoning our team applies to each patient’s situation individually.
Addressing Common Concerns
One barrier to NAD+ therapy that we hear frequently from prospective patients in the Richmond area is uncertainty about what the treatment is actually for and skepticism born from its association with wellness marketing. We share that skepticism about overclaiming. NAD+ is not a cure for depression, anxiety, aging, or any specific disease — and we do not present it that way. What we offer is a biologically grounded intervention for patients with specific clinical indications, administered by a medical team that evaluates each patient’s candidacy before recommending it. If NAD+ therapy is not the right fit for your situation, we will tell you that. Discuss your history and goals with our team, and we will give you an honest assessment.
What to Expect from the Time Commitment
A second barrier is the commitment of time that IV NAD+ therapy requires. Unlike shorter IV vitamin infusions, NAD+ sessions often run two to four hours per session and are typically administered over multiple consecutive days for the initial course. We work with patients to structure scheduling that minimizes disruption to their work and family commitments while ensuring the protocol delivers the intended clinical benefit. Our South Chesterfield facility is designed with patient comfort in mind, and our team remains present throughout infusions to monitor tolerance and adjust as needed. Results vary by individual, and we are transparent with each patient about what a realistic course of treatment looks like and what outcomes are supported by the available evidence.
For patients curious about how NAD+ therapy fits alongside other neurological recovery tools, our post on the neurological benefits of ketamine therapy offers useful context on how the brain responds to targeted infusion-based treatments.
Frequently Asked Questions
What Conditions Does Infuse RVA Use NAD+ Therapy to Address?
We most commonly use NAD+ therapy for patients in recovery from alcohol or opioid dependence, patients with chronic fatigue and cognitive fog, and patients whose neurological recovery from depression or chronic stress has been incomplete. We evaluate each patient individually and only recommend NAD+ where there is a clinical rationale based on their specific history.
How Is IV NAD+ Different from NAD+ Supplements?
Oral NAD+ precursors like NMN and NR are converted to NAD+ through a multi-step metabolic process with variable efficiency. IV administration bypasses the digestive tract entirely, delivering NAD+ directly into the bloodstream at concentrations that oral supplementation cannot match. This distinction matters most for patients with significant depletion or impaired gut absorption.
How Many NAD+ Sessions Will I Need?
Initial courses typically involve daily sessions over three to five consecutive days, followed by maintenance infusions as needed based on individual response. Our team will design a protocol based on your clinical situation and discuss realistic expectations during your initial consultation.
Can NAD+ Therapy Be Combined with IV Ketamine?
Yes. We frequently incorporate NAD+ therapy into comprehensive treatment plans that include IV ketamine or SPRAVATO® at Infuse RVA. The timing and sequencing are determined based on each patient’s clinical picture. Our team will help you understand how these treatments interact and why a combined approach may be appropriate for your situation.
Is NAD+ Therapy Covered by Insurance?
Coverage for IV NAD+ therapy is limited with most commercial insurance carriers. We provide transparent pricing and discuss payment options during your consultation. Contact our South Chesterfield office for current pricing information.
Key Takeaways
- NAD+ is an essential coenzyme for cellular energy production, DNA repair, and neurological function, and its levels decline with age, chronic stress, and substance use.
- IV NAD+ delivers higher plasma concentrations than oral supplementation and is administered over multi-hour sessions monitored by our clinical team.
- At Infuse RVA, NAD+ therapy is most commonly used for addiction recovery support, chronic fatigue, and neurological recovery alongside other treatments.
- It is not a standalone cure for any condition — our team evaluates each patient’s candidacy based on clinical history.
- Results vary by individual; discuss whether NAD+ therapy fits your treatment goals with our team.
Conclusion
The body’s capacity for neurological recovery is not unlimited — it depends on the biochemical resources available to fuel that recovery. At Infuse RVA in South Chesterfield, our team incorporates NAD+ therapy as a clinically grounded tool for patients whose neurological depletion is part of what is holding their recovery back. Whether you are in recovery from substance dependence, managing chronic fatigue, or looking for support alongside your ketamine treatment, we encourage you to reach out and explore whether NAD+ therapy belongs in your plan. Schedule a consultation with our team today or visit Infuse RVA online to learn more.
References
National Institutes of Health. NAD+ metabolism and its roles in cellular processes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608030/
Science. NAD+ in aging, metabolism, and neurodegeneration. https://www.science.org/doi/10.1126/science.aac4854
Cleveland Clinic. NAD+ Therapy. https://my.clevelandclinic.org/health/treatments/nad-therapy
National Institute on Drug Abuse. The neuroscience of addiction. https://nida.nih.gov/research-topics/neuroscience
About Infuse RVA Team
At InfuseRVA Ketamine & Wellness in South Chesterfield, VA, our team works specifically with patients in the greater Richmond area who have not found adequate relief through conventional treatment — those whose depression, PTSD, anxiety, or chronic pain persists despite prior medication and therapy trials. We evaluate each patient individually before recommending any treatment approach, with IV ketamine infusion therapy and SPRAVATO® (esketamine) available for patients who meet criteria for treatment-resistant depression following a thorough clinical review. Our care is built around both the physical and emotional dimensions of mental health: we take the whole patient seriously, from unexplained physical symptoms to the longer history that brought them to our door.
Medical Disclaimer
This content is provided by Infuse RVA for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. NAD+ therapy and all other treatments discussed should be evaluated in the context of your individual health history by a qualified medical provider. Results vary by individual, and no outcomes are guaranteed. Please discuss all treatment options with your provider before making any decisions about your care.
