Aging brings new challenges, including reduced energy and a slower metabolism, as well as increased vulnerability to chronic conditions. One of the underlying drivers of these changes is a natural decline in nicotinamide adenine dinucleotide (NAD+), a compound your body relies on for metabolism, DNA repair, and cellular vitality. That’s why many people are turning to NAD+ therapy, which helps restore these levels and helps you feel stronger, sharper, and healthier.

At Genesis Lifestyle Medicine, we believe in healing from the inside out. NAD+ therapy can be a powerful addition to your wellness plan, but it shouldn’t be approached casually. Like any supplement, NAD+ may interact with medications you already take. Knowing which combinations to avoid is crucial for maximizing benefits while staying safe.

How NAD+ may interact with your medications

NAD+ is deeply connected to your body’s metabolic and cellular processes. While this is why supplementation can be so beneficial, it also means NAD+ can affect how certain medications are absorbed, metabolized, or activated. Below, we describe some of the most important drug interactions to be aware of if you’re considering or already undergoing NAD+ therapy.

Insulin and blood sugar-lowering medications

If you manage diabetes with insulin or medications like metformin, NAD+ may alter your glucose response. High doses of nicotinamide (a precursor to NAD+) have been shown to reduce insulin sensitivity, meaning your body doesn’t respond as effectively to insulin. This can raise your blood sugar and counteract the intended effects of your medication. If you’re on diabetes medication, only pursue NAD+ under medical supervision and monitor your blood sugar.

Blood pressure medications

NAD+ has been linked to reductions in blood pressure when taken in high doses (above 2 grams per day). While this might sound beneficial, if you’re already taking antihypertensives, the combined effect may drop your blood pressure too low. Hypotension can cause dizziness, fainting, and dangerous cardiovascular stress. Work with your healthcare provider to monitor your blood pressure and adjust your medications as needed.

Cancer treatments

NAD+ fuels both healthy and unhealthy cells. Unfortunately, some cancer therapies rely on lowering NAD+ levels to limit tumor growth. Supplementing during chemotherapy can potentially interfere with treatment, making cancer cells more resistant. If you’re receiving chemotherapy or radiation therapy, avoid NAD+ unless specifically cleared by your oncologist.

Blood thinners

Niacin (a form of vitamin B3 that contributes to NAD+ production) can change how anticoagulants like warfarin are metabolized. This may increase your risk of bleeding or clotting complications. Physicians often recommend closer INR (clotting time) monitoring when patients combine these therapies. Never start NAD+ while taking blood thinners without clear medical clearance, guidance, and monitoring.

Antioxidants

Supplements like resveratrol and quercetin can naturally boost NAD+ levels. Pairing them with NAD+ therapy may supercharge results, but it can also amplify side effects such as flushing, nausea, headaches, and fatigue. Combining multiple NAD+ boosters can overwhelm your system. Discuss your supplement regimen with your provider first.

Antidepressants

The relationship between NAD+ and antidepressants is complex. Low NAD+ has been linked to mood disorders, and boosting it may help reduce symptoms of depression. At the same time, certain antidepressants influence NAD+ metabolism, meaning supplementation could alter their effectiveness. If you’re on antidepressants, seek professional guidance before starting NAD+.

Melatonin

Both NAD+ and melatonin influence your circadian rhythm. Taken together, they can deepen sleep but also cause excessive grogginess, brain fog, and fatigue the following day. Space out your doses or avoid combining unless your provider advises otherwise.

When to talk to your healthcare provider

Because NAD+ therapy is still being studied, there’s a lot we don’t yet know about its long-term safety. It is particularly important to avoid NAD+ if you are:

• Pregnant or breastfeeding
• A child or adolescent (safety data is lacking)
• Managing chronic conditions such as diabetes, hypertension, or cancer

Always consult your healthcare provider before combining NAD+ with prescription medications or other supplements. At Genesis Lifestyle Medicine, our providers don’t just administer NAD+ therapy: we personalize it to fit your overall health, medications, and long-term goals. If you’re interested in NAD+ therapy, we’ll guide you through every step, ensuring you understand the potential interactions and how to maximize your outcome.

NAD+ therapy holds promise for enhancing energy, promoting healthy aging, and enhancing overall wellness. However, like any treatment, you should consider how it may interact with other medications or supplements before starting. At Genesis Lifestyle Medicine, we are committed to helping you experience the benefits of NAD+ therapy safely. Schedule your consultation and learn how healing from the inside out can help you look and feel your best.