NAD+ in clinical practice: 5 takeaways from Dr. Loseke’s webinar

NAD+ (Nicotinamide Adenine Dinucleotide) has been used clinically since the 1960s for addiction treatment. Most providers are just discovering its applications now.

Dr. Melissa Loseke, D.O., admits she was skeptical. “I was not a big fan of NAD until I really kind of did a deep dive into the science, the benefits, and why we should be using it,” she shares.

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Her recent webinar hosted by Evitalin breaks down the research, real-world protocols, and practical implementation strategies that changed her mind.

In this session, Dr. Loseke covers patient selection, dosing protocols across different delivery methods, safety considerations, and the surprising patient populations who respond best.
Whether you’re considering adding NAD+ to your practice or refining your current protocols, these five takeaways will reshape how you think about cellular health optimization.

The decline starts earlier than you think

By age 50, NAD+ levels drop by nearly 50%. Oftentimes, Dr. Loseke explained, “the decline in NAD actually precedes any fatigue, cognitive decline, and metabolic dysfunctions that we see.”

Most providers run through a mental checklist when patients complain of fatigue: ferritin, vitamin D, B12, hormone status, thyroid function. NAD+ rarely makes that initial list. Dr. Loseke suggests reframing the approach. “Adding NAD to that almost immediate list of, well, I wonder what their NAD status looks like,” she says, could catch deficiencies before they progress.

The enzyme that produces NAD+ (NAMPT) decreases with age, stress, and inflammation. Dietary intake alone becomes insufficient to maintain adequate levels as patients get older. That makes supplementation increasingly important for maintaining cellular function, energy production, and DNA repair.

Patients often appear at your clinic after the decline has already impacted their quality of life. Testing options are not yet widely used, so clinical response becomes your first gauge. Most patients who supplement NAD+ report energy improvements within 24-48 hours, followed by better cognition, focus, and mental stamina.

Post-viral patients show remarkable responses

Dr. Loseke sees particular relevance in today’s clinical landscape. “As soon as we start talking post-viral, one of the places my mind goes to is in post-COVID patients,” she notes.

Post-viral syndromes create a high NAD+ debt. The body burns through stores fighting infection and managing inflammation. “We’ve probably all either been exposed, had COVID, or have been potentially vaccinated against it,” she said, “so such a role in everybody, especially in anybody who has had COVID and is continuing to struggle with ongoing symptoms.”

NAD+ supports immune balance by helping macrophages fight pathogens without overreacting. It helps rebalance the TH1 and TH2 response, which proves critical for immunity and protection against autoimmune disease. For patients with lingering symptoms months after viral illness, NAD+ addresses the cellular dysfunction at the root.

The mechanism makes sense. NAD+ is required for ATP production through glycolysis and the citric acid cycle. It activates PARP enzymes that repair damaged DNA. It fuels sirtuins (longevity genes) that regulate inflammation and mitochondrial health. Post-viral patients need all of these functions restored.

Treatment-resistant depression represents another promising application. NAD+ maintains dopamine, serotonin, and GABA levels through its role in neurotransmitter production. Dr. Loseke identifies this as “one great place to start thinking of NAD.”

Delivery method determines outcomes

Subcutaneous, IV, oral, liposomal, nasal spray. The options multiply, but they differ dramatically in effectiveness. Dr. Loseke offers clear guidance: “If you can buy it from Amazon, the quality is…probably not that great.”

Oral formulations lose substantial amounts through first-pass metabolism. IV and subcutaneous bypass gut degradation entirely, delivering near 100% bioavailability. “IV can raise tissue levels up to almost 10 to 20 times in about two to four hours,” Dr. Loseke explains, which accounts for both its effectiveness and the caution required.

Most capsules prove disappointing. The swish-and-swallow formulations or liposomal preparations work better if patients want an oral option. Nasal sprays exist, but Dr. Loseke admits, “I don’t think that the nasal works as well.”

In the end, patient selection drives the choice. Someone with mild mitochondrial dysfunction might respond to oral or nasal delivery. Post-viral patients, autoimmune conditions, or severe fatigue typically require subcutaneous or IV protocols. “This is gonna be kind of my step up for somebody who has some more severe dysfunction and some dysregulation that I suspect is really taking their NAD levels,” she says about IV therapy.

Subcutaneous offers the sweet spot for most patients: effective, affordable, and manageable at home once trained. Dr. Loseke typically starts at 25-50mg two to three times weekly, reassesses in 30 days, and adjusts based on response. Maximum dosing reaches 200mg two to three times weekly for patients who need it.

Patient selection prevents problems

Here’s where clinical judgment becomes essential. More NAD+ doesn’t always mean better outcomes. The top one-percenter already optimized for mitochondrial health might actually experience increased inflammation from additional NAD+.

“If we’re giving this to someone who doesn’t really need NAD because they are fairly well optimized, mitochondrial health is already great, and we add additional NAD, you can actually get an increase in inflammation throughout the body,” Dr. Loseke warns. That includes muscle, joint, cardiac, and organ inflammation.

The patient with a VO2 max already in the excellent range, no suspected mitochondrial dysfunction, and peak performance might not need NAD+. “They’re gonna be that person where I’m gonna be a little more hesitant, or I’m gonna start even lower and slower than I would in a normal patient.”

Active cancer remains an absolute contraindication from a protective standpoint. History of cancer requires conversation between patient and oncologist before proceeding. Pregnancy and breastfeeding lack safety data. G6PD deficiency carries rare hemolysis risk with high-dose niacin.

Hypotension deserves attention because of vasodilation effects. Patients on blood pressure medications, erectile dysfunction drugs, or nitroglycerin need careful monitoring. “Start low, slow, what does that frequency look like for that patient. And just make sure that they know what to look for from a hypotensive standpoint.”

The ideal patient shows signs of mitochondrial dysfunction, post-viral syndrome, metabolic issues, or performance optimization needs. Athletes recovering from training, anyone with brain fog and fatigue, and patients working on metabolic health all fit the profile.

Dr. Loseke’s shorthand for the ideal patient: “Anyone who you suspect mitochondrial dysfunction in.”

NAD+ makes other therapies work better

Think of NAD+ as a cellular primer. It amplifies what you’re already doing. Dr. Loseke explains: “NAD can definitely amplify other treatments. ..think of NAD as that cellular primer that’s gonna make everything else work better.”

Peptides pair particularly well. BPC-157 and TB-500 show faster tissue repair through increased tissue perfusion when combined with NAD+. HGH peptides gain effectiveness. The energy amplification enhances outcomes across the board.

Hormone optimization or replacement therapy becomes more effective. Patients who’ve “hit the wall” despite optimal lab values might need NAD+ added to the protocol. The same applies to thyroid management. Better energy utilization through enhanced mitochondrial function leads to improvements in energy, cognition, and libido.

Detoxification represents NAD+’s original clinical use. Beyond addiction treatment for opioids and alcohol, it supports phase one and phase two liver detox. Patients dealing with mold or environmental toxin exposure benefit from the cellular support.

Hyperbaric oxygen therapy gains synergistic mitochondrial boost. Senolytics (zombie cell clearers) work alongside NAD+ to help patients rebuild. “There are very few therapies where you can’t layer it in with,” Dr. Loseke notes.

The key remains strategic layering. “Don’t start too many mitochondrial treatments at the same time,” she cautions. If patients start four interventions simultaneously and feel better (or worse), you lose the ability to identify what’s working. Start NAD+, assess response, then add complementary therapies based on individual need.

Watch the complete webinar

Dr. Loseke’s full presentation includes live injection demonstration, detailed dosing protocols by condition, safety monitoring guidelines for in-clinic and at-home use, contraindication discussion, and Q&A addressing common provider questions about implementation.

Access the complete complimentary webinar to see exactly how Dr. Loseke approaches patient selection, performs subcutaneous injections, monitors for side effects, and combines NAD+ with other therapies for optimal outcomes.

The free session provides the clinical confidence you need to implement NAD+ therapy safely and effectively in your practice.

Evitalin does not compound medications. Our Pharmacy Partner is a 503A compounding pharmacy and all medications through them require a prescription. This content is educational and not a substitute for personalized medical advice from your healthcare provider.