Which supplements or medications are best not combined with NAD+?
The combination of NAD+ supplements (particularly nicotinamide) with platinum-based chemotherapy is the most concrete reason for caution; for other interactions the indications are preliminary but worth discussing with your doctor if you are using multiple substances.
The most direct warning applies to cancer patients receiving platinum-based chemotherapy (cisplatin): nicotinamide, a widely used NAD+ building block, can form a chemical compound with cisplatin. This reduces the amount of active platinum available to kill cancer cells. This has been observed in cell studies, not in humans, but the mechanism is specific enough to take seriously. Always discuss the use of NAD+ supplements with your oncologist if you are undergoing platinum-based chemotherapy.
A second, more subtle tension lies in nicotinamide itself. As an NAD+ building block, it supplies NAD+. But at high doses, nicotinamide simultaneously inhibits the enzyme SIRT1, which in turn needs NAD+ to function properly. That enzyme helps regulate oxidative stress. At excessively high doses of nicotinamide, that protective effect can therefore be lost, increasing free radical activity and inflammation. This has been demonstrated in cell studies, not in clinical research in humans.
Experimental cancer drugs that block NAD+ production (NAMPT inhibitors) cause dangerous platelet shortages. Nicotinic acid (niacin, another form of vitamin B3) can partially offset that damage via an alternative pathway. This shows that the NAD+ pathway is sensitive to disruption by medications and that B3 variants can interfere with one another.
Popular supplements such as quercetin, genistein, Ginkgo Biloba, soy isoflavones and milk thistle contain plant compounds that inhibit or activate liver enzymes. Those enzymes also break down many medications. Anyone combining NAD+ supplements with other substances that run through the same liver pathways risks having the effect of those medications strengthened or weakened. This is a broad interaction risk, not specific to NAD+, but relevant if you are taking multiple supplements or medications at the same time.
Sulforaphane (broccoli sprout extract) and fucoidan (a seaweed supplement) disrupt similar liver pathways. Sulforaphane clashed in cell studies with common medications such as the diuretic furosemide, the heart medication verapamil and the painkiller ketoprofen. Fucoidan inhibited liver enzymes in laboratory research. The evidence for this is limited and does not come from studies in humans, but the message is clear: even 'natural' supplements can unexpectedly interfere with medications.
All claims are based on cell and/or animal studies (PMID 42278515, 28000862, 25894564, 16289744, 23238480, 29096568). No large human RCTs or meta-analyses are available on these specific combinations. The level of evidence is therefore limited to preliminary mechanistic and toxicological indications.
Which supplements are best avoided in combination with blood thinners?
Several supplements can strengthen or weaken the effect of blood thinners; always mention them to your pharmacist or doctor before you start using them.
Are NAD+ supplements (NMN/NR) worth it?
NMN and NR demonstrably raise NAD+ in your blood and appear to be safe, but whether you will actually notice any difference in muscle strength, heart function or memory? That is far from proven in humans. Note too: NR is authorised as a supplement in the EU, NMN is not (yet).
What should you preferably not combine with creatine?
Combining creatine with caffeine produces no additional athletic performance benefits and can cause mild gastrointestinal complaints. If you want to use both, it is better to take them separately.
Does a NAD+ infusion do something that an NMN pill does not?
There is no study that directly compares a NAD+ infusion with an oral NMN pill, so any advantage of the infusion has not been demonstrated. If you want to start NAD+ support, oral NMN is the only option with some clinical backing.
What is NAD+ and what does it do in your body?
NAD+ is an indispensable molecule for energy, DNA repair and cell health, but the question of whether you should actively raise those levels for better health has not yet been answered for humans.
Which foods or habits effectively raise NAD+ levels?
Exercise and NAD+ supplements (NR or NMN) demonstrably raise NAD+ levels, but whether higher levels also confer health benefits in humans has not yet been proven. If you want to take action, regular physical exercise is the only approach for which broader health benefits have also been demonstrated.