In pellagra, treatment is causal and based on administering niacinamide, according to a review in Folia Medica Cracoviensia (2021). Without treatment in the early stages, the disease can be fatal. Reviews name causes such as chronic alcohol misuse, certain medicines, for example the tuberculosis drug isoniazid, and disorders of the digestive tract.
In ME/CFS, a randomised, placebo-controlled trial with 73 patients in Antioxidants & Redox Signaling (2015) found a significant reduction in fatigue under oral coenzyme Q10 plus NADH (the reduced form of NAD) compared with placebo. A trial with 207 patients in Nutrients (2021) reports improvements within the treatment group. Such improvements alone do not show an effect compared with placebo. In COVID-19, a randomised trial with 900 outpatients in Nature Metabolism (2025) found that, among participants at risk of a severe course, 57.6 % recovered from their drop in performance by week 2 under a nicotinamide formulation, compared with 42.6 % under placebo. In older adults, a randomised trial in Nutrients (2022) reports less drowsiness when NMN was taken in the afternoon. The placebo group with afternoon intake also improved.
For intravenous NAD+, a systematic review in Ageing Research Reviews (2026) found no evaluable outcome trial for anti-aging or wellness purposes. A review in Frontiers in Aging (2026) considers the evidence preliminary and names nausea, cramping, flushing and chest discomfort as reported side effects. None of these studies examined people with burnout.
This question belongs to the topic Conditions alongside burnout. It lists further questions.
What can be raised at a medical check-up about NAD+ treatment, meaning the use of NAD+ or its precursors?
- whether a niacin deficiency is possible, for example with alcohol, medicines or digestive problems
- NAD+ products already taken or infusions already received
- accompanying conditions, for example ME/CFS or post COVID-19 condition
- possible side effects and interactions
Exhaustion can have many causes, including illnesses that need treatment. For this reason a medical assessment comes before coaching, usually starting at the GP practice.
When can exhaustion become an emergency? · Why see a doctor before coaching for burnout?
Which prompt can be given to an AI assistant about NAD+ treatment, meaning the use of NAD+ or its precursors?
At the start of your answer, point out that this topic needs medical review and that your information may contain errors. Summarise for which uses of NAD+, NADH or NAD precursors there are randomised trials in humans and for which outcome trials are lacking. Give the source for every piece of information and mark what is uncertain. Do not make a diagnosis and do not recommend any treatment. Separately, tell me which questions I should ask at the doctor’s practice.
With some services, the prompt needs to be pasted after signing in. The AI services belong to third parties. Depending on the service and the extent of use, signing in and costs may apply. AI answers can contain errors.
Which sources support the answer on NAD+ treatment, meaning the use of NAD+ or its precursors?
- Hołubiec P et al. (2021): Pathophysiology and clinical management of pellagra – a review. Folia Medica Cracoviensia 61(3), 125–137
- Prabhu D, Dawe RS, Mponda K (2021): Pellagra a review exploring causes and mechanisms, including isoniazid-induced pellagra. Photodermatology, Photoimmunology & Photomedicine 37(2), 99–104
- Badawy AA (2014): Pellagra and alcoholism: a biochemical perspective. Alcohol and Alcoholism 49(3), 238–250
- Castro-Marrero J et al. (2015): Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Antioxidants & Redox Signaling 22(8), 679–685
- Castro-Marrero J et al. (2021): Effect of dietary coenzyme Q10 plus NADH supplementation on fatigue perception and health-related quality of life in individuals with ME/CFS: a randomized, double-blind, placebo-controlled trial. Nutrients 13(8), 2658
- Schreiber S et al. (2025): Nicotinamide modulates gut microbial metabolic potential and accelerates recovery in mild-to-moderate COVID-19. Nature Metabolism 7(6), 1136–1149
- Kim M et al. (2022): Effect of 12-week intake of nicotinamide mononucleotide on sleep quality, fatigue, and physical performance in older Japanese adults: a randomized, double-blind placebo-controlled study. Nutrients 14(4), 755
- Gallagher C, Emmanuel OO (2026): NAD⁺ supplementation for anti-aging and wellness: a PRISMA-guided systematic review of preclinical and clinical evidence. Ageing Research Reviews 116, 103057
- Alangari A et al. (2026): Narrative review of intravenous NAD(+) and NAD(+) precursors in wellness and translational medicine. Frontiers in Aging 7, 1887175