What Not to Mix with NAD Supplements: A Guide to Drug and Supplement Interactions

October 6, 2025 •

4 min read

While NAD supplements are gaining popularity for their potential anti-aging and cellular health benefits, it's a critical fact that they can have significant interactions with certain medications and other supplements. What not to mix with NAD supplements is a serious consideration, especially for individuals with chronic health conditions or those on long-term medication plans.

Quick Summary

Potential drug interactions exist between NAD boosters and various medications, including those for high blood pressure, diabetes, blood thinning, and cancer treatments. Combining NAD supplements with certain other antioxidants or melatonin can also alter their effects. Always consult a healthcare professional before combining NAD supplements with any other substance.

Key Points

Blood Pressure Meds: High-dose NAD supplements may lower blood pressure, which can cause dangerous hypotension when combined with antihypertensive drugs.
Diabetes Meds: NAD boosters can affect insulin sensitivity and glucose metabolism, potentially impacting the effectiveness of drugs like insulin and metformin.
Cancer Treatments: Avoid NAD supplements during chemotherapy, as they can interfere with treatment effectiveness and may fuel cancer cell growth.
Blood Thinners: Supplements containing niacin, a precursor to NAD, can affect anticoagulants like warfarin and increase bleeding risk.
Alcohol and Sugar: Consuming alcohol, high sugar, and processed foods can deplete NAD+ levels and interfere with the supplement's effectiveness.
Melatonin: Combining NAD supplements with melatonin may amplify sleepiness and cause excessive grogginess due to their effects on the circadian rhythm.

NAD (Nicotinamide Adenine Dinucleotide) is a vital coenzyme found in every cell of the body, essential for energy metabolism and healthy cellular function. As NAD levels naturally decline with age, supplements designed to boost its levels, such as Nicotinamide Riboside (NR) and Nicotinamide Mononucleotide (NMN), have become popular. However, their widespread availability does not negate the potential for significant interactions with other drugs, supplements, and even dietary choices. Understanding these risks is crucial for anyone considering adding an NAD booster to their health regimen.

Medications with Significant Interactions

Several classes of prescription medications can interact with NAD supplements, potentially altering their efficacy or increasing the risk of adverse side effects. These interactions are a primary reason to consult a healthcare provider before beginning supplementation.

Blood Pressure Medications

Certain NAD supplements, particularly high doses of precursors like nicotinamide riboside, may have a blood pressure-lowering effect. For individuals already taking antihypertensive drugs to manage high blood pressure, combining these could lead to a dangerous drop in blood pressure, a condition known as hypotension. This can cause dizziness, lightheadedness, and even fainting.

Diabetes Medications

NAD supplements can influence glucose metabolism and insulin sensitivity, which is a concern for people with diabetes. For example, studies suggest that high doses of some NAD precursors might decrease insulin sensitivity, potentially interfering with the effectiveness of medications like insulin and metformin. The complex interplay between NAD and blood sugar regulation means that monitoring is essential.

Cancer Treatments

This is one of the most critical and complex interactions. Some cancer cells are known to use NAD+ to fuel their growth and repair. While some research explores using NAD+ against certain cancers, the consensus for individuals undergoing treatment is often to avoid boosting NAD+ levels. Some chemotherapy drugs are specifically designed to deplete NAD+ in order to starve cancer cells, and supplementation could counteract this intended effect. Always discuss with an oncologist before taking any supplements.

Blood Thinners (Anticoagulants)

NAD boosters, especially precursors that contain niacin, can affect the metabolism of anticoagulant medications like warfarin (Coumadin). This interaction could alter how long it takes for blood to clot, increasing the risk of bleeding complications. Close monitoring of the International Normalized Ratio (INR), a measure of clotting time, is advised if these are taken concurrently.

Antidepressants

Limited but inconclusive research suggests that NAD boosters may interact with medications for depression. Some antidepressants can affect the body's NAD levels, and taking supplements might influence the effectiveness of these mental health medications. Consultation with a doctor is necessary to understand potential effects on mood and medication efficacy.

Other Supplements and Substances to Watch Out For

Other Anti-Aging Supplements and Antioxidants

Some popular anti-aging and antioxidant supplements can amplify the effects, and potentially the side effects, of NAD boosters.

Quercetin and Resveratrol: These antioxidants are known to influence NAD levels. When taken alongside an NAD booster, they may magnify both the desired effects and potential side effects, such as flushing or abdominal discomfort.
High-Dose Niacin: While niacin (vitamin B3) is a precursor to NAD, supplementing with high doses can paradoxically deplete NAD levels and cause significant side effects like flushing. It should be avoided when taking other NAD precursors like NMN or NR.

Melatonin

NAD supplements can influence the circadian rhythm, the body's natural sleep-wake cycle. Since melatonin is also involved in regulating sleep, combining the two may amplify sleepiness and potentially cause excessive grogginess or fatigue.

Alcohol, Sugar, and Processed Foods

Certain lifestyle choices can also interfere with NAD supplementation.

Alcohol: Alcohol consumption is known to deplete NAD+ levels and can counteract the benefits of supplementation. It is recommended to avoid alcohol for at least 24-48 hours around treatment.
High Sugar and Refined Carbohydrates: These can cause blood sugar spikes that interfere with how the body processes NAD+, and are best avoided, especially before an IV infusion.
Heavy or Processed Foods: Eating heavy, fatty meals or processed foods can place a burden on the digestive system, potentially increasing the likelihood of nausea during NAD treatment.

Potential Drug Interactions with NAD Supplements


Interaction	Medication Class	Potential Outcome	Important Consideration
Blood Pressure Meds	Antihypertensives	Dangerous drop in blood pressure (hypotension)	Monitor blood pressure closely with a doctor's supervision.
Diabetes Meds	Insulin, Metformin	Altered insulin sensitivity, potentially affecting blood sugar levels	Careful blood glucose monitoring is necessary.
Cancer Treatments	Chemotherapy	Reduced effectiveness of chemotherapy; may fuel cancer cell growth	Avoid unless specifically advised by an oncologist.
Blood Thinners	Warfarin	Increased risk of bleeding due to altered clotting time	Regular INR monitoring is essential with a doctor.
Antidepressants	SSRIs, SNRIs	May interfere with medication efficacy by affecting NAD levels	Consult a doctor before combining to assess impact on mood.
Other Supplements	Resveratrol, Quercetin	Amplified effects and potential side effects	Use with caution and consider starting with lower doses.
Melatonin	Sleep aids	Excessive drowsiness or fatigue due to combined effect on circadian rhythm	Avoid taking simultaneously to prevent excessive sleepiness.

Conclusion

Navigating the world of supplements requires a thoughtful and informed approach, especially concerning potent compounds like NAD boosters. While NAD offers promising potential for cellular health and anti-aging, ignoring potential interactions with medications, other supplements, and lifestyle factors can be dangerous. The lack of extensive long-term human studies underscores the importance of a cautious approach. Always engage in an open discussion with a healthcare provider before initiating NAD supplementation, particularly if you have pre-existing health conditions or are taking any other medications. This proactive step ensures your safety and helps maximize any potential benefits while minimizing risks.

For more detailed information on supplement interactions, the National Institutes of Health provides extensive resources on dietary supplements. National Institutes of Health (NIH) | Dietary Supplements

Frequently Asked Questions

You should not take NAD supplements with blood pressure medication without strict medical supervision. NAD precursors can significantly lower blood pressure, which, when combined with antihypertensive drugs, could lead to dangerous hypotension.

NAD supplements can affect how your body regulates blood sugar and processes insulin. This can alter the effectiveness of diabetes medications like insulin and metformin. Any use should be managed with your doctor and involve close blood glucose monitoring.

It is generally not recommended to take NAD supplements during chemotherapy. Some cancer treatments work by depleting NAD+, and supplementing could interfere with the treatment's mechanism and potentially support cancer cell growth. Always consult an oncologist first.

Combining NAD boosters with blood thinners requires caution. Some NAD precursors, particularly those containing niacin, can affect blood clotting time and increase the risk of bleeding. Close medical monitoring of INR is essential if you choose to combine them.

The research on this is limited, but NAD supplements may interact with antidepressants by affecting the body's natural NAD levels. This could potentially alter the efficacy of your mental health medication, so you should consult a doctor before starting.

Yes, you should avoid alcohol while taking NAD supplements. Alcohol consumption is known to deplete NAD+ levels and can counteract the intended benefits of supplementation. It is best to avoid alcohol for at least 24 to 48 hours around treatment.

Combining melatonin and NAD supplements is not recommended. Both can influence the circadian rhythm and sleep cycles, and taking them together may amplify sleepiness, potentially leading to excessive grogginess or fatigue.