{"entity":{"id":"rejuv-frontier-nad-precursors","kind":"technology","name":"NAD+ precursors taken by mouth","aka":[],"tldr":"NAD+ falls with age, and swallowing a precursor raises it in the blood. That much is established. Whether raising it does anything for a person who has had cancer is not. The one B3 compound with a real cancer result is plain nicotinamide, for preventing skin cancers in people who keep getting them, which is a different claim entirely.","summary":"Nicotinamide riboside and nicotinamide mononucleotide are precursors of nicotinamide adenine dinucleotide. They raise blood NAD+ reliably: in NR-SAFE, a randomised double-blind trial of 20 people with Parkinson's disease given 1,500 mg twice daily for four weeks, there were no moderate or severe adverse events and blood NAD+ rose up to fivefold. That is a safety and pharmacokinetic result, not an efficacy one, and the trial was in Parkinson's disease, not cancer.\n\nThe compound in this family with a hard clinical result is nicotinamide itself. In the ONTRAC trial, 386 people who had had at least two non-melanoma skin cancers in the previous five years took nicotinamide 500 mg twice daily or placebo for 12 months. New non-melanoma skin cancers were 23 per cent lower (95% CI 4 to 38, P = 0.02), with no noteworthy difference in adverse events and no benefit after the drug was stopped. That is a chemoprevention result in a high-risk skin group; it is not evidence that nicotinamide, or any NAD+ precursor, slows ageing or repairs anything after chemotherapy.\n\nThere is no randomised trial of an NAD+ precursor in cancer survivors for recovery, fatigue or biological age. There is also an unresolved laboratory question about whether raising NAD+ favours tumour cells, which NAD-dependent repair enzymes also use; no human data settle it either way. The honest summary is that these are well tolerated, do what they say to a blood level, and have never been shown to do anything a survivor would notice.","status":"phase-2","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Nicotinamide_riboside","links":[{"label":"Brakedal et al., NR-SAFE: a randomized, double-blind safety trial of high dose nicotinamide riboside in Parkinson's disease (Nat Commun 2023)","url":"https://doi.org/10.1038/s41467-023-43514-6"},{"label":"Chen et al., A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention, ONTRAC (NEJM 2015)","url":"https://doi.org/10.1056/NEJMoa1506197"}],"tags":["rejuvenation","survivorship","evidence:insufficient","supplement"],"related":["rejuv-frontier-nad-infusions"],"cancers":[],"sections":["rejuvenation","supportive-care"],"technologies":["survivorship-care-plan"],"targets":[],"drugs":["nicotinamide"],"companies":[],"institutions":[],"pathways":[],"terms":["late-effects"],"trials":[],"people":[],"bottlenecks":["b-survivorship"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"NAD+ is the cofactor for sirtuins, PARPs and CD38 and falls with age in several tissues. Oral precursors enter the salvage pathway and raise NAD+ in blood and some tissues; the hypothesis is that restoring the cofactor restores sirtuin-dependent repair and mitochondrial function.","strengths":["Oral dosing reliably raises blood NAD+, demonstrated in randomised trials","Well tolerated at high doses over weeks","Plain nicotinamide has a positive randomised chemoprevention result in high-risk skin cancer"],"limitations":["No randomised trial in cancer survivors for any rejuvenation outcome","Raising a blood level is not an outcome","Unresolved laboratory question about NAD+ availability to tumour cells","Marketed with claims the trials do not support"]},"route":"/technologies/rejuv-frontier-nad-precursors/","neighbours":{"technology":[{"id":"rejuv-frontier-nad-infusions","kind":"technology","name":"Intravenous NAD+ drips","route":"/technologies/rejuv-frontier-nad-infusions/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"drug":[{"id":"nicotinamide","kind":"drug","name":"Nicotinamide","route":"/drugs/nicotinamide/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}]}}