NAD+ Supplements and Medication Considerations
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme involved in hundreds of metabolic processes, from converting food into cellular energy to supporting DNA repair. Your body produces it naturally, but NAD+ levels decline significantly with age. Research in specific tissues suggests NAD+ levels may decline significantly with age, which has driven growing interest in supplements designed to restore them.
The most common NAD+ supplement ingredients include nicotinamide riboside (NR) or Nicotinamide mononucleotide (NMN), precursors the body converts into NAD+. Our own REFUSEtoAGE formula also contains supporting compounds like trans-resveratrol and quercetin to support the activation and absorption of the NR.
But if you're one of the roughly 131 million American¹ adults currently taking at least one prescription medication, the relevant question isn't just whether NAD+ supplements work, it's whether the ingredients in your NAD+ supplement are compatible with the medications you already take.
Here's what you should know.
How NAD+ Supplement Ingredients Can Interact With Medications
NAD+ supplements can be just the precursor NR or NMN but others aren't just one ingredient. For formulas that combine an NAD+ precursor (like nicotinamide riboside) with antioxidant and bioavailability-supporting compounds, each ingredient carries its own interaction profile, and the ones that matter most involve your liver's drug-processing system.
The Role of CYP450 Enzymes
Your liver uses a family of enzymes called cytochrome P450 (CYP450) to break down both medications and many supplement ingredients. When a supplement ingredient inhibits or accelerates one of these enzyme pathways, it can change how much of a medication actually reaches your bloodstream and how long it stays there.
This is the primary mechanism behind most supplement-drug interactions, and it's especially relevant for NAD+ formulas that include resveratrol or quercetin.
Nicotinamide Riboside (NR)
Nicotinamide riboside is a form of vitamin B3 that the body converts into NAD+. As a nutrient the body already produces and uses, NR has a relatively favorable safety profile. Clinical studies to date have not identified significant drug interactions at typical supplement doses (250–500 mg per day), and the European Food Safety Authority has evaluated it as a safe novel food ingredient².
That said, because NR is metabolized into nicotinamide (niacinamide) in the body, it shares some metabolic overlap with other forms of vitamin B3. Nicotinamide has documented interactions with certain medications³, particularly some diabetes drugs and anticonvulsants, though these interactions are generally observed at much higher doses than what NAD+ supplements typically provide.
The bottom line: NR alone is not considered a high-risk ingredient for drug interactions, but it's still worth disclosing to your healthcare provider, especially if you take medications metabolized through pathways affected by B vitamins.
Trans-Resveratrol
Resveratrol is where medication interactions become more clinically relevant. This polyphenol, found naturally in grape skins and red wine, is included in NAD+ formulas for its role in activating sirtuins which are proteins involved in cellular repair and aging.
However, resveratrol is also a known inhibitor of several CYP450 enzymes⁴, most notably CYP3A4, CYP1A2, and CYP2C9. These enzymes are responsible for metabolizing a substantial portion of all prescription drugs. When resveratrol inhibits them, it can slow down how quickly your body processes certain medications, effectively increasing the drug's concentration in your bloodstream.
Medications that deserve particular attention alongside resveratrol include:
Blood thinners (warfarin, Eliquis, Xarelto): Resveratrol has mild antiplatelet properties on its own. Combined with anticoagulant or antiplatelet medications, there's an additive effect that may increase bleeding risk⁵.
Statins (atorvastatin, simvastatin): Many statins are metabolized by CYP3A4⁶. Inhibition of this enzyme can raise statin levels in the blood, potentially increasing the risk of muscle-related side effects.
Antidepressants (certain SSRIs and SNRIs): Some antidepressants are metabolized through CYP enzymes that resveratrol can affect. Changes in drug levels can influence both efficacy and side effects.
Immunosuppressants and chemotherapy agents: These medications often have narrow therapeutic windows, meaning even small changes in blood concentration can matter. Resveratrol's enzyme inhibition is particularly relevant here.
Research also indicates that resveratrol has mild estrogen-like properties⁷, which is an additional consideration for anyone taking hormone therapies or managing hormone-sensitive conditions.
Quercetin
Quercetin is a flavonoid found in foods like onions, apples, and berries. In NAD+ supplements, it's typically included for its antioxidant and senolytic properties (helping clear damaged cells).
Like resveratrol, quercetin can inhibit CYP450 enzymes⁸ — particularly CYP3A4⁹ and CYP2C9. It can also affect drug transport proteins (such as P-glycoprotein and OATP transporters) that control how medications move in and out of cells. This means quercetin has the potential to increase the bioavailability of certain drugs, effectively amplifying their effects.
Medications that may be affected include cyclosporine, certain antibiotics (fluoroquinolones), and some blood pressure medications. At typical supplement doses, these interactions are generally modest, but they become more significant for medications with narrow therapeutic windows.
Which Medication Categories Should You Pay Attention To?
Based on ingredient-level pharmacist review, here's a general framework for how NAD+ supplement ingredients relate to common medication categories. (For specific product-level results, see our pharmacist-reviewed interaction tables.)
Blood thinners and antiplatelet medications — High concern. Resveratrol's antiplatelet activity and CYP enzyme inhibition create a meaningful interaction concern. If you take warfarin, Eliquis, Xarelto, or daily aspirin for cardiovascular prevention, discuss NAD+ supplementation with your physician before starting.
Statins and cholesterol medications — Moderate concern. CYP3A4 inhibition from resveratrol can affect statin metabolism, particularly for atorvastatin and simvastatin (which rely heavily on that enzyme pathway). Rosuvastatin and pravastatin use different metabolic routes and may be less affected, but a conversation with your prescriber is still warranted.
Antidepressants — Moderate to elevated concern depending on the specific medication. SSRIs and SNRIs metabolized through CYP2D6 or CYP3A4 pathways may be affected. Combined with quercetin's effects on drug transport proteins, this category warrants physician consultation.
Diabetes medications — Moderate to lower concern for most oral diabetes drugs and insulin, though nicotinamide (a downstream metabolite of NR) has theoretical interactions at high doses. GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) have limited documented interaction with typical NAD+ supplement ingredients, but this is a newer drug class with less long-term interaction data available.
Blood pressure medications — Generally lower concern. Most standard antihypertensives (ACE inhibitors, ARBs, diuretics, beta-blockers) do not have widely reported interactions with NR, resveratrol, or quercetin at typical supplement doses.
Cancer treatments and immunosuppressants — High concern. These medications frequently have narrow therapeutic windows, and any CYP450 modulation can meaningfully alter drug levels. NAD+ supplements containing resveratrol or quercetin should generally be avoided during active chemotherapy or immunosuppressive therapy unless explicitly approved by your oncologist.
Hormone therapies — Moderate to lower concern. Resveratrol's mild estrogenic activity is relevant for anyone on hormone replacement therapy or taking medications for hormone-sensitive conditions.
What Makes This Different From Other NAD+ Supplements
Most NAD+ supplements on the market list their ingredients and move on. They don't evaluate or disclose how those ingredients interact with the medications their customers are most likely taking.
At RYOS, our REFUSEtoAGE formula goes through a pharmacist-led review process. Each ingredient: nicotinamide riboside, trans-resveratrol, quercetin, and galactomannans is evaluated individually against the most commonly prescribed medication categories tracked by the CDC. The results are published in our medication interaction tables so you can see exactly where your medications fall.
This doesn't replace your physician's guidance. It's a starting point, one that gives you specific, ingredient-level information to bring to that conversation rather than going in blind.
Practical Recommendations
If you're considering an NAD+ supplement and you currently take prescription medications, here are a few concrete steps:
Review the ingredient list, not just the marketing. An "NAD+ supplement" can contain very different ingredients depending on the brand. The interaction profile of a formula with resveratrol and quercetin is meaningfully different from one that contains only nicotinamide riboside.
Check the interaction tables. If you take medications for any of the conditions listed above, especially blood thinners, statins, antidepressants, or cancer treatments, review the specific interaction results for the product you're considering. For REFUSEtoAGE, those results are published here.
Talk to your pharmacist or physician. Bring the specific supplement label and your full medication list. The more specific information you can share, the more useful the conversation will be.
Don't assume "natural" means "no interactions." Resveratrol and quercetin are plant-derived compounds with real biological activity. That biological activity is exactly why they may be beneficial and exactly why they can interact with medications that use the same metabolic pathways.
Frequently Asked Questions
Can I take NAD+ supplements with blood pressure medication? In most cases, NAD+ supplement ingredients like nicotinamide riboside, resveratrol, and quercetin do not have widely reported interactions with standard blood pressure medications (ACE inhibitors, ARBs, beta-blockers, diuretics) at typical supplement doses. However, we always recommend confirming with your prescribing physician.
Is nicotinamide riboside safe with statins? Nicotinamide riboside itself has a relatively favorable safety profile alongside statins. The greater consideration is resveratrol, which can inhibit CYP3A4, the enzyme that metabolizes several statins. If your NAD+ supplement contains resveratrol and you take atorvastatin or simvastatin, discuss this with your doctor.
Can I take NAD+ supplements with Ozempic or Wegovy? GLP-1 receptor agonists are a relatively new drug class, and long-term interaction data with NAD+ supplement ingredients is limited. Current evidence does not indicate a major interaction concern, but we recommend consulting your physician given the evolving nature of the research.
Should I stop my NAD+ supplement before surgery? If your NAD+ supplement contains resveratrol, it may be worth discussing with your surgeon. Resveratrol has mild antiplatelet properties that could theoretically affect bleeding during procedures. Many physicians recommend stopping supplements with blood-thinning potential 1–2 weeks before planned surgery.
Are all NAD+ supplements the same when it comes to medication interactions? No. The interaction profile depends entirely on what's in the formula. A supplement containing only nicotinamide riboside has a very different risk profile than one combining NR with resveratrol, quercetin, or other botanical extracts. Always check the full ingredient list.
Reviewed by Sunny Chow, RPh — Registered Pharmacist
This article is for educational purposes only and does not constitute medical advice. Always consult your physician or pharmacist before starting any new supplement, especially if you take prescription medications.
Hales CM, Servais J, Martin CB, Kohen D. "Prescription Drug Use Among Adults Aged 40–79 in the United States and Canada." NCHS Data Brief No. 347. 2019.
EFSA NDA Panel. "Extension of use of nicotinamide riboside chloride as a novel food pursuant to Regulation (EU) 2015/2283." EFSA Journal. 2021;19(11):6843.
Drugs.com. "Nicotinamide Interactions Checker." https://www.drugs.com/drug-interactions/nicotinamide.html
Hyrsova L, Vanduchova A, Dusek J, et al. "Interactions of resveratrol and its metabolites with serum albumin, cytochrome P450 enzymes, and OATP transporters." Food & Chemical Toxicology. 2022;167:113252.
Boulle C, et al. "Potential Cytochrome P450-mediated Interactions." Review article.
Bertelli AAE, Das DK. "Grapes, wines, resveratrol, and heart health." Journal of Cardiovascular Pharmacology. 2009;54(6):468-476.
Mohos V, Fliszár-Nyúl E, Ungvári O, et al. "Inhibitory effects of quercetin and its main methyl, sulfate, and glucuronic acid conjugates on cytochrome P450 enzymes, and on OATP, BCRP and MRP2 transporters." Nutrients. 2020;12(8):2306.
Gehm BD, McAndrews JM, Chien PY, Jameson JL. "Resveratrol, a polyphenolic compound found in grapes and wine, is an agonist for the estrogen receptor." Proceedings of the National Academy of Sciences. 1997;94(25):14138-14143.
Zanger UM, Schwab M. "Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation." Pharmacology & Therapeutics. 2013;138(1):103-141.