NAD+ Injection Standard Operating Procedure (SOP)

Purpose

To provide a structured and detailed protocol for the administration and management of NAD+ injections, ensuring consistent, safe, and effective patient care.

Supplies Needed

• Alcohol swabs
• Bacteriostatic water (for reconstitution)
• 10 mL syringe with attached needle (for reconstitution)
• 0.5cc syringe with 5/16″ 30g attached needle (for injection)
• Sharps container

Consumable Deliveries and Inventory Management

1. Receiving and Storing Medication:

• Upon delivery, check the medication for accuracy and expiration dates.
• Store unopened/unreconstituted vials in a controlled room temperature environment as per manufacturer recommendations. Do not freeze.
• Once reconstituted, store vials in the refrigerator at 36°F to 46°F (2°C to 8°C).

2. Opening and Labeling:

• When opening a new vial, write the date on the vial.
• Assign and record the label ID in the patient management system (if applicable).
• Note that the contents of a vial expire 30 days after opening. Discard expired vials and contact the supervisor for further instructions.

3. Inventory Restock SOP:

• Regularly audit consumable supplies, including syringes, alcohol swabs, and sharps containers.
• Notify the designated inventory manager for restocking if supplies are low.

Patient Pre-Treatment Protocol

1. Patient Eligibility:

• Complete registration, consent forms, and General Fitness Evaluation (GFE) before proceeding.
• Ensure patients are aware that NAD+ treatments are not eligible for discounts, exchanges, or store credits.

2. Pre-Treatment Questions:

• Any health changes since the last visit?
• Any new medications?
• Are you pregnant or breastfeeding?

3. Contraindications:

• Known allergy or hypersensitivity to NAD+ or its components.
• Severe hepatic or renal impairment.
• Cardiovascular disease or bleeding disorders.
• History of cancer (including skin cancer).
• Any exceptions or letters of clearance must be approved by the supervisory team or noted in the GFE.

Dosage and Administration

1. Initial Dose:

• Start with 50 mg (0.5 mL) subcutaneously once weekly for 4 weeks.

2. Titration Criteria:

• Evaluate patient progress every 4 weeks:
  • No/minimal side effects: Increase dose to 100 mg (1 mL) once weekly.
  • Effective dose with no/minimal side effects: Maintain the current dose for the next 4 weeks.
  • Intolerance to side effects: Decrease the dose to 50 mg for the next 4 weeks or consider discontinuing treatment with medical consultation.

• Maximum dose: 100 mg once weekly.

3. Injection Sites:

• Recommended sites:
  • Abdomen (RUQ, RLQ, LUQ, LLQ).
  • Back of the upper arm.
  • Front of the thigh

• Rotate injection sites at each appointment to prevent tissue irritation and nodule formation.
• Avoid using the same injection site as another injection received on the same day.

Anticipated Side Effects and Management

1. Injection Site:

• Discomfort, erythema, or small nodules.

2. Systemic Effects:

• Mild fatigue, nausea, or headache (especially with higher doses).
• Mitigation strategies:
• Slow the injection rate.
• Split doses if necessary.

3. Management:

• Most side effects can be managed with OTC therapies.
• Persistent or severe side effects should be escalated to a supervising clinician.

Biological Role of NAD+

1. Energy Production:

• NAD+ is essential for mitochondrial function and ATP production.

2. Sirtuin Activation:

• Regulates histone acetylation, influencing gene expression related to stress resistance and metabolic homeostasis.

3. Lipid and Glucose Metabolism:

• Enhances insulin sensitivity and lipid metabolism, benefiting metabolic disorders.

4. DNA Repair and Genomic Stability:

• Activates PARP enzymes for DNA repair.
• Sustains genomic integrity to prevent mutations and age-related cellular damage.

5. Cellular Aging and Immune Modulation:

• Declining NAD+ levels contribute to cellular aging and inflammation.
• Supports macrophage polarization, promoting anti-inflammatory responses.

Mechanism of Action

Indication – “Fountain of Youth”:

• Anti-Aging: Promotes DNA repair, reduces oxidative stress, and enhances cellular health.
• NAD+ levels naturally decline with age and stress, impacting energy levels, cellular repair, and overall health.
• Restoring NAD+ levels improves energy, supports cellular repair, and promotes longevity.

Talking Point for Patients: “Imagine your body is like a car, and NAD+ is the premium fuel it needs to run smoothly. Without enough NAD+, your engine struggles, but with the right levels, you’re firing on all cylinders!”

Storage and Handling

1. Unreconstituted Vials:

• Store at controlled room temperature.
• Do not freeze.

2. Reconstituted Vials:

• Store in the refrigerator at 36°F to 46°F (2°C to 8°C).
• If accidentally left out for more than 4 hours, contact the supervisor.

3. Expiration:

• Vials expire 30 days after opening or reconstitution. Discard expired vials.

Summary

This SOP provides clear guidelines for the administration of NAD+ injections, ensuring patient safety and optimized results. NAD+ plays a critical role in energy production, DNA repair, and cellular health. By following this protocol, Walnut Creek Aesthetics can deliver consistent, high-quality care while promoting the therapeutic benefits of NAD+ supplementation.