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NMN/NR (Nicotinamide Mononucleotide/Riboside) Geriatric (65+) Monitoring: A Clinical Guide

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At a glance

  • Regulatory status / Oral dietary supplements in the US; not FDA-approved drugs [5]
  • Trial size / Human studies have generally been small [4]
  • Doses studied in older adults / NMN 250 mg/day in older men; NR 1 g/day in 12 older men [3][2]
  • Side effects reported / NR was well tolerated in a crossover trial of middle-aged and older adults; mild events included nausea, flushing, leg cramps and bruising [1]
  • Muscle function / 2025 meta-analysis found no significant NMN effect on muscle index, grip strength, gait speed or chair stand [6]
  • Kidney or liver disease / Not studied in these trials [4]

What did trials in older adults measure?

  • NR 1 g/day for 21 days in 12 men aged 70 to 80 (Elhassan 2019). Muscle NAD+ was not raised (210 vs 197 pmol/mg, p=0.22), although a marker of NAD+ synthesis (NAAD) doubled. Mitochondrial respiration, grip strength, insulin sensitivity and muscle blood flow were unchanged [2].
  • NR 500 mg twice daily in two 6-week crossover periods, 24 completers aged 55 to 79 (Martens 2018). NAD+ in blood cells was about 60% higher than with placebo. The blood pressure change was not significant [1].
  • Healthy older men, NMN 250 mg/day for 6 or 12 weeks (Igarashi 2022). Blood NAD+ and metabolites rose. Gait speed and left grip improved nominally but were not corrected for multiple comparisons; body composition did not change [3].
  • 108 older Japanese adults, NMN 250 mg/day for 12 weeks (Kim 2022). Afternoon NMN had the largest effect sizes for 5-times sit-to-stand (d=0.72) and drowsiness (d=0.64), but all groups improved on sit-to-stand, including placebo [7].

A randomized safety study gave NMN 1,250 mg once daily for up to 4 weeks to 31 healthy adults aged 20 to 65; it did not include adults older than 65 [8].

Does NMN or NR improve function after 65?

A 2025 meta-analysis of randomized trials in older adults (mean ages 60.9 to 83) found no significant NMN effect on skeletal muscle index, handgrip strength, gait speed or the 5-times chair stand test [6]. A second 2025 meta-analysis of 12 studies and 513 participants found NMN raised blood NAD but most clinical outcomes, such as fasting glucose, triglycerides and cholesterol, were not significantly different from control [9].

What side effects were reported?

In a crossover trial of middle-aged and older adults, NR 1,000 mg/day was reported as well tolerated, with mild events (nausea, flushing, leg cramps, bruising) and no serious events [1]. In 20 people with Parkinson's disease given NR 3,000 mg/day for 4 weeks, there were no moderate or severe adverse events; NR recipients had a slight initial rise in serum homocysteine [10]. The apparent clinical improvement in that trial was also associated with a shorter interval since the last levodopa dose, so it is confounded [10].

Trials were short (generally up to about 12 weeks) and small. Cancer risk with chronic NAD+ boosting has been raised as a theoretical concern, but no human data were identified [4].

What about kidney disease, liver disease and other medicines?

People with cancer, kidney disease or liver disease, and people who are pregnant or breastfeeding, were not studied in the cited trials, so safety in those groups is unknown [4]. No human drug-interaction studies of NMN or NR (CYP, transporter or pharmacodynamic) were found in a PubMed search, so neither safety with nor interaction with a specific drug can be claimed [4].

Frequently asked questions

Does NMN improve strength or walking speed after 65?
A 2025 meta-analysis of randomized trials in older adults found no significant effect of NMN on skeletal muscle index, handgrip strength, gait speed or the 5-times chair stand test [6].
Does NR lower blood pressure in older adults?
In the NR crossover trial, the blood pressure change (systolic -3.9, diastolic -2.0 mmHg) was not significant. Only an exploratory post hoc subgroup with elevated baseline blood pressure showed a larger drop, and the authors called for further trials [1].
What doses were used in trials of older adults?
NMN 250 mg once daily for 6 to 12 weeks in older men and in 108 older Japanese adults; NR 1 g/day in 12 older men [3][7][2]. These were doses used in trials, not recommended doses. Neither NMN nor NR is FDA-approved to treat aging or any disease [5].
Is NMN or NR safe for someone with kidney disease?
People with kidney or liver disease were not studied in the cited trials, so safety in those groups is unknown [4].

References

  1. Martens CR, Denman BA, Mazzo MR, Armstrong ML, Reisdorph N, McQueen MB, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9(1):1286. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults
  2. Elhassan YS, Kluckova K, Fletcher RS, Schmidt MS, Garten A, Doig CL, et al. Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome and Induces Transcriptomic and Anti-inflammatory Signatures. Cell Rep. 2019;28(7):1717-1728.e6. Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome and Induces Transcriptomic and Anti-inflammatory Signatures
  3. Igarashi M, Nakagawa-Nagahama Y, Miura M, Kashiwabara K, Yaku K, Sawada M, et al. Chronic nicotinamide mononucleotide supplementation elevates blood nicotinamide adenine dinucleotide levels and alters muscle function in healthy older men. NPJ Aging. 2022;8(1):5. Chronic nicotinamide mononucleotide supplementation elevates blood nicotinamide adenine dinucleotide levels and alters muscle function in healthy older men
  4. Freeberg KA, Udovich CC, Martens CR, Seals DR, Craighead DH. Dietary Supplementation With NAD+-Boosting Compounds in Humans: Current Knowledge and Future Directions. J Gerontol A Biol Sci Med Sci. 2023;78(12):2435-2448. Dietary Supplementation With NAD+-Boosting Compounds in Humans: Current Knowledge and Future Directions
  5. Official web page. Official web page
  6. Prokopidis K, Moriarty F, Bahat G, McLean J, Church DD, Patel HP. The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis. J Cachexia Sarcopenia Muscle. 2025;16(3):e13799. The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis
  7. Kim M, Seol J, Sato T, Fukamizu Y, Sakurai T, Okura T. 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. 2022;14(4). 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
  8. Fukamizu Y, Uchida Y, Shigekawa A, Sato T, Kosaka H, Sakurai T. Safety evaluation of β-nicotinamide mononucleotide oral administration in healthy adult men and women. Sci Rep. 2022;12(1):14442. Safety evaluation of β-nicotinamide mononucleotide oral administration in healthy adult men and women
  9. Zhang J, Poon ET, Wong SH. Efficacy of oral nicotinamide mononucleotide supplementation on glucose and lipid metabolism for adults: a systematic review with meta-analysis on randomized controlled trials. Crit Rev Food Sci Nutr. 2025;65(22):4382-4400. Efficacy of oral nicotinamide mononucleotide supplementation on glucose and lipid metabolism for adults: a systematic review with meta-analysis on randomized controlled trials
  10. Berven H, Kverneng S, Sheard E, Søgnen M, Af Geijerstam SA, Haugarvoll K, et al. NR-SAFE: a randomized, double-blind safety trial of high dose nicotinamide riboside in Parkinson's disease. Nat Commun. 2023;14(1):7793. NR-SAFE: a randomized, double-blind safety trial of high dose nicotinamide riboside in Parkinson's disease
Evidence overview for nad nmn: NMN/NR (Nicotinamide Mononucleotide/Riboside) Geriatric (65+) Monitoring: A Clinical Guide