Research & Educational Use Only. This protocol guide is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before beginning any research protocol.
Cellular Energy / Mitochondrial Repair StackEvidence Grade: B (Both Compounds)
NAD+ + SS-31 Stack Protocol Guide
The NAD+ + SS-31 (Elamipretide) stack targets mitochondrial function from two complementary angles. NAD+ is an essential coenzyme that declines with age, fueling sirtuins, PARP DNA repair enzymes, and mitochondrial electron transport. SS-31 is a mitochondria-targeted peptide that concentrates 5000-fold within the inner mitochondrial membrane, stabilizing cardiolipin and optimizing electron transport chain efficiency while reducing reactive oxygen species. Together, NAD+ provides the fuel for mitochondrial enzymes while SS-31 repairs the machinery itself.
Protocol Overview
Compounds
NAD+ + SS-31 (Elamipretide)
Category
Cellular Energy / Mitochondrial Repair
Mechanism
NAD+: sirtuin activation, PARP DNA repair, electron transport cofactor. SS-31: cardiolipin stabilization, ETC optimization, ROS reduction
Half-Life
NAD+ (IV): ~30-45 min | SS-31: ~4 hrs
Route
NAD+: IV infusion or SubQ | SS-31: SubQ
Frequency
NAD+: 1-3x/week | SS-31: 1x daily
Cycle Length
8-12 weeks
Synergy & Mechanism
NAD+ Mechanism
NAD+ is the master coenzyme that declines 50%+ by age 60. It fuels sirtuins (SIRT1-7) which regulate gene expression, DNA repair, and metabolism. It powers PARP enzymes for DNA damage repair. It is a critical cofactor in mitochondrial Complex I of the electron transport chain. Replenishing NAD+ restores these fundamental cellular processes.
SS-31 Synergy
SS-31 (Elamipretide) is a tetrapeptide that targets the inner mitochondrial membrane with extraordinary specificity. It stabilizes cardiolipin, a phospholipid essential for ETC complex assembly, and optimizes electron flow to reduce ROS production. While NAD+ provides the fuel, SS-31 repairs the engine. This combination addresses both the substrate and structural components of mitochondrial decline.
Combined Dosing Protocol
Protocol
Compound 1
Compound 2
Timing
Duration
Standard
NAD+ 250mg IV 1x/week
SS-31 5mg SubQ daily
Weekly IV + daily SubQ
8 weeks
Enhanced
NAD+ 500mg IV 2x/week
SS-31 10mg SubQ daily
2x/week IV + daily SubQ
8-12 weeks
SubQ Only
NAD+ 100mg SubQ daily
SS-31 5mg SubQ daily
Both AM SubQ
8-12 weeks
Reconstitution & Preparation
NAD+ Preparation
NAD+ for IV: pre-mixed infusion bags (250mg, 500mg)
NAD+ SubQ: vials for injection (100-200mg/mL)
IV infusion: 2-4 hour drip at clinic
SubQ: inject slowly, expect stinging
SS-31 Preparation
SS-31 vial: 5mg or 10mg lyophilized
5mg vial + 1mL BAC water = 5mg/mL
5mg dose = 100 units (full vial)
Refrigerate, use within 14 days
Stacking Schedule (AM/PM Timing)
AM Protocol
Morning: SS-31 5mg SubQ, abdomen
NAD+ IV days: Schedule clinic infusion
NAD+ SubQ: 100mg SubQ, different site
Can inject SS-31 and NAD+ SubQ sequentially
PM Protocol
No PM dosing typically required
NAD+ IV days: afternoon energy surge normal
Stay hydrated
Quality sleep supports mitochondrial repair
Expected Timeline
Week 1-2
NAD+ replenishes cellular stores. SS-31 concentrates in mitochondria. Early improvements in energy and clarity. NAD+ IV may cause temporary chest tightness.
Week 3-4
Sirtuin activation improving cellular repair. SS-31 optimizing ETC. Noticeable improvement in exercise recovery and stamina.
Week 5-8
Full mitochondrial restoration. Significant improvements in physical and cognitive energy. Skin quality improving.
