What is this medicine?

Product Dispensed: Nicotinamide adenine dinucleotide NAD+ (ni kuh tee nuh mide a duh neen dai nook lee uh tide)

Description: 10 mL Amber vial, Clear solution

What are the Ingredients?

Active ingredients: Nicotinamide Adenine Dinucleotide

Inactive ingredients: Sodium Phosphate Monobasic USP Anhydrous, Sodium Phosphate Dibasic USP (dried powder), Benzyl Alcohol NF, Sodium Chloride USP Granular, Sterile Water for Injection USP

Manufactured By: Olympia Pharmaceuticals 6700 Conroy Rd Suite 155 Orlando FL 32835

If you have any further questions or concerns about the ingredients used in your customized, compounded formulation, please contact
one of our pharmacists at 407-420-8222

Tell your healthcare provider if you have any of the following before taking this medication

Kidney Disease
Liver Disease
Current medications including blood pressure, diabetes, benzodiazepine or
anti-seizure medications

Please give a complete list to your doctor or healthcare provider and pharmacist of all your allergies, prescription medications, nonprescription medications, supplements, herbals over the counter drugs that you take. Also tell your doctor or healthcare provider and pharmacist if you are a smoker, drink alcohol or use street drugs". Any of the listed items may possibly interact with your customized, compounded formulation

How should I use this medicine?

To be administered intravenously, intramuscularly, or subcutaneously as prescribed

Always use your customized, compound medication as your doctor or healthcare provider
or pharmacist has told you based on the label on your medication. You should speak with your doctor or healthcare provider or pharmacist if you are not sure how to take or use
your medication

What if I miss a dose?

Take the missed dose when you remember, unless it is near the time to take next scheduled dose. If it is near the time to take the next scheduled dose, skip the missed dose and take only the scheduled dose. Do not double up on doses.

What may interact with this medicine?

High dose Niacin (B3)
Alcohol
Excessive Caffeine

Do not take Nicotinamide adenine dinucleotide (NAD+) if you are/have:

Allergic to NAD+ or any of the other ingredients of this medication
Pregnant and breastfeeding

What side effects may I notice from receiving this medicine?

Nausea
Vomiting
Fatigue
Nervousness
Headaches

Call your doctor if you have any unusual problems while taking this medication such as a severe allergic reaction as swelling of the face, tongue or lips. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program, online (www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088

What should I watch for while using this medicine?

Tell your doctor or healthcare provider if your symptoms do not improve (in a timely manner) and/or you develop new symptoms. It may take some time for this medication to begin working and for your body to feel changes in your condition.

Where should I keep my medicine?

Keep this medication out of the reach of children and pets
Keep medication away from extreme heat
Store at refrigerated temperatures (2 to 8 C)
Wash hands after use to avoid contamination

General information about the safe and effective use of Nicotinamide adenine dinucleotide (NAD+). Do not give or take NAD+ to/from other people, even if they have the same symptoms that you have. It may harm them or you. You can ask your pharmacist or healthcare provider for more information about NAD+ that is written for health professionals. This is a compounded drug. Compounded drugs are permitted to be prescribed but are not FDA approved for safety and efficacy. If you have questions about your product, or the condition of your product upon delivery, contact Olympia pharmacists at 888-323-7788, M-F 9am to 6pm EST or askthepharmacist@olympiapharmacy.com California patients – contact your local health department for questions regarding HIV or Hepatitis C testing and treatment options. For information on proper disposal of medications please visit https://safe.pharmacy/drug-disposal/

DO NOT DISCARD UNUSED MEDICATION VIA WASTEWATER. REFER TO LOCAL OR STATE REQUIREMENTS FOR MEDICATION DISPOSAL

Patient Education Sheet: NAD+ Nasal Spray

NOTE: This sheet is a summary. it may not cover all possible Information. If you hove questions about this medicine, talk to your doctor, pharmacist. or health care provider.

IMPORTANT: This product is a compounded preparation of nicotinamide adenine dinucleotide (NAD+) for intranasal use. It is not approved by the U.S. Food and Drug Administration (FDA) and has not been evaluated by the FDA for safety, effectiveness,
or quality. There is currently no FDA-approved intranasal NAD+ product. Use is at the discretion of your prescribing healthcare provider as part of an individualized
treatment plan.

What is NAD+ Nasal Spray?

NAD+ Nasal Spray is a compounded liquid medication that is sprayed into the nose. The active ingredient is nicotinamide adenine dinucleotide (NAD+), a naturally occurring molecule (called a coenzyme) that the body uses to help cells make energy and carry out routine repair and signaling functions.

Your prescribing provider may recommend NAD+ Nasal Spray to support cellular energy metabolism, cognitive wellness, or general neurologic support. These are not FDA-approved uses. Outcomes vary from person to person, and no specific clinical result is guaranteed.

Active ingredient: Nicotinamide Adenine Dinucleotide (NAD+)

Route: Intranasal (sprayed into the nose)

Dosage form: Aqueous nasal spray with metered-dose actuator

Strength: As prescribed and indicated on your pharmacy label

Who Should NOT Use NAD+ Nasal Spray

Do not use NAD+ Nasal Spray if any of the following apply to you:

• You have had an allergic or hypersensitivity reaction to NAD+, niacin (nicotinic acid), nicotinamide, or any other ingredient in the formulation (including the preservative system).
• You have significant damage to the lining of your nose, untreated chronic rhinitis, recent nasal surgery, or active nasal infection, unless your prescribing provider has specifically cleared you for use.
• You are pregnant, planning to become pregnant, or breastfeeding, unless your provider has determined the potential benefits clearly outweigh the unknown risks (see Section 7).

If you are unsure whether any of these apply to you, talk to your prescribing provider or pharmacist before using this medication.

Warnings and Precautions

Limited safety data. Long-term safety information for compounded intranasal NAD+ is limited. The long-term effects of repeated intranasal NAD+ administration on the nasal lining, sense of smell, and surrounding tissues are not fully characterized.

Nasal irritation. Intranasal products can cause irritation, burning, dryness, or bleeding of the nasal lining, particularly with frequent or long-term use. Stop using and contact your provider if you develop persistent or worsening nasal pain, repeated nosebleeds, or signs of infection (such as fever, thick discolored drainage, or facial pain).

Allergic reactions. Stop using NAD+ Nasal Spray and seek immediate medical attention if you develop rash, hives, swelling of the face, lips, tongue, or throat, difficulty breathing, wheezing, dizziness, or a sudden drop in blood pressure.

Underlying medical conditions. Use caution and discuss with your provider if you have a history of liver disease, kidney disease, gout, low blood pressure, diabetes, peptic ulcer disease, or any condition affecting the nasal passages or sinuses.

Do not exceed the prescribed dose. Using more sprays, more often than directed, will not improve results and may increase the risk of side effects.

Possible Side Effects

Like all medications, NAD+ Nasal Spray can cause side effects. Most are mild and go away on their own. The list below is not complete. Contact your provider or pharmacist for medical advice about side effects.

Common side effects

• Nasal burning, stinging, or irritation
• Nasal congestion or runny nose
• Sneezing
• Unpleasant taste or post-nasal drip
• Headache
• Mild flushing or warmth (face, neck, or chest)
• Mild lightheadedness shortly after dosing

Less common or potentially serious side effects

• Nosebleeds (epistaxis)
• Persistent nasal pain, ulceration, or crusting of the nasal lining
• Loss or change in sense of smell
• Allergic reactions: rash, itching, hives, swelling of the face/lips/tongue/throat, wheezing, or difficulty breathing
• Chest discomfort, palpitations, or significant drop in blood pressure
• Severe or persistent headache

Seek emergency medical care immediately for any signs of a serious allergic reaction, chest pain, difficulty breathing, or fainting.

Drug and Substance Interactions

Well-established drug interactions for compounded intranasal NAD+ have not been fully characterized. Because of this uncertainty, tell your provider and pharmacist about all medications, supplements, and substances you use, including:

• All prescription and over-the-counter medications
• Vitamins and dietary supplements (especially niacin, nicotinamide, niacinamide, nicotinamide riboside (NR), or nicotinamide mononucleotide (NMN))
• Blood pressure medications
• Medications for diabetes
• Blood thinners (anticoagulants or antiplatelet medications)
• Other nasal sprays or intranasal medications
• Alcohol, cannabis, and recreational substances

Combining NAD+ with other niacin- or NAD-related products may increase the risk of flushing and other side effects. Using other nasal sprays at the same time may increase nasal irritation or change how well each product works.

Special Populations

Pregnancy and breastfeeding. The safety of compounded intranasal NAD+ during pregnancy or breastfeeding has not been established. Do not use NAD+ Nasal Spray during pregnancy or while breastfeeding unless your provider has specifically determined the potential benefit outweighs the unknown risk. Tell your provider right away if you become pregnant while using this medication.

Children and adolescents. The safety and effectiveness of compounded intranasal NAD+ in patients under 18 years of age have not been established. This product is not intended for pediatric use.

Older adults. Use caution in older adults, particularly those with multiple chronic conditions, those on multiple medications, or those with chronic nasal or sinus problems.

Liver or kidney impairment. Tell your provider if you have liver or kidney disease before starting NAD+ Nasal Spray.

How to Use NAD+ Nasal Spray

Use NAD+ Nasal Spray exactly as prescribed by your healthcare provider. Read the label on your bottle and follow your provider's instructions for the number of sprays, which nostril(s) to use, and how often to dose.

Step-by-step use

• Wash your hands before and after each use.
• Gently blow your nose to clear the nasal passages.
• Prime the bottle if this is your first use or if it has been unused for several days. Spray into the air, away from your face, until you see a fine mist (follow the pharmacy's priming instructions on the label).
• Shake gently if instructed by your pharmacy.
• Tilt your head slightly forward. Close one nostril with a finger. Place the spray tip into the open nostril, pointing slightly toward the outer wall (not toward the center of your nose).
• Breathe in gently through your nose as you press down on the pump to release one spray. Avoid sniffing forcefully.
• Repeat in the other nostril if directed.
• Wipe the spray tip with a clean tissue and replace the cap.

Do not blow your nose immediately after dosing. Avoid sharing the bottle with anyone else.

If you miss a dose

If you miss a dose, take it as soon as you remember. If it is close to your next scheduled dose, skip the missed dose and resume your normal schedule. Do not use a double dose to make up for a missed one

If you use too much

If you use more NAD+ Nasal Spray than prescribed, contact your provider or your local poison control center for guidance. In the United States, you can call Poison Control at 1-800-222-1222. Go to the nearest emergency room if you experience symptoms such as chest pain, difficulty breathing, severe headache, fainting, or signs of a serious allergic reaction.

Storage and Disposal

• Store as directed on your pharmacy label. Refrigeration (36-46 degrees F / 2-8 degrees C) is generally preferred for stability unless your pharmacy directs otherwise.
• Protect from light and excessive heat. Do not leave the bottle in direct sunlight or in a hot vehicle.
• Keep the bottle tightly closed when not in use.
• Avoid repeated temperature changes (for example, freezing and thawing).
• Do not use after the beyond-use date (BUD) printed on the pharmacy label.
• Do not use if the liquid appears cloudy, discolored, contains particles, or if the bottle is damaged or leaking.
• Keep out of reach of children and pets.
• Dispose of unused or expired medication according to your pharmacist's instructions or through an authorized medication take-back program. Do not flush down the toilet unless specifically instructed.