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Although a direct causal link between NAD+ supplementation and cancer progression has not been proven, experts recommend that patients with an ongoing cancer or a history of cancer only consider NAD+ therapy with clearance from their oncologist

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The FDA's 2022 guidance placed it in the category of bulk drug substances that may present safety, effectiveness, or quality concerns for compounding, effectively removing it from the legal compounding pathway for 503A and 503B pharmacies