SS-31 vs NAD+
Comprehensive side-by-side comparison of mechanisms, dosing, side effects, and research
Also: Elamipretide, Bendavia
SS-31 (sequence D-Arg-Dmt-Lys-Phe-NH2), known generically as elamipretide and sold as FORZINITY, is a synthetic tetrapeptide that homes in on the energy-producing machinery inside your cells. It works by binding cardiolipin, a fat unique to the inner mitochondrial membrane, to help mitochondria run cleaner and make more ATP with less oxidative damage. This is the rare research peptide with a real regulatory finish line: the FDA granted it accelerated approval in September 2025 for Barth syndrome, though it has failed several other major trials.
Also: Nicotinamide Adenine Dinucleotide, NAD
NAD+ is not a peptide at all, it is a coenzyme every cell uses to move electrons around during energy production. It gets grouped with peptides because it is sold in the same places and injected the same way. Levels fall with age, which is the entire basis of the longevity interest, but the leap from that observation to injecting it is longer than most sellers admit.
Key Comparison Insights
- SS-31 is FDA approved, while NAD+ remains in research stages.
- Both peptides belong to the Anti-Aging category, suggesting similar primary applications.
- SS-31 has stronger research evidence (FDA Approved) compared to NAD+ (Human Trials).
Detailed Comparison
| Attribute | SS-31 | NAD+ |
|---|---|---|
| Category | Anti-Aging | Anti-Aging |
| FDA Status | FDA Approved | Not FDA Approved |
| Clinical Status | Pre I II III IV FDA | Pre I II III IV FDA |
| Mechanism of Action | SS-31 is a cell-permeable, mitochondria-targeted peptide that concentrates in the inner mitochondrial membrane and binds tightly to cardiolipin. Cardiolipin is essential for keeping the membrane's folded cristae structure intact and for organizing the proteins of the electron transport chain that generate ATP. By stabilizing cardiolipin, SS-31 helps preserve cristae shape, reduces the electron leakage that produces reactive oxygen species, and supports more efficient ATP production. Studies also suggest it modulates the membrane's surface electrostatics and can limit opening of the mitochondrial permeability transition pore, a trigger for cell death, though the full mechanistic picture is still being worked out. | NAD+ is a required cofactor in the reactions that turn food into ATP, and it is consumed as a substrate by two families of enzymes tied to ageing: sirtuins, which regulate DNA repair and metabolic signalling, and PARPs, which repair DNA damage. Because NAD+ is used up by these processes, sustained DNA damage or metabolic stress can deplete it. The theory is that restoring NAD+ restores the function of everything downstream. The unresolved problem is delivery: NAD+ is a large charged molecule that does not readily cross cell membranes, which is why most serious research uses precursors like nicotinamide riboside or NMN that cells can actually take up and convert internally. |
| Common Dosing | 40 mg subcutaneous daily Once daily | 50-100 mg subcutaneous, 2-3x weekly Two to three times weekly, or per clinic protocol for IV |
| Administration | Subcutaneous injection or IV infusion | Subcutaneous injection or slow IV infusion. Fast infusion is the main cause of the flushing and chest tightness people report. |
| Typical Duration | Variable by condition | Ongoing use is common. No controlled long-term injectable data exists. |
| Best Time to Take | Morning | Morning |
Possible Side Effects May vary by individual |
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| Research Summary | Unlike most peptides in this space, SS-31 has been through extensive human trials, with a mixed but consequential record. In TAZPOWER, a randomized placebo-controlled crossover study in Barth syndrome, elamipretide improved skeletal muscle strength and cardiac stroke volume, and the long open-label extension showed sustained benefit, which ultimately supported FDA accelerated approval in September 2025 as the first treatment for that ultra-rare disease. It has also failed prominently: the Phase 3 MMPOWER-3 trial in primary mitochondrial myopathy missed its primary endpoints on the six-minute walk test, the ReCLAIM trial in dry age-related macular degeneration did not hit its primary endpoints, and a heart-failure trial (PROGRESS-HF) also missed its primary endpoint. Across these studies the drug was generally well tolerated, with mostly mild effects such as injection-site reactions, headache and nausea. The accurate summary is that SS-31 is a validated mitochondrial-targeting peptide with one approved indication and a string of negative trials elsewhere, so its benefit appears to depend heavily on the specific disease. | The decline of NAD+ with age is well documented, and precursor supplementation reliably raises blood NAD+ levels in human trials. What those trials have not clearly shown is that raising NAD+ produces the functional benefits people are hoping for. Human studies on nicotinamide riboside and NMN show good safety and consistent biomarker changes, with inconsistent effects on measurable outcomes like muscle function, insulin sensitivity or fatigue. Direct injected or infused NAD+ has far thinner evidence than the precursors do: most of what exists is small, uncontrolled, or observational, and the widely reported subjective effects of IV NAD+ have not been separated from placebo in good trials. Anyone telling you injected NAD+ has strong human evidence is describing the precursor literature and attaching it to a different product. |
Frequently Asked Questions: SS-31 vs NAD+
What is the difference between SS-31 and NAD+?
SS-31 is a anti-aging peptide that ss-31 (sequence d-arg-dmt-lys-phe-nh2), known generically as elamipretide and sold as forzinity, is a synthetic tetrapeptide that homes in on the energy-producing machinery inside your cells. it works by binding cardiolipin, a fat unique to the inner mitochondrial membrane, to help mitochondria run cleaner and make more atp with less oxidative damage. this is the rare research peptide with a real regulatory finish line: the fda granted it accelerated approval in september 2025 for barth syndrome, though it has failed several other major trials. NAD+ is a anti-aging peptide that nad+ is not a peptide at all, it is a coenzyme every cell uses to move electrons around during energy production. it gets grouped with peptides because it is sold in the same places and injected the same way. levels fall with age, which is the entire basis of the longevity interest, but the leap from that observation to injecting it is longer than most sellers admit. The main differences lie in their mechanisms of action and clinical applications.
Which is better, SS-31 or NAD+?
Neither is universally "better" - the choice depends on your specific goals. SS-31 is typically used for anti-aging purposes, while NAD+ is used for anti-aging. Always consult with a healthcare provider to determine which may be appropriate for your situation.
Can SS-31 and NAD+ be used together?
Some peptide protocols combine multiple compounds for synergistic effects. However, using SS-31 and NAD+ together should only be considered under medical supervision, as both compounds have their own side effect profiles and potential interactions. Research on their combined use may be limited.