Short answer: Elamipretide (SS-31) is FDA approved as Forzinity, but only for Barth syndrome, a rare genetic disease, and it failed its main trial in another mitochondrial disease. Oral NAD+ precursors (NR, NMN) raise NAD+ in small human trials. NAD+ injections have no randomized trials we found, and MOTS-c has mouse data only. None is proven to raise energy in healthy people.
What people discuss for energy and mitochondria
What people discuss, and the strongest evidence we found for this goal
| Compound | Best evidence | What it shows |
|---|
| SS-31 (elamipretide, Forzinity) | Approved for a different use | Approved in 2025 under accelerated approval to improve muscle strength in Barth syndrome. It missed its main goals in a 218-person trial in primary mitochondrial myopathy. |
| Oral NAD+ precursors (NR, NMN) | Human trials | Small randomized trials show oral NR raises NAD+ in older adults and NMN improved muscle insulin sensitivity in 10 weeks in women with prediabetes. |
| NAD+ injection or IV | Small or early human studies | We found no randomized trial. A 2026 chart review of commercial IV NAD+ reported stomach symptoms, faster heart rate and chest pressure during infusions. |
| MOTS-c | Animal or lab studies only | Prevented diet-induced obesity and insulin resistance in mice. FDA found no human studies of MOTS-c given to people. |
"Animal or lab studies only" means no published human trial for this goal that we could find. Results in rats or cells often do not carry over to people. Compounds that are not FDA-approved have no tested label for dose, purity or safety.
SS-31 (elamipretide): approved for one rare disease
Elamipretide is a small peptide that binds to the inner membrane of mitochondria, the parts of cells that make energy. On September 19, 2025, FDA granted it accelerated approval as Forzinity, the first treatment for Barth syndrome, a rare inherited disease that weakens muscles and the heart.
- What the label says. Forzinity is indicated "to improve muscle strength" in Barth syndrome patients weighing at least 30 kg. Approval rests on knee muscle strength, and continued approval depends on a confirmatory trial.
- The trial. In a 12-person crossover trial, it did not beat placebo on its main goals (6-minute walk and fatigue). Knee strength gains showed up later, in the open-label extension.
- Side effects. Injection-site reactions were the most common: any injection-site reaction in 100% on Forzinity vs 67% on placebo.
- Other diseases. In MMPOWER-3 (218 adults with primary mitochondrial myopathy, 24 weeks), elamipretide did not improve walking distance or fatigue compared with placebo.
There are no trials of SS-31 for energy or fatigue in healthy people.
NAD+: pills have trials, injections mostly do not
NAD+ (nicotinamide adenine dinucleotide) is a helper molecule every cell uses to make energy. Two vitamin B3 forms that the body turns into NAD+ have been tested in randomized trials:
- Nicotinamide riboside (NR): a 2018 placebo-controlled crossover trial in healthy middle-aged and older adults (6 weeks per arm) found it was well tolerated and raised NAD+ levels. Effects on blood pressure were only a hint for future trials.
- Nicotinamide mononucleotide (NMN): a 2021 placebo-controlled trial in postmenopausal women with prediabetes found 10 weeks of NMN improved how well muscle responds to insulin.
Raising NAD+ in blood is not the same as feeling more energetic, and neither trial showed that. NAD+ given by IV or under the skin is a different product. The only human study we found is a 2026 retrospective review of a commercial clinic: people getting 500 mg IV NAD+ for four days reported moderate to severe stomach symptoms, faster heart rate and chest pressure during infusions, and infusions took about 97 minutes on average. We found no published half-life for NAD+ under the skin.
MOTS-c: mouse data only
MOTS-c is a 16-amino-acid peptide coded in mitochondrial DNA. In a 2015 mouse study, MOTS-c treatment prevented age-related and high-fat-diet insulin resistance and diet-induced obesity. In its 2026 review, FDA found no clinical studies giving MOTS-c to people, and no human safety data, and proposed that it not be added to the list of substances pharmacies may compound.
Safety, and what is still unknown
- Healthy people are untested. We found no randomized trial showing any of these improves energy or fatigue in healthy adults.
- Fatigue is a symptom, not a diagnosis. Low iron, thyroid disease, sleep apnea, depression, low testosterone and medicines are common causes a clinician can test for.
- Compounded and research products of MOTS-c or SS-31 are not Forzinity. FDA lists possible immune reactions for MOTS-c.
This page is education, not medical advice. A clinician should diagnose the problem and make any prescription decision with you.
What is worth tracking
- Doses with time. For IV or injected NAD+, note how long each session took and how you felt during it.
- An energy score. Rate energy 0-10 in the daily check-in at the same time each day. After a few weeks, compare with the weeks before you started.
- Sleep. Log sleep hours or a sleep score, since sleep drives energy more than any supplement.
- Side effects. Flushing, nausea, chest tightness, a racing heart or injection-site reactions, each with a date.
- Lab results. Store iron, thyroid, glucose or A1C results with dates. The NMN trial measured insulin sensitivity, so glucose labs are a fair thing to watch.
- Weight and activity. A weekly weight and a note on exercise help explain energy changes that have nothing to do with the compound.
Terms on this page: Peptide · Half-life · Compounding pharmacy
This page is education, not medical advice, and it is not a recommendation to use any compound. It does not cover dosing. Talk to a licensed clinician before starting, changing or stopping anything, and get diagnosed before treating a symptom.