Combined Protocol
STACK · Retatrutide + MOTS-c + GLOW 70 + NAD+
SCIENCE • STRENGTH • LONGEVITY
This document covers sequencing only. Reconstitution math, per-compound titration, and product-specific cautions live in the four individual protocol sheets. This one answers a different question: what order to bring them in, how a full week fits together, and where the four interact. Read it alongside the individual sheets, not instead of them.
These four compounds work through unrelated pathways, which is why they can be run together at all. Retatrutide acts on incretin and glucagon receptors. MOTS-c acts on AMPK and mitochondrial signaling. GLOW 70 works on tissue repair and remodeling. NAD+ is a coenzyme feeding cellular energy metabolism. Nothing here competes for the same receptor.
What they do share is a direction of effect on blood glucose, and a lot of overlapping side effects during the first few weeks. Both are handled by the phase-in schedule below.
PHASE-IN SCHEDULE
Do not start four compounds on the same day. Retatrutide, MOTS-c, and NAD+ can all produce nausea in their opening weeks. Started together, a bad week is unattributable — there is no way to know which one to adjust, and the usual response is to quit all four. Staggering the introduction is the whole reason this schedule exists.
| Phase | Weeks | Add | Why here |
|---|---|---|---|
| 1 | Weeks 1–4 | Retatrutide + GLOW 70 | Retatrutide carries the highest side-effect burden and needs a clean read. GLOW shares no systemic pathway with anything else, so it can run from day one without confusing attribution. |
| 2 | Weeks 5–8 | Add MOTS-c | Retatrutide tolerance is established by now. MOTS-c is the first compound to touch glucose alongside it. |
| 3 | Week 9 onward | Add NAD+ | Last in. Its injection reaction is distinctive and easier to identify once everything else is stable. |
- Hold each phase for its full duration even if everything feels fine. The point is a clean baseline, not speed.
- If a new symptom appears, the compound added most recently is the first suspect. Step that one back before touching anything else.
- Never advance a titration step on two compounds in the same week.
FULL WEEKLY SCHEDULE
Once all four are running. This assumes retatrutide has been moved to a fixed weekly day — on its native 6-day interval the dosing day walks through the week and a schedule like this cannot hold.
| Day | Morning | Also | Injections | Notes |
|---|---|---|---|---|
| Monday | Retatrutide + MOTS-c | GLOW | 3 | Fixed retatrutide day |
| Tuesday | MOTS-c + NAD+ | GLOW | 3 | |
| Wednesday | MOTS-c | GLOW | 2 | |
| Thursday | MOTS-c + NAD+ | GLOW | 3 | |
| Friday | MOTS-c | GLOW | 2 | |
| Saturday | NAD+ | GLOW | 2 | MOTS-c off day |
| Sunday | — | GLOW | 1 | MOTS-c off day |
NAD+ sits on Tuesday, Thursday, Saturday deliberately. Placing it opposite the retatrutide day caps the schedule at three injections on any single day instead of four. It also separates the two compounds most likely to cause nausea, which makes a bad day easier to attribute.
- A separate sterile syringe for every compound. Never combine any two in one barrel — stability and pH profiles differ across all four.
- A different site for every injection on a shared day.
- Morning dosing throughout. NAD+ in particular disrupts sleep when injected later in the day.
- GLOW is the only daily compound with no off day, which is why it gets its own dedicated site zone below.
INJECTION SITE MAP
Three compounds want the abdomen. Assigning each one a zone prevents repeated trauma to the same tissue and makes it obvious which injection caused a local reaction.
| Compound | Zone | Rotation |
|---|---|---|
| GLOW 70 | Upper glute | Alternate left and right daily |
| Retatrutide | Lower abdomen | Alternate left and right weekly |
| MOTS-c | Outer thigh | Alternate left and right daily |
| NAD+ | Upper abdomen and back of upper arm | Rotate through four positions — never repeat within a week |
NAD+ needs the most rotation and gets the strictest rule. A 100 mg dose at 100 mg/mL is a full millilitre — by far the largest volume in this stack, and the one most likely to leave nodules. Combine that with GLOW stinging on a daily basis and there is a real cumulative load on the tissue. Keep those two zones well apart and never let either land on the same spot twice in a week.
GLUCOSE — THE CENTRAL INTERACTION
This is the one genuine interaction in the stack and the reason the phase-in matters. Three of the four compounds push blood glucose in the same direction.
| Compound | Mechanism | Effect on glucose |
|---|---|---|
| Retatrutide | GLP-1 / GIP / glucagon receptors | Affects insulin response; lowers glucose |
| MOTS-c | AMPK activation | Increases muscle glucose uptake; lowers glucose |
| NAD+ | Cellular energy metabolism | May increase insulin sensitivity over time |
| GLOW 70 | Tissue repair and remodeling | No meaningful glucose effect |
- Three separate mechanisms, one direction. The combined effect is not something either compound produces alone, and it has not been characterized in any trial.
- Fasted training is where a low-glucose episode is most likely to surface. That is the highest-risk window in this entire protocol.
- Metformin and berberine are a fourth AMPK route. Layering either on top of this stack is where the risk becomes serious rather than theoretical.
- Anyone on existing glucose-lowering medication should not be assembling this stack without clinician involvement.
- Symptoms to know: shakiness, sweating, confusion, unusual hunger, racing heart. These warrant stopping and eating, not pushing through.
Overlapping side effects
Beyond glucose, the four share enough surface-level effects that attribution gets difficult without the phase-in.
| Effect | Which compounds | Most likely source |
|---|---|---|
| Nausea | Retatrutide, NAD+ | Retatrutide, especially on a titration step |
| Fatigue | MOTS-c, NAD+ | Whichever was added most recently |
| Injection-site sting | GLOW, NAD+ | GLOW if glute; NAD+ if pushed too fast |
| Headache | NAD+ | NAD+ during early titration |
| Sleep disruption | NAD+ | NAD+ dosed too late in the day |
STORAGE AND STABILITY
The four have very different reconstituted lifespans, and two of them will outlive their stability window before the vial runs out. This is the most commonly missed part of running a multi-compound stack.
| Compound | Stable for | Vial lasts | Problem |
|---|---|---|---|
| Retatrutide | 28–60 days | ~7 weeks | None — vial is consumed inside the window |
| MOTS-c | ~7 days | ~2.5 weeks | Outlives window by 2.5x. Aliquot and freeze. |
| GLOW 70 | TB-500 fades at 1–2 weeks | 30 days | Back half of each vial has a diminishing TB-500 fraction |
| NAD+ | 14–30 days | ~2–3 weeks | None at maintenance dosing |
MOTS-c is the one that needs action. Split the reconstituted vial into weekly aliquots in sterile vials and freeze what is not in immediate use. Frozen aliquots hold two to three months at −20 °C. Left as a single refrigerated vial, the last week of every MOTS-c vial is past its potency window.
SUPPLY PLANNING — 12-WEEK CYCLE
Assuming the phase-in above: retatrutide and GLOW from week 1, MOTS-c from week 5, NAD+ from week 9.
| Product | Vials | Basis | Note |
|---|---|---|---|
| Retatrutide 15 | 2 | 12 weekly doses, ~23 mg total | Second vial needed around week 7 |
| GLOW 70 | 3 | 84 daily draws at 30 per vial | One vial per on-period |
| MOTS-c | 4 | 8 weeks at 5 mg weekly | Aliquot each vial into weekly portions |
| NAD+ | 2 | 4 weeks at 3x weekly | Assumes titration from 50 to 100 mg |
- U-100 insulin syringes — roughly 130 injections across the full 12 weeks. Buy a box of 200.
- Bacteriostatic water — 4 to 5 bottles at 10 mL.
- Sterile empty vials for MOTS-c aliquots.
- Alcohol prep pads and a sharps container sized for the volume.
- Round everything up for priming losses and dropped syringes.
COMBINED CAUTIONS
Any single one of these rules out the full stack. Individual compound sheets carry the complete lists.
- Type 1 diabetes, or any existing glucose-lowering medication.
- Personal or family history of medullary thyroid cancer, or a history of pancreatitis — retatrutide.
- Active cancer or a strong cancer history — GLOW promotes angiogenesis, and NAD+ supports cellular proliferation. Two independent reasons.
- Wilson’s disease or other copper-handling disorders — GLOW.
- Active retinal vascular disease.
- Severe liver or kidney impairment — NAD+.
- Pregnancy or breastfeeding — no safety data exists for any compound in this stack.
- All four are prohibited by WADA and will test positive.
Record keeping
A log stops being optional at four compounds. Record date, compound, units, and site for every injection, plus any symptom and the day it appeared. When something goes wrong across a four-compound stack, the log is the only thing that identifies which compound and which step it started on. Without it there is no way to adjust one variable — the only remaining option is stopping everything.