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Survodutide28 residuesHQGTFTSDYSKYLDERAAKDFIKWLESAEach bubble = one amino acid. Size = residue mass. Color = chemical class.Also known as: BI 456906, BI-456906
80% liver fat reduction in 48 weeks. That number, from a 2024 NEJM trial of 293 MASH patients, put survodutide on the map as a dual GLP-1/glucagon receptor agonist built for metabolic liver disease. Boehringer Ingelheim is running Phase 3 (SYNCHRONIZE) with results pending. The compound also produced 18.7% body weight loss at 46 weeks in a separate Phase 2 obesity trial. It isn't FDA-approved, and the 40-week dose escalation schedule is slow by any standard. For people tracking MASH therapies or next-generation weight loss agents, survodutide is one to watch closely.
80% liver fat gone in under a year. That's the headline number from the Phase 2 MASH trial published in the New England Journal of Medicine (n=293)[1]. Survodutide (BI 456906) is a dual glucagon and GLP-1 receptor agonist developed by Boehringer Ingelheim. It works two angles at once: GLP-1 receptor activation suppresses appetite and slows gastric emptying, while glucagon receptor activation drives hepatic fat oxidation and thermogenesis. The MASH trial at 4.8 mg weekly showed 62% histological MASH resolution without fibrosis worsening, 52.3% fibrosis improvement, and roughly 80% liver fat reduction at 48 weeks. Those numbers beat placebo by a wide margin (18.2% MASH improvement in the control arm). A separate Phase 2 obesity trial (Lancet 2024, n=387)[2] landed on 18.7% weight loss at 46 weeks with the same 4.8 mg dose. Phase 3 is underway. SYNCHRONIZE-1 (NCT06066528) tests 3.6 mg and 6.0 mg doses in MASH patients over 76 weeks. SYNCHRONIZE-2 adds an obesity-with-diabetes cohort. Neither trial has published primary outcomes yet. One wrinkle worth knowing: Phase 2 turned up a non-linear dose response for MASH. The 6.0 mg arm actually had worse MASH resolution than 4.8 mg (43% vs 62%). Whether that pattern holds in Phase 3 will matter. The compound is not FDA-approved, not commercially available, and carries the usual GLP-1 class GI burden. About 75% of Phase 2 participants reported gastrointestinal side effects.
Survodutide activates two receptors that complement each other. GLP-1 receptor agonism suppresses appetite through hypothalamic signaling, slows gastric emptying (which extends satiety), and boosts glucose-dependent insulin secretion. That side of the molecule handles the appetite and blood sugar piece. The glucagon receptor component does something GLP-1-only drugs cannot. Glucagon receptor activation increases hepatic fat oxidation, converting stored liver fat into energy. It also raises energy expenditure through thermogenesis and promotes lipolysis in adipose tissue. This is the mechanism behind the dramatic liver fat reduction in the MASH trial. A C18 diacid modification on the peptide enables albumin binding in the bloodstream. That extends the half-life to approximately 6 days, making weekly subcutaneous dosing practical. The dual-receptor approach creates a built-in counterbalance: GLP-1 lowers blood glucose while glucagon tends to raise it. In clinical trials, the net effect on fasting glucose was neutral to mildly favorable in non-diabetic participants, with no significant hypoglycemia reported.
Phase 2 data supports meaningful weight loss (up to 18.7% at 46 weeks) and MASH resolution (62% histological, ~80% liver fat reduction at 48 weeks) at 4.8mg weekly. Phase 3 SYNCHRONIZE testing 3.6mg and 6.0mg is enrolled but primary outcomes not yet published as of April 2026.
Phase 2 MASH trial: NEJM 2024 (PMID 38847460): 83% MASH improvement without fibrosis worsening, 52.3% fibrosis improvement, ~80% liver fat reduction at 4.8mg, 48 weeks. Phase 2 obesity trial: Lancet 2024 (PMID 38330987): 18.7% weight loss at 46 weeks at 4.8mg vs. 2.3% placebo.
No Phase 3 efficacy results published yet. Phase 2 MASH trial had non-linear dose-response: 4.8mg outperformed 6.0mg for MASH resolution (62% vs 43%). Long-term safety >48 weeks uncharacterized. Not FDA-approved.
Very limited self-experimentation; most community discussion is about trial data, not personal reports. Discussed as a future leading MASH + obesity agent. Less accessible than tirzepatide or retatrutide in grey market.
Community interest exists but meaningful self-reported dosing data is essentially absent. The compound is too difficult to source and the titration schedule too long for substantial grey-market use. All meaningful data is from controlled trials.
| Level | Dose / Injection | Frequency |
|---|---|---|
| Beginner | 600mcg | Weekly |
| Moderate | 2,400mcg | Weekly |
| Aggressive | 4,800mcg | Weekly |
Survodutide requires a 10 mg vial and 2 mL bacteriostatic water for reconstitution. That gives you 5 mg/mL, or 5,000 mcg/mL. On a standard U-100 insulin syringe, each unit equals 50 mcg. So 0.6 mg (the starting dose) is 12 units. The 1.2 mg escalation dose is 24 units. At the full 4.8 mg MASH target, you're drawing 96 units. The thing most people miss about survodutide is the escalation timeline. You're looking at 40 weeks of dose escalation before reaching therapeutic range. That's nearly 10 months. The clinical trials built this in deliberately because the GI burden is dose-dependent; skipping steps causes severe nausea and vomiting. If you need to pause dosing for more than 2 weeks, restart from 0.6 mg and re-titrate. That's the clinical trial protocol, not optional caution. Store reconstituted vials at 2 to 8 degrees Celsius and use within 4 weeks.
Based on SYNCHRONIZE Phase 3 trial design (76 weeks). Titrate from 0.6mg weekly over 20 weeks. Long-term maintenance data not yet available.
No cycling data exists. Phase 3 SYNCHRONIZE treats survodutide as continuous 76-week therapy with no off periods. Weight regain upon discontinuation is expected (consistent with GLP-1 class). Long-term maintenance protocols post-76 weeks are not yet established.
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Expected: Phase 2 at 4.8mg: 18.7% weight loss at 46 weeks (ITT). 83% achieved ≥5% weight loss; 55% ≥15%. Phase 3 at 6.0mg results pending.
Monitor: Monitor weight, GI tolerability, blood glucose (T2D patients especially). Hepatic function panel at baseline and quarterly for MASH patients.
Reconstitute one 10 mg vial with 2.0 mL bacteriostatic water. Aim the stream at the glass wall, not directly onto the powder. Swirl gently until dissolved. This yields 5,000 mcg per mL (50 mcg per insulin syringe unit).
Draw your dose using a U-100 insulin syringe with a 29 to 31 gauge needle. Starting dose: 12 units (600 mcg / 0.6 mg). Escalation schedule: 24 units at week 9 (1.2 mg), 36 units at week 17 (1.8 mg), 48 units at week 25 (2.4 mg), 72 units at week 33 (3.6 mg).
At the 6.0 mg Phase 3 target dose, you'll need 120 units (a full 1 mL draw). Use a 1 mL syringe or split into two 0.5 mL draws from the same vial.
Rotate injection sites each week to prevent lipohypertrophy (the C18 diacid modification makes site rotation especially important).
If you're getting significant nausea during escalation, switch to evening injections before sleep. Pre-medicating with ondansetron during escalation weeks is a practical option if GI tolerance is consistently poor.
Store reconstituted vials at 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit). Discard after 4 weeks.
Community-discussed adjunct for MASH. Hepatoprotective bile acid. Not clinically tested with survodutide. Theoretical additive hepatic benefit; limited to community speculation.
Do not combine: overlapping GLP-1 receptor agonism with additive GI toxicity and no additional mechanistic benefit.
Do not combineDo not combine: overlapping GLP-1 receptor agonism with additive GI toxicity.
Do not combineDo not combine: overlapping GLP-1 and glucagon receptor agonism. Nearly identical mechanistic profile with additive GI toxicity and unpredictable combined pharmacodynamics.
Do not combineDo not combine: both are GLP-1/glucagon dual agonists with identical receptor overlap and additive GI toxicity.
Do not combinePricing updated 2026-04-09
GI toxicity is the dominant safety signal. In the Phase 2 obesity trial, approximately 75% of participants on survodutide reported gastrointestinal side effects. Nausea, diarrhea, and vomiting were the most common, and they followed a predictable pattern tied to dose escalation. Each step up in dose triggered a new wave of GI symptoms that typically settled within 2 to 4 weeks at a stable dose level. The frequency data from Phase 2 breaks down as follows. Nausea was common (reported in more than 40% of participants at 4.8 mg). Diarrhea affected roughly 20 to 30%. Vomiting occurred in approximately 15 to 25% depending on the dose arm. Decreased appetite was frequent but often welcomed by participants in the obesity trial. Constipation showed up at higher doses as well. One safety point that deserves attention: the GLP-1 receptor agonist class carries a boxed warning in approved compounds (semaglutide, tirzepatide) for thyroid C-cell tumors observed in rodent studies. This signal has not been confirmed in humans, but survodutide belongs to the same class. Thyroid monitoring at baseline is warranted. Pancreatitis is a class concern. Any episode of persistent, severe abdominal pain should prompt lipase and amylase testing and immediate discontinuation if pancreatitis is confirmed. For people with type 2 diabetes on insulin or sulfonylureas, adding survodutide raises hypoglycemia risk. The glucagon component partially offsets this in non-diabetic users, but the combination with exogenous insulin removes that safety margin. Contraindications include personal or family history of medullary thyroid carcinoma (MTC), Multiple Endocrine Neoplasia syndrome type 2 (MEN2), history of pancreatitis, pregnancy, breastfeeding, severe gastrointestinal disease such as gastroparesis, and decompensated cirrhosis. A dedicated pharmacokinetic study [3] confirmed that survodutide's PK is not significantly altered by cirrhosis, but safety data in decompensated (Child-Pugh C) cirrhosis is insufficient. If GI effects are disproportionately severe at the 0.6 mg starting dose, suspect inaccurate vial concentration from grey-market sourcing. Request a certificate of analysis.
Verify Survodutide dosing and safety with a second opinion
Investigational compound with no commercial formulation. Grey-market research peptides carry unknown synthesis quality, purity, and dosing accuracy. No compounding pharmacy (503A/503B) pathway confirmed as of April 2026. Pricing ranges $95–$290/10mg vial from unvetted sources.
| Test | When | Target |
|---|---|---|
| Body weight | Weekly | — |
| Liver function panel (ALT, AST, bilirubin, INR, albumin) | Baseline, then every 12 weeks | ALT/AST trending toward normal; INR <1.5; albumin >3.5 g/dL |
| MRI-PDFF or liver ultrasound | Baseline and 48 weeks | — |
| Fasting glucose and HbA1c | Baseline, week 12, week 24, then every 24 weeks | Fasting glucose 70–100 mg/dL (non-T2D); HbA1c per T2D treatment goals |
| TSH (thyroid) | Baseline; annually or if symptoms arise | — |
| Lipase / amylase | At any episode of persistent abdominal pain | — |
Primary efficacy measure; track 5% and 10% milestone thresholds
MASH patients: confirm hepatic benefit vs. worsening. Flag decompensation early.
Objective liver fat quantification: key MASH endpoint used in Phase 2 trial.
Glucagon receptor agonism can cause transient glucose fluctuation; T2D patients require closer monitoring during escalation.
Class precaution for GLP-1 receptor agonists: rodent thyroid C-cell signal not confirmed in humans but warrants baseline.
Rule out pancreatitis: class risk for GLP-1 agonists
Starting dose 0.6mg weekly. Mild appetite suppression may begin. GI side effects (nausea, diarrhea) are most common during early titration. Minimal weight loss expected: this is a tolerability phase.
Dose escalated through 1.2mg and 1.8mg. Appetite reduction becomes more noticeable. Early weight loss of 2-4%. GI symptoms typically peak during each dose increase then improve.
Continued escalation toward target dose (3.6mg or 6.0mg). Steady weight loss accumulating. Liver fat reduction measurable on imaging in MASH patients.
Maintenance at target dose. Phase 2 data showed up to 14.9% weight loss at 46 weeks (4.8mg, planned treatment analysis) and nearly 19% in completers. MASH trial showed up to 80% liver fat reduction at 48 weeks.
Extended maintenance phase (Phase 3 SYNCHRONIZE design). Further weight loss and metabolic improvements expected. Long-term outcomes data pending from ongoing trials.
Weeks 1 through 8: Starting dose is 0.6 mg weekly. Expect minimal weight change during this phase. GI adaptation is the priority, not results. Nausea and diarrhea are most likely during these first weeks. No meaningful liver fat reduction occurs yet. No substantive community dosing data exists for this compound. Weeks 9 through 24: Dose climbs through 1.2 mg and 1.8 mg with escalation every 4 to 8 weeks. Appetite suppression kicks in noticeably. Early weight loss of 2 to 5% may start. GI symptoms peak around each dose step, then settle within 2 to 4 weeks. Nausea, vomiting, and constipation are the main complaints during this window. Weeks 25 through 40: Mid-range doses of 2.4 to 3.6 mg. Cumulative weight loss reaches 5 to 10%. For MASH patients, liver fat reduction becomes measurable on imaging. The 3.6 mg level is the Phase 3 SYNCHRONIZE low-dose arm target. Weeks 41 through 48: Therapeutic dose of 4.8 mg. Phase 2 obesity data at this level: 14.9% weight loss at 46 weeks (modified intention-to-treat). The MASH trial showed roughly 80% liver fat reduction and 62% histological MASH resolution at 48 weeks. GI effects typically stabilize once the dose holds steady. Weeks 49 through 76: Extended maintenance matching the Phase 3 SYNCHRONIZE design. Weight loss may continue or plateau. Long-term outcomes data is pending from ongoing trials.
Minimal weight change. GI adaptation at 0.6mg. No significant liver fat reduction yet.
No substantive first-person data available.
Early appetite suppression begins. Weight loss of 2–5% may start. GI symptoms peak around each dose step, then improve.
No first-person data. Clinical data: GI effects peak and resolve within 2–4 weeks per dose level.
Cumulative weight loss 5–10%. Liver fat reduction measurable on imaging for MASH patients.
No first-person data.
Phase 2 obesity: 14.9% weight loss at 46 weeks (mITT). MASH trial: ~80% liver fat reduction and 62% histological MASH resolution at 48 weeks.
No first-person data.
Phase 3 SYNCHRONIZE runs to 76 weeks. Weight loss may continue or plateau. Phase 3 results pending.
No data available.
Source: Phase 1/2 PK data; t½ ~109-115h median, ~6 days reported (albumin-bound C18 diacid conjugate)
Loading the interactive decay curve.
Survodutide is an investigational drug. It is not FDA-approved for any indication as of April 2026. No New Drug Application (NDA) filing has been officially confirmed by Boehringer Ingelheim. The compound is currently in Phase 3 clinical trials. SYNCHRONIZE-1 (NCT06066528) evaluates MASH with fibrosis. SYNCHRONIZE-2 targets obesity with type 2 diabetes. Both trials are ongoing with primary endpoints pending. Survodutide is not available through compounding pharmacies under 503A or 503B pathways. Any product marketed as survodutide is a research chemical sold without regulatory oversight. Pricing from unvetted grey-market sources ranges from $95 to $290 per 10 mg vial. Purity and dosing accuracy cannot be guaranteed. Request HPLC and mass spectrometry certificates of analysis; the peptide molecular weight is approximately 4,000 Da. WADA status has not been explicitly addressed, but GLP-1 receptor agonists as a class should be assumed prohibited in competition pending specific guidance. This content is for educational and research purposes only. It does not constitute medical advice. Consult a licensed healthcare provider before using any investigational compound.
Peptide Schedule Research TeamReviewed Apr 20266 Citations
