Survodutide: The Definitive Guide

What is survodutide?

Survodutide is an experimental weight-loss and liver-disease drug given as one injection a week. It copies two natural hormones at once, GLP-1 and glucagon, and is being developed by Boehringer Ingelheim for obesity, fatty liver disease and type 2 diabetes. Its phase 3 trials have reported results, but it is not approved anywhere yet. [11], [8], [10]

The two hormones do different jobs. GLP-1 (glucagon-like peptide-1) is a gut hormone released after eating; it signals fullness to the brain, slows the stomach and helps the pancreas release insulin when blood sugar is high. Glucagon is a pancreas hormone that tells the liver to release stored energy and burn fat. Survodutide is a single lab-made peptide, a chain of 29 amino acids with a fatty side chain, built to act on both receptors. It was designed to mimic oxyntomodulin, a natural gut hormone that does the same. [1], [16], [10]

Its development code is BI 456906. Boehringer Ingelheim and Zealand Pharma co-invented it, and Zealand licensed it to Boehringer, which runs the development. [1], [2], [9] Online, people shorten the name to "survo", and a low dose added to tirzepatide is nicknamed "ghetto reta". These are informal names, not separate medicines. [17], [18]

People discuss survodutide for two reasons: weight loss in the same range as some approved medicines, and unusually large falls in liver fat, which reflect its glucagon side. It is also one of the few drugs in this family sold online as an unapproved "research" powder, often as an add-on to tirzepatide. [8], [10], [14]

[16], [2], [5], [3], [4], [11]

Typical Survodutide Protocols

The most common pattern in the trials is 0.3 mg once a week to start, raised in small steps every 2 to 4 weeks over about 14 to 24 weeks to a weekly dose between 2.4 and 6.0 mg, and then continued without a break. [5], [6], [7], [10]

Titration Raising the dose in steps

Every published obesity and liver trial schedule started at 0.3 mg a week; one group in the short diabetes trial started at 0.6 mg and reached 2.7 mg in 6 weeks, a pace its authors linked to more side effects. The phase 2 obesity and MASH trials mostly raised the dose every 2 weeks, by 0.3 mg at first and by 0.6 mg or more later; the lower-target groups held some steps for 4 weeks. In the phase 3 SYNCHRONIZE trials, the dose rose to 3.6 or 6.0 mg over a 24-week escalation that could be stretched with one or two restarts, and after reaching 3.6 mg, the next step could be delayed or the dose lowered one level for 2 to 4 weeks if stomach side effects were a problem. The exact phase 3 step schedule is not published; trial participants describe steps of about 4 weeks through 0.3, 0.6, 1.2, 2.4 and 3.6 mg. [5], [6], [21], [7], [22], [23], [24]

Breaks and cycles

Not studied. Every trial gave survodutide continuously for 46 to 76 weeks with no planned breaks, and none has reported what happens after the last dose (see stopping). One trial protocol set a rule for missed doses: after two missed doses in a row during the maintenance phase, restart two steps lower and step back up weekly. [5], [8], [6]

Read the units: doses are in milligrams (mg), and each weekly dose is also the weekly total. Trial participants injected the company's own liquid from prefilled syringes, two 0.5 mL syringes per weekly dose in phase 2. Syringe units only come up with "research" vials that are mixed with water; see how units convert. [5]

These are the dose groups of clinical trials, kept exactly as each trial ran them. Low, mid and high are alternatives tested in different people, not steps to climb, and no regulator has approved survodutide at any dose. [11]

Strong cautions before reading further. About 1 in 5 people on survodutide stopped because of stomach and bowel side effects in each phase 3 trial, mostly while the dose was rising. The trials excluded people with a resting heart rate over 100, fast heart-rhythm disorders, past pancreatitis, a personal or family history of medullary thyroid cancer, pregnancy, breastfeeding and anyone under 18. Survodutide has never been tested alongside tirzepatide or any other GLP-1 drug, which is how it is most often used online, and "research" vials are not the trial product. [11], [10], [6], [19], [14]

Where schedules differ: step speed, 0.6 mg starts, 3.6 versus 6.0 mg, split doses, add-ons, cycles and stopping ↓

What is survodutide commonly used for?

Most people look into survodutide for weight loss. Boehringer Ingelheim is also testing it for fatty liver disease, including the more serious inflamed form (MASH), and for type 2 diabetes, and a university hospital has registered a kidney study. Online, it is also promoted as a cheaper, milder stand-in for retatrutide and as a "liver-friendly" add-on to tirzepatide, neither of which has been studied. [11], [30], [31], [32], [33]

None of these is an approved use. The results below come from trials of the company's own product in adults who met strict entry rules and were monitored closely; an online vial is a different situation.

Weight loss

This is where the evidence is largest. In the phase 2 trial, 386 adults with obesity or overweight and no diabetes took survodutide or placebo for 46 weeks. Average weight fell by 6.2% on 0.6 mg, 12.5% on 2.4 mg, 13.2% on 3.6 mg and 14.9% on 4.8 mg, versus 2.8% on placebo, and 54.7% of people assigned to 4.8 mg lost at least 15%. Only 60.4% of participants finished the treatment period. [19]

In the phase 3 trial SYNCHRONIZE-1, 725 adults with obesity, or overweight with a related health problem, and no diabetes took survodutide up to 3.6 mg or 6.0 mg, or placebo, for 76 weeks. Counting everyone who started, weight fell by 12.2% on 3.6 mg and 13.0% on 6.0 mg, versus 5.4% on placebo, and 72.6% and 71.9% lost at least 5%, versus 46.3%. [8] Assuming everyone had stayed on treatment, the figures were 15.3% and 16.6%, versus 3.2%. [34], [9] In a news report of the full results, 28.5% of people on 6.0 mg lost at least 20%, versus 6.6% on placebo. [34]

Doserly

How much weight did people lose on survodutide?

Average body-weight change (%); each row has its own placebo group.

Phase 2 obesity · 4.8 mg weekly

adults with obesity or overweight, no diabetes · 46 weeks · everyone as randomized · peer reviewed. Survodutide −14.9%; placebo −2.8%.

SYNCHRONIZE-1 · 3.6 mg weekly

adults with obesity or overweight, no diabetes · 76 weeks · treatment-regimen estimand (everyone who started) · peer reviewed. Survodutide −12.2%; placebo −5.4%.

SYNCHRONIZE-1 · 6.0 mg weekly

adults with obesity or overweight, no diabetes · 76 weeks · treatment-regimen estimand (everyone who started) · peer reviewed. Survodutide −13.0%; placebo −5.4%.

SYNCHRONIZE-1 · 6.0 mg weekly

adults with obesity or overweight, no diabetes · 76 weeks · efficacy estimand (if everyone stayed on treatment) · company and news reports. Survodutide −16.6%; placebo −3.2%.

SYNCHRONIZE-MASLD · 6.0 mg weekly

obesity or overweight with fatty liver disease · 48 weeks · treatment-regimen estimand (everyone who started) · peer reviewed. Survodutide −8.7%; placebo −1.4%.

SYNCHRONIZE-1 6.0 mg appears twice: counting everyone who started gives −13.0%, assuming everyone stayed on treatment gives −16.6% (company and news reports). More than 16% of the placebo group used other GLP-1 medicines.

Average weight change in the main survodutide trials; populations, length and analysis differ, so this is not a head-to-head comparison.

The placebo group in SYNCHRONIZE-1 lost more than expected, partly because more than 16% of its members used an outside GLP-1 medicine during the trial. That narrows the gap in the "everyone who started" figures. [34] In the phase 2 trial, women and people with a lower starting BMI (body mass index) lost a larger share of their weight. [35]

Fatty liver (MASLD and MASH)

Fatty liver disease is now called MASLD (metabolic dysfunction-associated steatotic liver disease): too much fat in the liver, usually alongside excess weight or high blood sugar. When the fat comes with inflammation and liver-cell damage, it is called MASH, which can lead to scarring (fibrosis) and eventually cirrhosis. This is where survodutide's glucagon side is thought to matter most. [10], [6]

• Liver fat. In SYNCHRONIZE-MASLD, 216 adults with obesity and at-risk fatty liver took 6.0 mg or placebo for 48 weeks. Liver fat on MRI fell by at least 30% in 68.5% on survodutide versus 28.6% on placebo, counting everyone, or 84.2% versus 24.3% assuming everyone stayed on treatment. Assuming everyone stayed on treatment, liver fat returned to normal (under 5%) in 61.0% versus 5.7%, and the liver enzyme ALT (alanine aminotransferase) fell by 36.8% versus 11.0%. [10], [11]
• Inflammation and scarring on biopsy. In the phase 2 MASH trial, 293 adults with biopsy-confirmed MASH and mild to advanced scarring (stages F1 to F3) took 2.4, 4.8 or 6.0 mg or placebo for 48 weeks. MASH improved without worse scarring in 47%, 62% and 43%, versus 14% on placebo. Scarring improved by at least one stage in 34%, 36% and 34%, versus 22%. [6]
• Cirrhosis. In a small open-label study (everyone knew they were getting survodutide), blood levels after a single dose were similar in people with mild, moderate or severe cirrhosis and in people without it. In a 28-week part in people with no, mild or moderate cirrhosis, liver fat, liver stiffness and weight fell. [4]

Two numbers cause confusion. The company has reported that "up to 83.0%" of people improved their MASH versus 18.2% on placebo, and that scarring improved in "up to 64.5%" of those with moderate or advanced scarring (F2 and F3) versus 25.9%. These come from different analyses of the same phase 2 trial, not from a second trial, and the journal paper's main figures are the 47%, 62% and 43% above. [36], [6]

In the FDA's eyes, this liver work is the most advanced part of the program: survodutide has Fast Track (May 2021) and Breakthrough Therapy (September 2024) designations for MASH with moderate or advanced scarring, and two large phase 3 liver trials, LIVERAGE (about 1,800 people) and LIVERAGE-Cirrhosis (about 1,590), are recruiting. Designations speed up review; they are not approvals. [11], [37], [38]

Type 2 diabetes

In the phase 2 diabetes trial, 413 adults with type 2 diabetes on metformin took survodutide at several doses, placebo, or open-label semaglutide (up to 1.0 mg) for 16 weeks. HbA1c, a blood test that reflects average blood sugar over about three months, fell by 0.91 to 1.71 points on survodutide, versus 1.47 on semaglutide, and weight fell by up to 8.7%, versus 5.3%. [21]

The phase 3 diabetes trial, SYNCHRONIZE-2, has finished, and its main results are scheduled for the European diabetes meeting on October 1, 2026, after this guide was checked. A further phase 3 blood-sugar trial started in August 2026. [39], [30], [40]

Heart, blood pressure and kidneys

• Blood pressure. In the phase 2 obesity trial, systolic blood pressure (the top number) fell by 6.2 to 8.7 mmHg (millimeters of mercury) on survodutide, versus 2.5 mmHg on placebo. [5], [41]
• Heart outcomes. SYNCHRONIZE-CVOT, a trial in 5,531 people designed to check heart safety, finished in June 2026; results are expected later in 2026. Until then, there is no evidence either way on heart attacks or strokes. [42], [43], [44]
• Kidneys. A university-led trial of albumin in the urine in chronic kidney disease is registered but not yet recruiting. [31]

Studies still under way

These registered studies have no results yet. [30], [42], [45], [46]

Where do survodutide protocols differ?

The trial schedules are simple: start at 0.3 mg and step up slowly. The confusion comes from how fast to step, website ladders that start at 0.6 mg, whether 6.0 mg beats 3.6 mg, split doses, low-dose add-ons to tirzepatide, cycling and stopping.

Doserly

How did the trials step up the weekly dose?

Milligrams per weekly injection over weeks 1 to 24; each group then stayed on its final dose.

Phase 2 obesity · 2.4 mg group · Trial · registry schedule

0.3 mg weeks 1–2; 0.6 mg weeks 3–4; 0.9 mg weeks 5–6; 1.2 mg weeks 7–10; 1.8 mg weeks 11–14; 2.4 mg from week 15.

Phase 2 obesity · 4.8 mg group · Trial · registry schedule

0.3 mg weeks 1–2; 0.6 mg weeks 3–4; 0.9 mg weeks 5–6; 1.2 mg weeks 7–8; 1.8 mg weeks 9–10; 2.4 mg weeks 11–12; 3.3 mg weeks 13–14; 4.2 mg weeks 15–16; 4.8 mg from week 17.

Phase 2 MASH · 6.0 mg group · Trial · protocol schedule

0.3 mg weeks 1–2; 0.6 mg weeks 3–4; 0.9 mg weeks 5–6; 1.2 mg weeks 7–8; 1.8 mg weeks 9–10; 2.4 mg weeks 11–12; 3.0 mg weeks 13–14; 3.6 mg weeks 15–16; 4.2 mg weeks 17–18; 4.8 mg weeks 19–20; 5.4 mg weeks 21–22; 6.0 mg from week 23.

Common website ladder · Not tested in any trial

0.6 mg weeks 1–2; 1.2 mg weeks 3–4; 1.8 mg weeks 5–6; 2.4 mg weeks 7–8; 3.6 mg weeks 9–10; 4.8 mg weeks 11–12; 6.0 mg from week 13.

Every obesity and liver trial started at 0.3 mg. Phase 3 (SYNCHRONIZE) raised the dose to 3.6 or 6.0 mg over 24 weeks; its exact steps are not published.

Trial ladders climb from 0.3 mg in 2-week steps; the common website ladder reaches 6.0 mg by week 13. None of these is an approved schedule.

How fast should the dose go up?

Slowly, based on everything the trials learned. Survodutide's early trials tried faster ladders, and many people could not keep up. In the first multiple-dose study, 40.3% of people on survodutide in one part dropped out of their planned escalation; in a Japanese study, two-thirds of the group stepping toward 4.8 mg did. [47], [3]

The phase 2 diabetes trial raised doses over just 6 weeks, and its authors wrote that this fast escalation "most likely led to" more side effects and more people stopping because of them while the dose was rising. [21] The obesity and MASH trials that followed used mostly 2-week steps over 14 to 22 weeks, and phase 3 stretched escalation to 24 weeks with room to pause. Even so, most stomach side effects and most stopping still happened while the dose was rising. [5], [6], [7], [11]

Trial participants online describe how hard individual steps felt: nausea or vomiting at 1.2 mg that needed anti-nausea medicine, weekly vomiting at 2.4 mg, and flu-like aches and exhaustion after the 3.6 and 4.8 mg steps. [48], [49], [50]

Why do so many websites start at 0.6 mg?

Not because of the obesity or liver trials. Those all started at 0.3 mg; the only published 0.6 mg start was one group in a 16-week diabetes trial, whose fast schedule its authors linked to more side effects. [21] Among the dosing websites that state a starting dose, 0.6 mg is the most common, and many of those pages share the same tables. One widely copied ladder adds 0.6 mg every 2 weeks and reaches 6.0 mg by week 13, nearly twice as fast as the phase 2 MASH trial and far faster than phase 3. [25], [51], [52], [6], [7]

These schedules describe what websites publish, not what was tested. Other recurring errors include wrong trial names ("OASIS" and "COURAGE" are not survodutide trials), the phase 2 result of 14.9% credited to 3.6 or 6.0 mg, and half-lives from 3 days to 32.5 days. [54], [55], [56], [57], [58]

3.6 mg or 6.0 mg: is higher better?

In the phase 3 obesity trial, 6.0 mg added little weight loss over 3.6 mg, with more side effects. Counting everyone, weight fell 13.0% on 6.0 mg and 12.2% on 3.6 mg; stomach and bowel side effects affected 89.7% and 80.9%, and stopping for them was 20.2% and 17.8% in a news report of the full results. [8], [34]

For the liver, higher was not clearly better either. In the phase 2 MASH trial, 4.8 mg produced the best biopsy result (62%), and 6.0 mg did not do better (43%). In SYNCHRONIZE-MASLD, 80.2% of people who stayed on treatment were still on 6.0 mg at the end; the rest had settled on 4.8, 3.6 or 2.4 mg, the lowest dose the trial allowed. [6], [10]

In the phase 2 obesity trial, weight was still falling on 4.8 mg at 46 weeks; the phase 3 design paper notes "no indication of a weight plateau at that time point". [19], [22]

Once a week, or split into smaller doses?

The obesity, liver and phase 3 trials all used one injection a week. Survodutide's half-life of about 5 to 6 days keeps blood levels fairly steady across a week. [3], [4]

Twice-weekly dosing has some trial data: the phase 2 diabetes trial tested 1.2 mg and 1.8 mg twice a week, and 1.8 mg twice a week produced the largest weight loss in that 16-week trial (8.7%). The first human study also tried daily dosing. Neither became the schedule used later. [21], [47] In community education groups, educators sometimes suggest splitting the weekly amount to soften nausea; that is opinion, not a tested approach.

Adding survodutide to tirzepatide ("ghetto reta")

No trial has tested this combination, and it doubles up on GLP-1 activity. Approved drugs in the same family carry the opposite instruction: the prescribing information for Zepbound (tirzepatide) states that "coadministration with other tirzepatide-containing products or with any GLP-1 receptor agonist is not recommended". [59]

It is still the most common way survodutide is used outside trials. Public accounts describe weekly survodutide, mostly 0.3 to 2 mg, taken 3 to 4 days after tirzepatide, usually to break a weight-loss stall or to ease tirzepatide tiredness, sometimes while lowering the tirzepatide dose. Results range from a restarted scale to no difference at all. [60], [61], [62], [63], [64], [65] In community education groups, the same pattern dominates: the eight members who stated a dose used 0.3 to 3.5 mg of survodutide a week, half of them 0.5 to 1.2 mg, taken halfway between tirzepatide doses, with small or no steps. These doses sit inside the trials' early escalation steps, not at the trial maintenance doses. [5]

What the trials can say about low doses alone: 0.6 mg a week for 46 weeks produced 6.2% weight loss, versus 2.8% on placebo. [19] How much a low dose adds on top of tirzepatide, and what it does to heart rate or side effects, is unknown. The developer also studies survodutide with a different kind of appetite drug (an NPY2 receptor agonist), not with tirzepatide. [66], [67]

Adding it to retatrutide, or switching between them

No trial has tested it, and retatrutide already acts on the GLP-1 and glucagon receptors. Educators in community education groups advise against the pairing, and public accounts describe severe constipation and little clear benefit. [68]

Switching is a separate question. The phase 3 fatty-liver trial excluded anyone who had used weight-loss medicines in the previous 3 months, so the trials say nothing about moving straight from tirzepatide, semaglutide or retatrutide. A planned trial, SYNCHRONIZE-START, will study starting doses and switching from other GLP-1 medicines. [10], [11] People who switch from retatrutide online often do so because of its heart-rate rise, and one described tolerating survodutide after itching on retatrutide. [32], [69]

Do you need breaks or cycles?

No trial has tested cycling. The trials treated people continuously for up to 76 weeks. [8] Dosing websites describe 12- to 16-week "cycles" or 12 weeks on and 4 weeks off; neither has any survodutide evidence behind it. [51], [53] Trial participants describe needing about a month of stepping back up after a month-long pause, and gaining weight in the meantime. [70]

How do milligrams convert to syringe units?

Units appear only with freeze-dried vials that are mixed with water (reconstitution) and drawn into an insulin syringe. Syringe units measure volume, not drug. On a U-100 syringe, 100 units equal 1 mL, so the amount of survodutide in each unit depends on how much water went into the vial. [71], [25]

Mix-ups between milligrams, units and pens do happen. One public account describes an accidental double dose from a dosing-day mix-up, followed by nausea and four days without appetite. [62] In community education groups, the harms described were also accidental double doses, followed by days of nausea, lost appetite, tiredness and, in one case, a racing heart.

For example, a 10 mg vial mixed with 2 mL of water holds 5 mg per mL. The trial starting dose of 0.3 mg is then 0.06 mL, or 6 units, and 2.4 mg is 48 units. The same vial mixed with 1 mL holds 10 mg per mL, so 0.3 mg is 3 units. Reading the unit numbers for one mix while using the other doubles or halves the dose. At 5 mg per mL, 6.0 mg would be 120 units, more than a full syringe. Doserly's reconstitution calculator works out the arithmetic for any vial and shows each step. [71], [52] Correct arithmetic also says nothing about whether the vial contains what its label claims (see research vials).

What happens when you stop survodutide?

Nobody knows yet for people. No trial, paper or company announcement has reported what happens to weight, liver fat or blood sugar after survodutide is stopped. [8], [10]

• What the trials did. The trials reported results while people were still on treatment and followed them for side effects for 28 days after the last dose. [6], [5]
• How fast it leaves the body. With a half-life of about 5 to 6 days, blood levels would be expected to halve roughly every week after the last dose. The phase 2 MASH protocol asked women who could become pregnant to keep using two birth-control methods for at least 5 weeks after the last dose. [3], [4], [6]
• In similar drugs (context only). Across trials of GLP-1 medicines, people regained about 60% of the weight they had lost within a year of stopping. That is a different set of drugs and cannot be used as a survodutide estimate. [72]

In public accounts, former trial participants describe appetite returning and 4 to 5 pounds regained in the first month off; one held their weight after moving to tirzepatide. [70], [73] In community education groups, members describe using it indefinitely, skipping doses when their weight dips, and nobody reports what happened months after stopping.

Tapering. No trial has compared tapering with stopping all at once, and no taper schedule has been published.

How is survodutide given, and how long does it last in the body?

Survodutide has only been given by injection in people. Every trial used subcutaneous injections, once a week in all the main trials, from prefilled syringes. No pill, nasal spray or patch has been tested in people. [5], [10], [21]

The half-life is about 5 to 6 days: more than 100 hours in the first human studies, 114 hours in Japanese men and 139 hours in European participants on a similar schedule, and "about 6 days" in a later paper. Blood levels peaked 6 to 28 hours after an injection and rose in proportion to the dose. Because each weekly dose adds to what is left of the last one, blood levels take several weeks to settle after each dose change. [47], [3], [4]

The long half-life comes from the molecule's design. A fatty acid chain (an 18-carbon diacid on a short linker) attached to its 24th amino acid makes it bind to albumin, the main protein in blood, which slows its removal. A non-standard amino acid at position 2 protects it from DPP-4, an enzyme that quickly breaks down natural GLP-1. [1], [16]

Like other drugs in this family, survodutide slows how fast the stomach empties, which contributes to fullness and nausea. In the first human studies this effect, measured with paracetamol, was temporary. [47]

Does liver or kidney function change the dose?

In the cirrhosis study, blood levels after a single dose were similar across mild, moderate and severe liver impairment, and the authors concluded that no dose adjustment for blood levels was needed. A kidney-impairment study has finished without posted results, and the MASH trial excluded people with markedly reduced kidney function (an estimated filtration rate, eGFR, under 45). [4], [74], [6]

Pens and new formulations

The trials used prefilled syringes, not pens, although some dosing websites say otherwise. Boehringer has run several studies comparing new formulations, including a pen-type injector, with no results posted yet. [5], [75], [76], [77]

How should survodutide be stored, and how long does it last?

Not established. Survodutide has no approved label, and no regulator, trial paper or registry record has published its storage temperature, shelf life or in-use time. The phase 2 MASH protocol only says trial supplies were kept as the (non-public) label directs, with temperature logs. [6]

Dosing websites fill the gap with numbers that have no survodutide testing behind them: keep the powder frozen at −20 °C or at room temperature, keep mixed vials in the fridge at 2–8 °C, and use them within 14, 28 or 30 days. [25], [51], [78], [79] For compounded GLP-1 medicines dispensed in multi-dose vials, the FDA recommends using a vial within 28 days of first use, and it advises not using any injectable GLP-1 drug that arrives warm. [14] Treat any use-by period for a mixed "research" vial as unverified.

Public accounts include people freezing mixed portions for later use and vials that stayed cloudy after mixing, which the seller replaced. Neither practice nor product was tested. [80], [81]

This guide does not cover mixing or injection technique; the Academy note below covers practical handling.

What do we actually know about survodutide in people?

A fair amount, for an unapproved drug. About 2,300 people took part in the eight published human studies below, including two phase 3 trials, and thousands more are enrolled in phase 3 trials that have not reported yet. All the trials were funded by Boehringer Ingelheim. [47], [3], [21], [19], [6], [4], [8], [10], [30], [42], [37]

In a randomized controlled trial, people are assigned by chance to the drug or a comparison such as a placebo, so differences between the groups can be credited to the drug. All but the cirrhosis study below were randomized and placebo-controlled.

What do "efficacy" and "treatment-regimen" results mean?

They answer two different questions (estimands), and headlines often mix them. The treatment-regimen estimand counts everyone who started, including people who stopped early or took other drugs; the efficacy estimand estimates what would happen if everyone kept taking the drug as assigned. The second is usually larger. In SYNCHRONIZE-1, 6.0 mg gave 13.0% by the first method and 16.6% by the second; in SYNCHRONIZE-MASLD, 8.7% and 12.2%. [8], [34], [10]

The company's announcements lead with the efficacy figures ("up to 16.6%"), and the journal abstract leads with the treatment-regimen figures. Both are correct; they measure different things. The efficacy figure is not a "completers only" result, and 13.4%, a number seen online, is simply 16.6% minus the placebo group's 3.2%. [9], [8], [82]

Where does "18.7%" come from?

From a sensitivity analysis of the phase 2 obesity trial, on 4.8 mg, not 6 mg. It counts only the time people were on the dose they actually reached (the "actual treatment, on-treatment" analysis); the main result for the 4.8 mg group was 14.9%. The phase 3 design paper reports it as 18.7% ("placebo-adjusted 16.4%"). Several websites wrongly attribute 18.7% to 6 mg or call it the main result. [19], [22], [83], [84]

Is the weight lost fat or muscle?

Mostly fat, in the one scan study reported so far. In an MRI substudy of SYNCHRONIZE-1 with about 25 people per group, visceral fat (fat around the organs) fell by up to 34.0% versus 11.8% on placebo, and liver fat by 63.1% versus 24.5%. The company reports that lean tissue made up no more than 11.3% of the tissue lost at the highest dose, a figure it corrected upward from 10.8%. [11], [34]

That means survodutide does lose some lean mass, as other weight-loss drugs do; one report puts the fall in lean volume at 9.8%. No survodutide study has measured muscle strength. [34]

What else changed in the trials?

• Blood sugar and insulin. In later analyses of the phase 2 trials, markers of insulin resistance and fasting blood sugar fell; whether this lasts after stopping is unknown. [85]
• Liver enzymes and inflammation. ALT fell by 36.8% on 6.0 mg in SYNCHRONIZE-MASLD, and an MRI marker of liver inflammation improved. [10]
• Waist. Waist size fell by 8.3 to 16.0 cm in the phase 2 obesity trial, versus 4.0 cm on placebo. [5]

These are measured changes in trial participants. They do not yet show fewer heart attacks, strokes, cirrhosis or kidney failure; the outcome trials are designed to test that. [42], [37]

How does survodutide work?

Survodutide switches on two receptors: the GLP-1 receptor and the glucagon receptor. That is measured in cells engineered to carry each human receptor. What each receptor contributes inside a person has not been separated: human trials measure the combined result (weight, liver fat, blood sugar, heart rate). [1]

Is it more GLP-1 or more glucagon?

More GLP-1. In plain cell tests, survodutide was about equally potent at the two receptors. In tests run in human blood plasma, which better reflect the body because the drug binds to albumin, it was about eight times more potent at the GLP-1 receptor (1.0 versus 8.3 nanomolar). Zealand describes the molecule as "deliberately designed with strong bias towards the GLP-1 receptors". [1], [2], [3]

Online claims that survodutide is "glucagon-dominant", has more glucagon activity than retatrutide or mazdutide, or also acts on the receptor for GIP (another gut hormone, targeted by tirzepatide and retatrutide) do not match the published data. It has no GIP activity. [1], [84], [32]

What does each part do?

• GLP-1 side. Works like semaglutide: lowers appetite, slows the stomach and helps the pancreas release insulin when blood sugar is high. In mice, survodutide reached appetite centers at the edge of the brain, where GLP-1 receptors are plentiful and glucagon receptors barely present, so the appetite effect is thought to come from GLP-1. [86]
• Glucagon side. Glucagon tells the liver to release stored energy and burn fat. In mice, survodutide switched on liver glucagon-receptor markers, lowered liver fat more than GLP-1 drugs alone and raised energy use, which together gave more weight loss than the highest effective semaglutide dose. In people, early studies saw falls in blood glucagon and amino acids, a sign the glucagon receptor was engaged. [1], [87], [47]

The energy-use idea has not been confirmed in people; a dedicated human study has not reported. [45] For the liver, a later analysis of the phase 2 MASH trial estimated that weight loss explained about two-thirds of the improvement in MASH but only about a third of the improvement in scarring, which suggests a more direct liver effect on scarring. [88]

Why does it raise heart rate?

Both GLP-1 and glucagon can speed up the heart. In heart muscle taken from patients during heart surgery and tested in a dish, survodutide increased the force of contraction through both receptors. That finding comes from a conference abstract described in reviews by the same laboratory, not from measurements in living people. [89], [90] The human heart-rate data are in the risks section.

What did animal studies show?

About eight short animal and tissue studies report lower weight, liver fat and blood fats, including combinations with other experimental drugs; they are summarized in the research library. In the company's toxicology summary, the highest safe dose in monkeys was limited by weight loss itself. No long-term animal cancer or reproduction studies have been published. [91], [66], [87]

What are the risks and unanswered questions?

Is survodutide safe?

In trials of up to 76 weeks, its main problems were stomach and bowel side effects, a modest heart-rate rise and occasional gallbladder events; serious harms were no more common than on placebo, but long-term and outcome data are not yet published. In SYNCHRONIZE-MASLD, serious adverse events affected 9.6% on survodutide and 11.4% on placebo, with no confirmed drug-induced liver injury, pancreatitis, pancreatic cancer or thyroid cancer on survodutide. Products sold outside trials add risks of their own, including wrong doses and unknown sterility. [10], [6], [13], [92]

What are the most common side effects?

Nausea, vomiting, diarrhea, constipation and lower appetite, mostly while the dose is rising and mostly mild to moderate. [10], [11]

[6], [20], [10]

Doserly

How often did stomach side effects make people stop?

Share of people (%) in each trial, survodutide versus its own placebo group.

Phase 2 obesity · 46 weeks · all doses

Stomach and bowel side effects: Survodutide 75%; Placebo 42%. Stopped for any side effect (range across dose groups): Survodutide 14% to 27% by dose group; Placebo 5.2%.

SYNCHRONIZE-1 · 76 weeks

Stomach and bowel side effects: 3.6 mg 80.9%; 6.0 mg 89.7%; Placebo 47.9%. Stopped for stomach and bowel side effects (news report): 3.6 mg 17.8%; 6.0 mg 20.2%; Placebo 2.9%.

SYNCHRONIZE-MASLD · 48 weeks · 6.0 mg

Stomach and bowel side effects: Survodutide 77.4%; Placebo 42.9%. Stopped for any side effect: Survodutide 23.3%; Placebo 10%.

Phase 2 MASH · 48 weeks · all doses

Nausea only (total not reported): Survodutide 66%; Placebo 23%. Stopped for any side effect (registry, range across dose groups): Survodutide 16% to 23% by dose group; Placebo 2.7%.

Trials counted side effects differently, so compare each value with its own placebo, not across trials. Most events happened while the dose was being raised. The SYNCHRONIZE-1 dose split comes from a news report; the company reported 19% for both doses combined.

Stomach and bowel side effects were very common on survodutide, and about 1 in 5 people stopped because of side effects in the phase 3 trials.

Across the obesity trials, stomach and bowel side effects affected 75% on survodutide versus 42% on placebo in phase 2, and 80.9% (3.6 mg) and 89.7% (6.0 mg) versus 47.9% in SYNCHRONIZE-1. In SYNCHRONIZE-1, 19% stopped because of them, versus 2.9% on placebo. [19], [8], [11] Other effects more common than on placebo in SYNCHRONIZE-MASLD include decreased appetite (11.6% versus 10.0%) and fatigue (10.3% versus 5.7%). [10]

Does survodutide raise heart rate?

Yes, on average by a few beats per minute. Resting heart rate rose by 3.6 beats per minute on 6.0 mg versus 0.8 on placebo at week 52 of SYNCHRONIZE-MASLD, and by 3.2 to 3.5 at week 76 of SYNCHRONIZE-1, according to a report of the full results. In the 16-week diabetes trial, the rise was 2.3 to 7.3 beats per minute across doses, versus 5.9 on semaglutide and 1.7 on placebo. [10], [34], [21]

No one in SYNCHRONIZE-MASLD developed a markedly prolonged QT interval (an electrical change on a heart tracing), and a dedicated QT study has finished without posted results. In the first human study, one person had a serious fast heart rhythm from the lower chambers (ventricular tachycardia) judged related to the drug, and in one part of that study heart and blood-vessel side effects were the most common reason for stopping (6 of 80 people), including atrial fibrillation (an irregular heartbeat) and heart block (a delay in the heart's electrical signal). [10], [46], [47] In the small cirrhosis study, resting heart rate rose by 8.5 and 7.6 beats per minute after 28 weeks in people with mild and moderate cirrhosis, versus 4.1 in people without cirrhosis; the authors suggest the circulation changes of cirrhosis may add to the rise. [4]

The trials excluded people with a resting heart rate over 100 or fast heart-rhythm disorders such as atrial fibrillation, and the MASH trial stopped treatment if heart rate was over 120 on two readings 5 minutes apart. Averages also hide individual variation: in community reports, one person on survodutide plus tirzepatide reported a resting heart rate around 100. [6], [60] Heart-outcome results from SYNCHRONIZE-CVOT are expected later in 2026. [44]

Pancreas, gallbladder and liver

• Pancreas. No confirmed pancreatitis on survodutide in SYNCHRONIZE-MASLD or SYNCHRONIZE-1; raised pancreatic enzymes without symptoms were slightly more common. The trials excluded people with past pancreatitis. Regulators have strengthened pancreatitis warnings for approved drugs in this class. [10], [34], [6], [93]
• Gallbladder. Gallstones or gallbladder inflammation occurred in a few people on higher doses. The 4.8 mg group of the phase 2 obesity trial had one serious case of each, two people on 6.0 mg in the phase 2 MASH trial had gallstones, and one person on 6.0 mg in SYNCHRONIZE-MASLD had both. Across trials of GLP-1 medicines, gallbladder and bile-duct disease is more common than on placebo. [5], [6], [10], [94]
• Liver. No drug-induced liver injury was confirmed in SYNCHRONIZE-MASLD, and liver enzymes fell on average. [10]

Mood, allergy and blood sugar

• Mood. In SYNCHRONIZE-MASLD, major depressive disorder was reported in 4 people on survodutide (2.7%) and none on placebo, while suicidal thoughts or behavior were reported in none on survodutide and 2 on placebo. The trials screened mood with questionnaires and excluded people with recent severe depression or suicidal behavior. [10], [6]
• Allergic reactions. Angioedema (swelling of deeper skin layers, often of the lips, face or throat) was a serious event in one person on 3.6 mg in the phase 2 obesity trial and one on 2.4 mg in the phase 2 MASH trial. [5], [20]
• Low blood sugar. None on survodutide in SYNCHRONIZE-MASLD (2 on placebo). The risk rises with insulin or sulfonylureas, as the labels of approved drugs in the class warn. [10], [95]

Thyroid

The trials excluded people with a personal or family history of medullary thyroid cancer or MEN2 (multiple endocrine neoplasia type 2) and people with a high calcitonin level. No thyroid cancer was reported on survodutide in SYNCHRONIZE-MASLD, and the MASH trial protocol lists thyroid C-cell tumors as a potential class risk. [6], [10]

Are online "research" vials the same as trial survodutide?

No. The trial product is made by Boehringer Ingelheim for its trials and supplied in prefilled syringes. Powder sold online as "research use only" is unapproved, and what it contains is unknown:

• Wrong amounts. A 2026 preprint of public lab reports found that 64.0% of survodutide samples met both a purity and a label-content standard used for compounded drugs; the failures were amount errors rather than the wrong substance, and only about 16% met the stricter limits for manufactured medicines. The survodutide sample was small (about 25), and the study is not peer reviewed. [92]
• Regulator action. The FDA has sent warning letters to companies selling survodutide, in December 2024 and August 2026, and lists it among unapproved GLP-1 drugs "falsely labeled 'for research purposes'". The August letter notes that injectable products "can pose risks of serious harm to users". [96], [13], [14]
• Reactions. Public accounts include a vial that stayed cloudy, itching and eyelid swelling that led someone to stop, and palpitations, flushing and visual spots after a dose that the poster blamed on a faulty vial. None could be traced to a cause. [81], [97], [61]

Dosing mistakes are a separate risk (see units).

Is survodutide legal? Is it FDA approved?

Checked September 24, 2026. Rules differ by country and change often.

United States. Not approved. Boehringer describes survodutide as "an investigational agent" that "has not been approved for use", and the FDA's drug databases list no application or label. No application for approval had been announced. [11], [98], [12]

• May 2021. FDA Fast Track designation for MASH with moderate or advanced scarring. [11]
• September 2024. FDA Breakthrough Therapy designation for the same use. Both designations speed development and review; neither is an approval. [11]
• December 2024 and August 2026. FDA warning letters to companies selling survodutide online. [96], [13]
• Compounding. Survodutide is not on any FDA list of ingredients that pharmacies may use for compounding, so no legal compounding route is evident. [99], [100]

Canada. Not authorized; Health Canada's drug database has no survodutide product. [101]

United Kingdom. Not authorized; the product search of the UK medicines regulator (MHRA) returns no results. [102]

European Union. Not authorized. The European Medicines Agency accepted it into its PRIME support scheme for MASH with fibrosis in November 2023, a development step, not an approval. [103], [104], [11]

Australia. Not approved; no entry in the Australian Register of Therapeutic Goods. [105]

Other countries. China's regulator (June 2024) and Taiwan's (September 2024) granted breakthrough designations for MASH, again not approvals. Survodutide is sometimes confused online with mazdutide, a different GLP-1 and glucagon drug that is approved in China. [11], [106]

A "research use only" label does not make any of these products legal to sell for human use. [14]

Is survodutide banned in sport?

Athletes should treat it as banned. Survodutide is not named on the World Anti-Doping Agency's 2026 or 2027 Prohibited Lists, but WADA's S0 category bans at all times any substance "with no current approval by any governmental regulatory health authority for human therapeutic use", which describes survodutide. It is not part of WADA's Monitoring Program, which tracks semaglutide and tirzepatide. [107], [15], [108] The US Anti-Doping Agency (USADA) page on GLP-1 medicines says they are not prohibited, but it addresses approved drugs, not investigational ones; tested athletes should confirm with their anti-doping organization. [109]

Who should be especially cautious?

• Pregnancy and breastfeeding. Not studied. The trials excluded pregnant and breastfeeding women and required highly effective birth control during the trial and for at least 5 weeks after the last dose. [6]
• Under 18. Not studied; the trials enrolled adults only. [19], [8]
• Excluded from the trials, so not studied: past pancreatitis, a personal or family history of medullary thyroid cancer or MEN2, a resting heart rate over 100 or fast heart-rhythm disorders, a recent heart attack or stroke, recent severe depression or suicidal behavior, and previous weight-loss surgery. [6]
• Kidney impairment. Not studied in the main trials below an eGFR of 45; a dedicated study has not posted results. [6], [74]
• Tested athletes and people taking other medicines. See the questions above and below.

Can survodutide be taken with other medicines?

What has and has not been tested:

• Common medicines. Boehringer has completed a study of survodutide with bupropion, caffeine and midazolam (drugs used to check liver enzymes that break down many medicines). It has not posted results. [110]
• Birth-control pills. A study of survodutide with a birth-control pill has finished without posted results, and the phase 2 MASH trial did not allow birth-control pills, requiring other methods instead. For tirzepatide, the label says pills may work less well after starting and after each dose increase. [111], [6], [59]
• Diabetes medicines. Insulin and sulfonylureas raise the risk of low blood sugar with drugs in this family. [59]
• Other GLP-1 drugs. Never tested together with survodutide; approved drugs in the class say not to combine them (see add-ons). [59]
• Surgery and sedation. Approved drugs in this class warn that food can be breathed into the lungs during anesthesia and ask patients to tell their surgical team. The same caution is reasonable for survodutide. [59]

Bring a full list of everything you take, including supplements and other peptides, to a pharmacist or doctor.

What is still unknown?

• Type 2 diabetes results (SYNCHRONIZE-2) and heart-outcome results (SYNCHRONIZE-CVOT), both due in late 2026. [39], [44]
• Whether liver benefits translate into fewer cases of cirrhosis or liver failure (LIVERAGE trials, around 2029 to 2031). [37], [38]
• What happens after stopping, and whether energy use really rises in people. [45]
• Drug-interaction, kidney-impairment, QT and pregnancy data. [110], [74], [46]
• Low-dose add-ons to tirzepatide, split doses and long-term animal cancer and reproduction studies, none of which exist.

What should be monitored while using survodutide?

Survodutide has no label, so no official monitoring schedule exists. The trials show what researchers thought worth measuring. Use this summary to prepare questions for a clinician; it is not a personal testing plan. [6], [10]

What did the trials measure?

[6], [10], [19], [11]

What deserves the most attention?

Based on what the trials found, the practical watch points are:

• Stomach and fluids. Most stopping happened during dose increases. Persistent vomiting or diarrhea can cause dehydration, which approved drugs in this class warn may harm the kidneys. [11], [10], [59]
• Heart rate. Knowing your usual resting heart rate before starting makes a change easier to judge; the MASH trial stopped treatment if heart rate was over 120 on two readings 5 minutes apart. [6]
• Pancreas and gallbladder. Approved drugs in this class tell users to get help for severe stomach pain that will not go away, sometimes spreading to the back, or upper stomach pain with fever or yellowing of the skin or eyes. [59], [6]
• Mood. New low mood or dark thoughts are worth raising promptly; the trials checked mood with questionnaires. [10]
• Blood sugar. For anyone using insulin or other diabetes medicines. [95]

In community education groups, educators suggest broader panels, such as lipids and ApoB (a blood test of cholesterol-carrying particles), liver enzymes, HbA1c, kidney markers and blood pressure, and tracking lab markers rather than weight alone. Those are reasonable questions for a clinician, but they go beyond what the trials required.

How is the response judged?

In the trials, response meant the percentage of starting weight lost, the share of people whose liver fat fell by at least 30% on MRI, biopsy grades in MASH, or HbA1c in diabetes. No trial set a rule for stopping when there was little response. [8], [10], [6], [21] People care about different outcomes, such as weight, appetite, liver tests, energy or how they feel, and tracking what matters to you next to dose changes and side effects makes a conversation with a clinician more useful.

What do people in public communities report?

Two very different groups post about survodutide: former trial participants, who took the company's product on a trial schedule without knowing whether they had the drug or a placebo, and people using unapproved "research" vials, almost always alongside tirzepatide. We reviewed 41 public threads from a dedicated survodutide forum section and Reddit communities, plus discussions in community education groups, which are summarized here without identifying anyone. [60], [23], [64], [68]

These accounts show what people do and what they run into. They cannot show how well survodutide works or how often side effects happen: the people posting are self-selected, most take other drugs at the same time, trial participants often do not know their group, and no research vial was verified.

What do positive reports look like?

From trial participants, steady loss over months: 19% of body weight on 3.6 mg, 28 kg over 20 months with no other weight-loss drug, and 110 pounds over about 15 months in a heart and kidney trial. [49], [112], [113] From add-on users, a restarted scale after a long stall, less "food noise" (constant thoughts about food) and, for some, less of the tiredness they felt on tirzepatide. [61], [62], [97] These are individual stories; the trial averages are in human research.

How long do changes take?

Add-on users often describe the appetite effect as strongest in the first 2 or 3 days after each injection, and many place it mid-week, 3 or 4 days after tirzepatide, to cover the end of the week; one described strong suppression that faded after a couple of months. [114], [60], [65] Community education groups describe the same short window. Trial participants describe a fast first week, slower loss afterward and plateaus of weeks to months. [24], [115], [73]

What about people who do not respond?

Some report little or nothing: a month without a clear effect, no loss over 8 weeks on 1 mg with tirzepatide, or little benefit over 6 to 8 months. [60], [116], [63] Trial participants with slow loss often wonder if they are on placebo, which cannot be checked from a post. [117], [118] Because add-on users rarely stop tirzepatide, nobody can separate survodutide's share of any change, good or bad.

What unwanted effects come up most?

• Stomach and bowel. Nausea, vomiting, diarrhea, reflux and constipation, often worst in the first days after a dose or after a step up; trial participants describe weekly vomiting at 2.4 mg and eating only 200 to 400 calories on the worst days. [48], [49], [119], [120], [121]
• Tiredness and aches. Exhaustion after dose increases and flu-like aches at 4.8 mg in trial participants; fatigue at high add-on doses. [119], [50], [113]
• Sleep. Early-morning waking and broken sleep. [122]
• Heart rate. A resting heart rate around 100 in one person using survodutide with tirzepatide, while others say they noticed no rise compared with retatrutide. [60], [123]

In community education groups, few side effects are reported at the low add-on doses most members use, which almost certainly reflects those doses rather than good tolerance: nobody there described a trial-style course.

Mistakes, mixed vials and mystery products

Several accounts are about measurement or product rather than the drug: accidental double doses, freezing mixed portions, cloudy vials, and one person who got little effect from a whole vial. [62], [80], [81], [69] Trial participants note that their boxes show the volume (0.5 mL), not the milligram dose, a reminder that trial dose reports are often guesses. [23]

What claims circulate, and do they hold up?

How can you judge a story about survodutide?

Ask: Was it a trial injection or an online vial, and was the vial ever tested? Was the person in a trial where they might have been on placebo? What was the dose in milligrams, not units, and how fast was it raised? Was tirzepatide, retatrutide or anything else taken at the same time? Was the result a scale reading, a lab test or a feeling? What happened months later, and after stopping?

These selected discussions show what people ask and experience, not what the drug does. They are not a survey of users, a success rate or a substitute for the trials.

How does survodutide compare with tirzepatide, retatrutide, mazdutide, pemvidutide and semaglutide?

These are the drugs most often weighed against survodutide, because they work in overlapping ways, are used alongside it or target the same liver disease. Status was checked on September 24, 2026.

The results come from separate trials in different people, measured at different times and sometimes with different analysis methods, so the table cannot rank these drugs. No trial has compared survodutide head-to-head with any of them at obesity doses; the only direct comparison is the 16-week diabetes trial, against semaglutide up to 1.0 mg, open label. [21]

The real differences are in design and stage. Survodutide adds glucagon activity to GLP-1, which is thought to explain part of its large falls in liver fat, but unlike retatrutide and tirzepatide it has no GIP activity, and its phase 3 weight loss was smaller than theirs in their own trials. Among the GLP-1 and glucagon drugs, only mazdutide is approved anywhere, and semaglutide is the only drug here approved for MASH. [10], [1], [134]

Common questions about survodutide

Is survodutide FDA-approved? When will it be available?

No. Survodutide is not approved by the FDA or any other regulator, and no application had been announced when this guide was checked. Its FDA Fast Track and Breakthrough Therapy designations for liver disease speed development; they are not approvals. Results still to come include SYNCHRONIZE-2 (October 2026) and the heart-safety trial (later in 2026). Until then, legitimate supply is limited to clinical trials, and survodutide sold online is unapproved. [11], [12], [39], [44], [14] See legal status by country.

What dose of survodutide has been studied?

The obesity and liver trials started at 0.3 mg once a week and raised the dose in small steps over about 14 to 24 weeks; the 16-week diabetes trial stepped up over 6 weeks. Maintenance doses were 0.6 to 4.8 mg in the phase 2 obesity trial, 2.4 to 6.0 mg in the phase 2 MASH trial, 3.6 or 6.0 mg in phase 3, and 0.3 to 2.7 mg (or twice-weekly doses) in the phase 2 diabetes trial. The highest dose studied is 6.0 mg a week, and no dose is approved. [19], [6], [8], [21] See typical protocols.

How much weight do people lose on survodutide?

In SYNCHRONIZE-1, about 12% to 13% of starting weight over 76 weeks on 3.6 or 6.0 mg, counting everyone who started, versus 5.4% on placebo; about 15% to 17% for people who stayed on treatment. In the phase 2 trial, 4.8 mg gave 14.9% at 46 weeks. Individual results vary widely, and results in people with type 2 diabetes (SYNCHRONIZE-2) were not yet public when this guide was checked. [8], [34], [19], [39] See human research.

Is survodutide the same as retatrutide or mazdutide?

No. Retatrutide is a different molecule from a different company that also acts on the GIP receptor, making it a triple agonist. Mazdutide is, like survodutide, a GLP-1 and glucagon dual agonist, but it is a different molecule, developed mainly in China, where it is approved. Survodutide is weighted toward GLP-1 and has no GIP activity. [1], [126], [106] See how it compares.

Can survodutide be taken with tirzepatide?

It has never been tested. The low-dose add-on ("ghetto reta") is common online, but no trial has measured its benefit, heart-rate effect or side effects, and approved drugs in this family say not to combine GLP-1 medicines. Tirzepatide's prescribing information states that "coadministration with other tirzepatide-containing products or with any GLP-1 receptor agonist is not recommended". [59] See add-ons.

Does survodutide help fatty liver?

In trials, it lowered liver fat substantially: in SYNCHRONIZE-MASLD, liver fat fell by at least 30% in 68.5% of people on 6.0 mg versus 28.6% on placebo, and returned to normal in 61.0% of those who stayed on treatment. In the phase 2 MASH trial, liver inflammation improved without worse scarring in up to 62%, versus 14%. Whether this prevents cirrhosis is being tested in the LIVERAGE trials, and it is not approved for liver disease. [10], [6], [37] See fatty liver.

How long does survodutide stay in the body?

Its half-life is about 5 to 6 days, so blood levels roughly halve each week after the last dose, and it takes about a month (roughly five half-lives) for most of it to clear. The MASH trial asked women to keep using birth control for at least 5 weeks after the last dose. How long its effects on appetite and weight last after stopping has not been studied. [3], [4], [6] See stopping.

Does a 10 mg vial mean a 10 mg dose?

No. A vial label states the total amount of powder in the vial, not a dose. A 10 mg vial would hold many weeks of trial-style doses, and once mixed, the dose depends on how much water was added, so it has to be measured in milligrams, not units or vials. Labels themselves can be wrong: in public lab reports, about a third of survodutide samples missed a label-content standard. [92], [71] See units.

Glossary

Plain explanations of the medical, dosing and research terms used in this guide. Underlined terms in the text link here.

Adverse event

A harmful or unwanted medical event reported after someone used a treatment. A report alone does not prove the treatment caused it.

Albumin

The most common protein in blood. Survodutide's fatty side chain makes it stick to albumin, which slows its removal and allows weekly dosing.

Amino acid

A small chemical building block. Chains of amino acids make up peptides and proteins. Survodutide is a chain of 29.

Animal study

Research in animals such as mice, rats or monkeys. It shows what a substance does in a living body, but results in people can differ.

Bioavailability

How much of a dose reaches the bloodstream in a usable form. It depends heavily on the route. It has not been published for survodutide.

BMI (body mass index)

Weight in kilograms divided by height in meters squared. A BMI of 30 or more is classed as obesity and 25 to 29.9 as overweight.

Cell study (in vitro)

Research on cells or tissue in a dish. It gives early clues about biology, but it is far from proof of benefit in people.

Cirrhosis

Advanced scarring of the liver (fibrosis stage 4) that changes its structure and can lead to liver failure.

Compounding

When a pharmacy prepares a customized medicine from individual ingredients. Survodutide is not on any FDA list of ingredients allowed for compounding.

Randomized controlled trial

A study that assigns people by chance to a treatment or a comparison, often a placebo, so the groups can be compared fairly.

Course and cycle

A course is a period of repeated use. A cycle is a course plus a planned break. Survodutide trials used continuous treatment, not cycles.

Dose (amount each time)

The amount given on one occasion. For weekly survodutide injections, the dose is also the weekly total.

Dual agonist

A single drug that switches on two different receptors. Survodutide switches on the GLP-1 and glucagon receptors; it is one molecule, not a mix of two drugs.

Efficacy and treatment-regimen estimands

Two ways of analyzing a trial. The treatment-regimen estimand counts everyone who started, including people who stopped or took other drugs; the efficacy estimand estimates the effect if everyone kept taking the drug, and usually gives larger numbers.

Fast Track and Breakthrough Therapy

FDA programs that speed up the development and review of promising drugs for serious conditions. Neither is an approval.

Fibrosis

Scar tissue that builds up in an organ. In the liver it is graded from F0 (none) to F4 (cirrhosis).

GIP (glucose-dependent insulinotropic polypeptide)

A gut hormone released after eating that helps the pancreas release insulin. Tirzepatide and retatrutide act on its receptor; survodutide does not.

GLP-1 (glucagon-like peptide-1)

A hormone released by the gut after eating. It raises insulin when blood sugar is high, slows the stomach and signals fullness to the brain.

Glucagon

A hormone made by the pancreas that raises blood sugar by telling the liver to release stored glucose. It also increases fat burning in the liver.

Half-life

The time it takes for the level of a substance in the blood to fall by half. For survodutide it is about 5 to 6 days. It is not the same as how long an effect lasts.

HbA1c

A blood test that reflects average blood sugar over roughly the past three months. It is the main measure of diabetes control.

Investigational

Being tested in clinical trials but not approved by any regulator for sale or medical use. Survodutide is investigational everywhere.

Lean mass

Everything in the body that is not fat, including muscle, organs and water. A scan measures it; it is not the same as muscle strength.

Lipase and amylase

Enzymes made by the pancreas. Blood levels are checked when pancreatitis is suspected; mild rises without symptoms are common with drugs in this family.

Loading phase

Starting with a higher amount for a short period, then lowering it. No survodutide trial used one.

MASLD

Metabolic dysfunction-associated steatotic liver disease: excess fat in the liver linked to excess weight, high blood sugar or high blood fats. It was formerly called NAFLD.

MASH

Metabolic dysfunction-associated steatohepatitis: fatty liver with inflammation and liver-cell damage, which can lead to scarring. It was formerly called NASH.

mcg and mg

Micrograms and milligrams. 1 mg equals 1,000 mcg. Survodutide doses are written in mg, so 0.3 mg is 300 mcg.

MRI liver-fat scan (MRI-PDFF)

An MRI measurement of what share of the liver is fat. Under 5% is normal. It measures fat, not inflammation or scarring.

Open-label

A study in which participants and researchers know which treatment each person gets. It is less protected against bias than a blinded, placebo-controlled trial.

Peptide

A short chain of amino acids. Survodutide is a chain of 29 with a fatty side chain attached.

Pharmacokinetics

How the body absorbs, moves, breaks down and removes a substance.

Placebo

A dummy treatment with no active ingredient, used as a comparison in studies.

Preclinical research

Studies done before or alongside research in people: cell studies and animal studies.

QT interval

A measurement on a heart tracing (ECG) of how long the heart takes to recharge between beats. A prolonged QT can raise the risk of dangerous rhythms.

Reconstitution

Mixing a freeze-dried powder with a liquid so it can be measured and injected. The amount of liquid sets how much drug each unit holds.

Research use only

A label on products sold for laboratory research. It does not mean a product is approved, tested for human use or legal to sell as a medicine.

Subcutaneous (SC)

Injected into the fatty layer just under the skin. Every survodutide trial used subcutaneous injections.

Syringe units

Markings on an insulin syringe that measure volume. On a U-100 syringe, 100 units equal 1 mL. The amount of drug per unit depends on the vial's concentration.

Titration

Adjusting a dose in steps, usually starting lower and increasing. Survodutide's obesity and liver trials started at 0.3 mg and stepped up over about 14 to 24 weeks.

Visceral fat

Fat stored deep in the belly around the organs, as opposed to subcutaneous fat, which sits just under the skin. It is linked to diabetes, heart and liver disease.

WADA

The World Anti-Doping Agency, which publishes the list of substances banned in sport, including a category (S0) for drugs not approved anywhere.

Weekly total

All the amounts given in one week, added together. For a once-weekly injection it equals the single dose; split doses must add up to it.

Withdrawal and rebound

Withdrawal effects are symptoms caused by stopping a substance. A rebound is a problem returning after stopping. Neither has been studied for survodutide.

Explore more of the research

Go deeper into the laboratory and animal experiments behind the mechanism claims.

Across this guide, the citations include 18 original peer-reviewed papers on survodutide or, in one case, a close analogue: 12 human studies and later analyses of them, and 6 cell, tissue or animal studies, plus company announcements, registry records and regulator documents. The optional library below groups the laboratory and animal research by question. Preclinical results show what happened in cells or animals; they are not proof of the same effect in people, and animal doses are never converted to human doses here.

How this guide was researched

This guide is built from a thorough review of the sources cited throughout it: published clinical trials, clinical-trial registry records, company trial announcements, regulatory documents and published dosing descriptions. We also reviewed public online forums and community education groups where people describe their own experiences with survodutide.

The guide cites 137 sources, including 18 original peer-reviewed papers on survodutide or, in one case, a close analogue (12 human studies and later analyses of them, and 6 cell, tissue or animal studies), plus Boehringer Ingelheim's trial announcements and published trials of related drugs for comparison. Each type of source answers a different question. Trials show what was measured, company announcements show results not yet in a journal, dosing descriptions show how survodutide is discussed online, and personal accounts show what individual people experienced. Every numbered citation links to its entry below, labeled by source type. The research library above summarizes the laboratory and animal studies by question.

How this guide was made

Research and drafting were AI-assisted. Every cited source was checked against the original or, where the source list says so, a saved or indexed copy, and the guide was reviewed and edited by Doserly before publication. It has not had an independent clinical review, and Doserly does not currently have medical reviewers. Doserly makes a medication and health-tracking app and runs Doserly Academy, both of which are promoted in this guide. Read our editorial policy for how guides are researched, updated and corrected.

This guide is for educational purposes. It summarizes what the reviewed sources report so the research is easier to understand; it is not medical advice. For a deeper dive, or to check any point for yourself, go straight to the cited sources.

Explore the sources