Survodutide
Also called BI 456906
An investigational once-weekly peptide that activates both GLP-1 and glucagon receptors, studied for obesity and fatty liver disease (MASH). Phase 3 weight-loss results are positive, but it is not approved.
Overview
What it is
A long-acting glucagon/GLP-1 dual agonist developed by Zealand Pharma and Boehringer Ingelheim.
How it works
The GLP-1 side lowers appetite and blood sugar, while the glucagon side is intended to increase energy use and act on the liver. The mechanism is a reason to study it, not proof it is better than other GLP-1 drugs.
What the research shows
SYNCHRONIZE-1 (725 adults without diabetes) and SYNCHRONIZE-2 (752 adults with type 2 diabetes) compared two survodutide groups with placebo over 76 weeks; the sponsor's early analysis reported up to 16.6% average weight loss versus 3.2% with placebo. In the diabetes trial, HbA1c fell about 0.8 to 0.9 points. A 48-week phase 2 MASH trial found liver inflammation improved without worsening scarring in 43% to 62% versus 14% on placebo.
Studied for
- Obesityphase 3
- Obesity with type 2 diabetesphase 3
- MASH fatty liver diseasephase 2, phase 3 ongoing
Safety and regulatory status
Safety and side effects
Digestive side effects were very common: 81% to 90% in survodutide groups versus 48% on placebo in SYNCHRONIZE-1, mostly mild to moderate. Nausea, diarrhea and vomiting were also more frequent in the liver trial.
Regulatory status
Investigational as of October 2026. FDA development designations for MASH are not marketing approvals.
Mixing and dosing reference
Reference information only. Read before using this section.
Survodutide (10 mg Vial) Dosage Protocol
- Vial
- 10 mg Survodutide
- Add diluent
- 2 mL
- Concentration
- 5 mg/mL
- 1 unit (U-100)
- 50 mcg in 0.01 mL
- Route
- Subcutaneous
- How often
- Once per week (subcutaneous).
- Typical range
- 0.6–6.0 mg weekly with gradual titration over 10–12 weeks.
- Cycle length
- 12–16 weeks minimum; phase 3 trials extend to 48–72 weeks.
Standard / Gradual Titration
| Week | Weekly Dose (mg) | Weekly Dose (mcg) | Units (mL) |
|---|---|---|---|
| Weeks 1–2 | 0.6 mg | 600 mcg | 12 units (0.12 mL) |
| Weeks 3–4 | 1.2 mg | 1200 mcg | 24 units (0.24 mL) |
| Weeks 5–6 | 1.8 mg | 1800 mcg | 36 units (0.36 mL) |
| Weeks 7–8 | 2.4 mg | 2400 mcg | 48 units (0.48 mL) |
| Weeks 9–10 | 3.6 mg | 3600 mcg | 72 units (0.72 mL) |
| Weeks 11–12 | 4.8 mg | 4800 mcg | 96 units (0.96 mL) |
| Week 13+ | 6.0 mg | 6000 mcg | 120 units (1.20 mL)* |
How to mix
- Draw 2.0 mL bacteriostatic water with a sterile syringe.
- Inject slowly down the vial wall; avoid foaming.
- Gently swirl/roll until dissolved (do not shake).
- Label and refrigerate at 2–8 °C (35.6–46.4 °F), protected from light.
Dosing details
- Start: 0.6 mg weekly; increase by 0.6 mg every 2 weeks as tolerated.
- Target: 4.8–6.0 mg weekly by weeks 11–13.
- Frequency: Once per week (subcutaneous).
- Cycle Length: 12–16 weeks minimum; phase 3 trials extend to 48–72 weeks.
- Timing: Same day each week; rotate injection sites.
Storage
- Lyophilized: Store at ≤−20 °C (≤−4 °F) in dry, dark conditions; minimize moisture exposure.
- Reconstituted: Refrigerate at 2–8 °C (35.6–46.4 °F); protect from light and avoid repeated freeze–thaw cycles.
- Allow vials to reach room temperature before opening to reduce condensation uptake.
Administration technique
- Clean the vial stopper and skin with alcohol; allow to dry.
- Pinch a skinfold; insert the needle at 45–90° into subcutaneous tissue.
- Do not aspirate for subcutaneous injections; inject slowly and steadily.
- Rotate sites systematically (abdomen, thighs, upper arms) to avoid lipohypertrophy.
Important notes
- Use new sterile syringes; dispose in a sharps container.
- Rotate injection sites (abdomen, thighs, upper arms) to reduce local irritation.
- Inject slowly; wait a few seconds before withdrawing the needle.
- Document weekly dose, injection site, and any tolerability observations.
- For doses exceeding 100 units (1.0 mL), consider using a 1 mL Luer‑lock syringe or splitting into two injections.
Protocol source: PeptideDosages.com
Common questions
Is survodutide the same as semaglutide or tirzepatide?
No. These are different molecules with different receptor targets.
Why do headlines show different percentages?
Trials report more than one type of statistical analysis. Neither number predicts an individual result.
Does less liver fat mean liver scarring is reversed?
No. Liver fat, inflammation and scarring are separate measures.
Related in Metabolic Health
Sources and further reading (5)
- Zealand Pharma. Survodutide program and status (checked Oct 2026).
- le Roux CW, et al. Survodutide once weekly for adults with obesity. NEJM, 2026.
- Wharton S, et al. Survodutide in adults with obesity and type 2 diabetes. NEJM, Oct 2026.
- Sanyal AJ, et al. Phase 2 trial of survodutide in MASH and fibrosis. NEJM, 2024.
- Source summary: PeptideDosages.com research overview (rewritten for NVO).
Laboratory research material: Survodutide Research Use Only