Survodutide Dosage: The Phase 3 Numbers, the Titration & Reconstitution Math

Survodutide at a glance

What it is

Survodutide (development code BI 456906), an investigational once-weekly glucagon receptor and GLP-1 receptor dual agonist; PubChem CID 168429725, molecular formula C192H289N47O61, molecular weight approximately 4,232

Researched for

Obesity (phase 3, published), type 2 diabetes, metabolic dysfunction-associated steatohepatitis and steatotic liver disease including cirrhosis, and cardiovascular safety

Commonly reported range

The doses with phase 3 data behind them are 3.6 mg and 6.0 mg subcutaneously once weekly, each reached by titration from 0.3 mg. The two maintenance doses differed by 0.8 percentage points of weight change and by 9 points of gastrointestinal adverse events

Route reported

Subcutaneous injection, once weekly, in every trial in the programme

Reported frequency

Once weekly. Not a daily compound

Reported cycle

No cycling in any trial. SYNCHRONIZE-1 ran 76 weeks continuously; the cirrhosis phase 1 escalated from 0.3 mg to 6.0 mg across 24 weeks before a 4-week maintenance period

Half-life

Consistent with once-weekly dosing, but we could not source a specific published half-life figure from the trial reports checked. A phase 1 study found AUC and Cmax similar in people with cirrhosis and matched healthy individuals, with no pharmacokinetic dose adjustment required

Regulatory status

Not approved anywhere. DailyMed returned zero structured product labels for survodutide and openFDA's Drugs@FDA endpoint returned no match. Investigational; research use only

Reported ranges from research/community — examples, not recommendations.

What it is / mechanism

Survodutide is a synthetic peptide agonist at two receptors at once: the glucagon receptor (GCGR) and the glucagon-like peptide-1 receptor (GLP-1R). Its development code is BI 456906, and it is catalogued in PubChem as CID 168429725 with molecular formula C192H289N47O61 and a molecular weight of about 4,232 — roughly 4.6 times the mass of a small research peptide like BPC-157, and about the size class you would expect for a lipidated, albumin-binding, long-acting analogue dosed once a week rather than daily. The dual-agonist design is what distinguishes it from the semaglutide class. GLP-1 receptor agonism is the familiar half: slowed gastric emptying, increased satiety, glucose-dependent insulin secretion. Glucagon receptor agonism is the addition, and it is a deliberate reversal of the intuition most people bring to glucagon, which they know as the hormone that raises blood sugar. In the dual-agonist rationale, glucagon-receptor signalling contributes increased energy expenditure and direct hepatic effects on fat handling, while the GLP-1 arm supplies the appetite suppression and offsets glucagon's glycaemic effect. That combination is the reason the liver programme exists alongside the obesity programme. Survodutide is in phase 3 for metabolic dysfunction-associated steatohepatitis and steatotic liver disease as well as for obesity, and a mediation analysis published in Hepatology in 2026 explicitly asked whether its liver effects are weight-reduction-dependent or independent of weight loss — a question that only arises for a compound with a direct hepatic mechanism. It is also the reason the flagship obesity trial excluded people with diabetes. SYNCHRONIZE-1 enrolled adults with obesity without diabetes, and type 2 diabetes was studied separately in SYNCHRONIZE-2. When a programme splits its populations that way, the split is information: it says the sponsor wanted the glycaemic question answered in its own trial rather than inside the weight trial.

Researched effects

Survodutide is one of the few compounds in this library where the honest answer to "what does it do" comes from a published phase 3 trial rather than from inference, so it is worth quoting the numbers rather than summarising them. SYNCHRONIZE-1 (NCT06066515) randomised 725 adults with a BMI of 30 or higher, or 27 or higher with at least one obesity-related complication and without diabetes, in a 1:1:1 ratio to once-weekly subcutaneous survodutide titrated up to 3.6 mg, up to 6.0 mg, or placebo, all alongside lifestyle counselling. Mean age was 47.1 years, mean BMI 37.9, mean body weight 108.8 kg, and 40.6% of participants were men. At week 76, mean body-weight change from baseline was -12.2% (95% CI -13.6 to -10.8) in the 3.6 mg group, -13.0% (95% CI -14.4 to -11.6) in the 6.0 mg group, and -5.4% (95% CI -6.9 to -4.0) on placebo. Weight reduction of at least 5% was achieved by 72.6%, 71.9% and 46.3% of participants respectively, with p<0.001 for both comparisons against placebo. The results were published in the New England Journal of Medicine on 7 June 2026 (PMID 42253238) and funded by Boehringer Ingelheim. Three things in that paragraph deserve to be pulled out, because they are the parts most likely to be dropped when the number gets repeated. First, the placebo group lost 5.4%. The drug-attributable difference is therefore about 6.8 percentage points at 3.6 mg and 7.6 at 6.0 mg — real, statistically robust, and roughly half the headline figure. When you see "13% weight loss" quoted for survodutide, that figure includes everything the placebo arm also achieved on lifestyle counselling alone. Second, the two doses barely separated. Going from 3.6 mg to 6.0 mg — a 67% larger maintenance dose — bought 0.8 percentage points of additional mean weight change, and the proportion reaching 5% loss was fractionally lower on the higher dose (71.9% versus 72.6%). On this evidence the dose-response curve for weight is close to flat across the tested maintenance range. Third, the side-effect curve is not flat. Gastrointestinal adverse events occurred in 80.9% of the 3.6 mg group, 89.7% of the 6.0 mg group and 47.9% of placebo. So the step from 3.6 mg to 6.0 mg added about nine percentage points of gastrointestinal adverse events for less than one point of weight change. That is a genuinely useful thing to know and it is visible only if you read both halves of the results. The liver programme has now also reported: SYNCHRONIZE-MASLD, a randomised, double-blind, placebo-controlled phase 3 trial in adults with obesity and metabolic dysfunction-associated steatotic liver disease, was published in Nature Medicine in 2026 (PMID 42252333). None of this is a promise of outcome, and none of it applies to research-market material, which is not the trial product.

Dosage — reported ranges (overview)

The most useful thing a survodutide dosage page can say is that survodutide does not have a dose; it has a titration schedule with two possible endpoints. The two maintenance doses with phase 3 evidence behind them are 3.6 mg and 6.0 mg subcutaneously once weekly. Neither was started at. SYNCHRONIZE-1's primary analysis used an estimand that explicitly accounts for a prolonged dose-escalation period, and the phase 1 cirrhosis study — the clearest published description of an escalation schedule in the programme — went from 0.3 mg to 6.0 mg across 24 weeks before maintaining for 4. That is a twenty-fold climb over roughly six months. Someone who reads "survodutide dosage: 6 mg weekly" and starts there has skipped the part of the protocol that took the longest. The choice between the two endpoints is where the published data is most decision-relevant, and it points in an unexpected direction. At 76 weeks the 6.0 mg arm lost 13.0% and the 3.6 mg arm lost 12.2% — a difference of 0.8 percentage points, with overlapping confidence intervals — while the proportion reaching at least 5% loss was marginally higher on the lower dose. Gastrointestinal adverse events, meanwhile, went from 80.9% to 89.7%. Read the two together and the higher maintenance dose looks like it costs more than it returns, at least on the endpoints this trial measured. That is not a recommendation about what anyone should do; it is what the trial reported, and it is the opposite of the "more is better" assumption that governs most community dosing. On frequency: once weekly, in every trial in the programme. There is no daily regimen, no split dosing and no cycling anywhere in the registry record. SYNCHRONIZE-1 ran 76 continuous weeks and the cirrhosis study ran 28. The four-to-eight-week-on, break-off pattern common to community peptide use has no counterpart in any survodutide protocol, and a compound titrated over six months is structurally incompatible with it — you would spend the whole cycle escalating. One caution specific to the mechanism: this is a glucagon receptor agonist as well as a GLP-1 receptor agonist, and the phase 3 obesity trial excluded people with diabetes while a separate trial studied that population. Whatever the reason for that design, it means the obesity results describe people without diabetes, and generalising them past that is going beyond what was measured. Everything above describes what trials did. None of it is a personal dose, a protocol to follow, or medical advice, and research-market material is not the product any of these trials used.

A printable protocol sheet with a reconstitution reference and an injection log comes with All-Access Lifetime.

Reconstitution — bac-water math

Research-grade survodutide is supplied lyophilised and dosed in whole milligrams, which makes the concentration arithmetic straightforward and the syringe arithmetic unusually constraining. Concentration in mg/mL is the vial's milligrams divided by the millilitres of bacteriostatic water added. On a U-100 insulin syringe, 100 units is 1 mL, so units to draw = dose in mg divided by concentration in mg/mL, times 100. Worked example on a 10 mg vial: add 1 mL and the concentration is 10 mg/mL, so a 3.6 mg example is 3.6 / 10 x 100 = 36 units and a 6.0 mg example is 60 units — both comfortably inside one syringe. The constraint arrives as soon as you dilute further. At 2 mL in a 10 mg vial the concentration is 5 mg/mL, and a 6.0 mg example is 120 units — more than a U-100 insulin syringe holds, so it cannot be drawn in one go. The table below flags that row rather than hiding it. Anything more dilute than 2 mL on a 10 mg vial puts the higher trial dose out of single-draw range entirely. There is a second, less obvious problem, and it is the one that actually matters for a compound titrated across twenty-fold. The early escalation steps are small — the phase 1 study started at 0.3 mg. At 10 mg/mL, 0.3 mg is 3 units, where a single unit of measurement error is a third of the amount. At 2 mg/mL it is 15 units and far easier to measure accurately — but at 2 mg/mL a 6 mg example would be 300 units, which is three syringes. No single reconstitution volume serves both ends of this titration well. The arithmetic says a dilute preparation early and a concentrated one later, or different vial strengths at different stages; it does not say what anyone should inject. Add bacteriostatic water slowly down the vial wall and swirl rather than shake. All of the above is concentration math for handling research material, not a dosing instruction.

This is concentration math, not a dose recommendation.

Injection / administration basics

Every survodutide trial in the registry used subcutaneous injection once weekly, so unlike most compounds in this library there is no ambiguity about route or schedule — the published protocols and the community convention agree, because the community convention was copied from the protocols. What the trials describe in practical terms is a weekly subcutaneous administration in a titrating regimen, with the escalation extended over months rather than weeks. The SYNCHRONIZE-1 publication's treatment-regimen estimand accounts for a prolonged dose-escalation period alongside early discontinuation, which is an unusual thing to see written into a primary analysis and tells you escalation tolerance was a real feature of the trial rather than an administrative detail. General handling for a weekly subcutaneous peptide applies: a small-gauge insulin syringe, sites such as the abdomen and thigh rotated between administrations, and a reconstituted vial kept refrigerated between weekly draws — which is precisely the case where bacteriostatic water rather than sterile water matters, since a weekly regimen means a vial is entered repeatedly over a month or more. Sterile water has no preservative and is a single-entry diluent. The adverse-event profile is dominated by gastrointestinal effects and is dose-related: 80.9% at 3.6 mg, 89.7% at 6.0 mg, against 47.9% on placebo, described in the publication as typically mild to moderate. Nearly half the placebo group reported gastrointestinal adverse events too, which is worth holding onto when interpreting any single account of tolerability. This is general handling information for research material and not instruction for human use.

Half-life & frequency rationale

Survodutide is dosed once weekly in every trial in its programme, which places its half-life firmly in the multi-day range characteristic of albumin-binding, lipidated peptide analogues. Beyond that, we are not going to publish a number. We could not source a specific published elimination half-life for survodutide from the trial reports checked for this page, and there is no approved label to take one from — DailyMed holds no structured product label for this compound and openFDA's Drugs@FDA endpoint returns no match. Figures do circulate in secondary summaries; none of the ones we encountered named the study they came from, and this library's standing rule is that an unattributed pharmacokinetic figure is worth less than a plain statement of what is documented. What is documented, and is more practically informative than a half-life anyway, comes from the phase 1 trial in people with cirrhosis (NCT05296733, Journal of Hepatology 2024, PMID 38857788). After a single 0.3 mg subcutaneous dose, mean area under the curve to infinity and mean Cmax were similar in people with Child-Pugh class A, B or C cirrhosis and in matched healthy individuals, with the 90% confidence intervals for the adjusted geometric mean ratios spanning 1. The authors concluded that survodutide does not require pharmacokinetic-related dose adjustment in cirrhosis. For a compound being developed for liver disease, having that answered in the population with the most impaired clearance is a more useful pharmacokinetic fact than a half-life in healthy volunteers would be. The practical reading: treat this as a once-weekly compound whose exposure is stable enough that even substantial hepatic impairment did not change it materially, and treat any specific half-life figure you encounter as unsourced until someone names the study.

Stacking — overview

There is no published trial of survodutide combined with any other peptide, and there is a specific reason to be sceptical of the pairings that the market will suggest. Survodutide already contains a GLP-1 receptor agonist arm; combining it with semaglutide, tirzepatide, retatrutide or any other GLP-1-active compound is not additive in the way stacking usually implies — it is stacking the same receptor mechanism twice, with a gastrointestinal adverse-event rate that already reached 89.7% at the higher dose on its own. The comparison worth understanding is between these compounds rather than across them: what a glucagon-receptor arm adds relative to a GIP arm (tirzepatide) or a triple agonist (retatrutide). Our cross-compound stacking guide sets out where pairings are redundant rather than additive, and this is the clearest redundancy case in the incretin class. The pairings below are listed as comparison references, not as protocols.

For how combinations are grouped by research context, the named blends, and why a pre-mixed blend vial cannot be calculated from its total milligrams, see the peptide stacks guide.

Storage & handling

• Lyophilized (powder): store sealed and refrigerated at 2-8°C, protected from light and moisture; long-term storage is commonly at -20°C or below. Do not use past intended research shelf life.
• Reconstituted (liquid): refrigerate at 2-8°C, protect from light, and avoid freeze-thaw cycles and vigorous shaking.
• A once-weekly compound means a reconstituted vial is entered repeatedly across weeks, which is the case bacteriostatic water exists for — the benzyl alcohol preservative is what makes a multi-entry vial multi-entry. Sterile water carries no preservative and is a single-entry diluent.

Evidence File

The Survodutide Evidence File: 31 Trials, Two Estimands, and the Numbers the Press Releases Dropped

Survodutide is the rare research-market compound with published phase 3 results, which changes what an evidence file is for: not scraping for data, but auditing it. This file reads the complete ClinicalTrials.gov record - including the early trials that a search for the drug's name does not return - and fifteen published abstracts, from the first-in-human study through the 2026 Nature Medicine liver trial. It traces the figures that circulate in marketing copy back to the specific analyses that produced them, documents which completed trials have published nothing, and compares what the protocols actually did against what the research market assumes. Every number was checked against a source fetched on the verification date.

• 33 registry records reviewed; 7 findable only under BI 456906
• 6 circulating figures traced to their originating analysis
• 0 terminated, withdrawn or suspended trials in the registry
• 4 completed phase 3 trials with no published primary result

Sourcing File

The Survodutide Sourcing File: No CAS Number, One Undefined Stereocentre, and What a Real COA Must Show

There is no approved survodutide product anywhere, so every vial on the research market is a synthetic peptide whose identity rests entirely on the certificate that comes with it. This file anchors the compound's identity to its authoritative chemical record - down to which identifiers that record does and does not contain - and works out, number by number, what a mass spectrum and a purity trace of genuine material must look like. It then maps the specific ways a survodutide vial can be wrong, from substitution to salt-form arithmetic, and walks a certificate of analysis line by line, flagging which entries are commonly asserted rather than measured.

• 4 comparator peptides identity-verified against PubChem records
• 7 mislabelling and adulteration modes mapped to the tests that catch them
• 0 CAS or UNII identifiers on the compound's PubChem record
• 1 undefined stereocentre flagged on the authoritative record

Benefit & Outcome Review

Survodutide Benefit and Outcome Review: What Is Proven, What Is Mouse, and What Has Never Been Measured

Survodutide's claims come in three kinds. Some rest on large randomised human trials, including published phase 3 results - rare territory for a research-market peptide. Some rest on mouse experiments that marketing copy quietly promotes into human facts. And some rest on nothing located at all, which this review treats as findings in their own right: each absence is documented with the exact literature search that returned empty. This file grades every major claim - weight, liver, glucose, metabolism, blood pressure, heart, combinations - against what was actually measured, in which species, at which trial phase, and states plainly where the record simply stops.

• 2 outcomes supported by human phase 3 data
• 1 core mechanism claim with zero human measurements
• 8 absences documented with the exact searches that found nothing
• 0 published cardiovascular outcome results

Guide FAQ

Quick answers about guide scope, access, and educational use context.