Metabolic / Weight Loss · 10mg × 10 vials
think of survodutide as "mazdutide pushed harder on the glucagon arm".
Survodutide (BI-456906) is a once-weekly injectable peptide co-developed by Boehringer Ingelheim and Zealand Pharma that hits two metabolic receptors at once: GLP-1 (the "Ozempic pathway", appetite suppression + slowed gastric emptying) and the glucagon receptor (drives the liver to burn fat for energy, bumps total energy expenditure, drives hepatic fat clearance). Structurally it is a glucagon-analog backbone with a C18 fatty-acid chain bolted on for albumin binding (the half-life-extending trick) and engineered to also engage GLP-1R. Critically, survodutide is glucagon-leaning in its receptor balance: in vitro potency at GCGR is roughly comparable to GLP-1R, which is a different tilt than mazdutide (which sits closer to balanced) and very different from semaglutide or tirzepatide (zero glucagon activity). In plain language: think of survodutide as "mazdutide pushed harder on the glucagon arm". You get appetite suppression like sema, plus a meaningful metabolic-rate increase and direct liver fat burn from the glucagon pathway. The trade-off is that the glucagon-leaning balance means more upfront GI effects and a higher rate of injection-site reactions than mazda or reta, but the hepatic fat data is the best of the dual/triple class and Phase 2 weight loss landed at ~19% at the top dose at 46 weeks. The compound holds FDA breakthrough therapy designation for MASH (fatty liver), the only GLP-1-class compound currently holding that designation in the liver indication.
Typical dose ranges by experience level - educational reference. Message us and we tailor it to you.
Phase 2 protocol started at 0.6 mg with 2-week step-ups. Survodutide is one of the few dual agonists where the trial start dose actually matches community practice, because the glucagon-leaning balance forced the trial to start low. 10 mg vial + 2 ml BAC = 5 mg/ml, so 0.6 mg = 0.12 ml = 12 IU on a U-100 syringe. Inject subQ into abdomen or outer thigh, rotate sites.
Phase 2 obesity trial (Le Roux et al, Lancet 2024) at 3.6 mg averaged 14.9% body weight loss at 46 weeks. The 4.8 mg arm averaged 18.7%. This band is where the body composition reads start matching tirz top doses, and where MASH/fatty-liver reads are strongest (the glucagon arm is doing real hepatic work here). Resting heart rate creep of ~5-8 bpm is the standard signal at this band, slightly more than mazda's signal because the glucagon arm punches harder. Check resting HR weekly, hold dose if it climbs >15 bpm above baseline.
Phase 2 at 4.8 mg averaged 18.7% body weight loss at 46 weeks; the 6 mg arm hit 19.0% but with a meaningfully higher AE-driven discontinuation rate (24.6% discontinued at the 4.8/6 mg combined high arm vs 11% placebo). The Phase 2 MASH trial (Sanyal et al, NEJM 2024) at 6 mg showed 83% of participants hit MASH resolution at 48 weeks, the best published hepatic outcome in the class. Discontinuation due to AEs at 6 mg was the highest of any dual agonist in publication, which is why most community users top out at 4.8 mg.
Straight talk - what people actually report, and what the studies measured.
Peer-reviewed studies and clinical guidelines - tap any to read the source.
00027-3/fulltext) - pivotal Phase 2, 387 pts, 46 weeks, 18.7% loss at 4.8 mg, 19.0% loss at 6 mg
Read study ↗PubMed / NEJMSanyal et al, Survodutide in MASH Phase 2, NEJM 202483% MASH resolution at 6 mg, 48 weeks, no fibrosis worsening
Read study ↗PubMedBoehringer/Zealand dual agonist preclinical pharmacology, Cell Metabolism 2022receptor balance, glucagon-leaning vs balanced
Read study ↗PubMedSurvodutide cardiovascular and hepatic outcomes review, J Hepatol 2025class comparison, MASH positioning
Read study ↗Clinical guidelinesBoehringer Ingelheim SYNCHRONIZE Phase 3 program announcementPhase 3 program in obesity and MASH, breakthrough therapy designation
Read study ↗Clinical guidelinesFDA Breakthrough Therapy Designation for Survodutide in MASH, 2024regulatory positioning
Read study ↗Aggregated sentiment from public forums & socials - real-world reports, not individual endorsements.
Nausea: most-reported sensation, peaks weeks 2-6, "harder than mazda, harder than reta" is the consensus description on GLP-1 forums. Most users who push through find it manageable by week 8.
Vomiting at titration steps: more commonly reported than on any other dual/triple agonist in the community, including mazda. Multiple forum reports of needing to skip a dose or step back at the 3.6 → 4.8 mg jump.
Fatigue: similar pattern to mazda but lasts longer, often a 1-2 week "blah" after each titration step
No dysesthesia / sunburn-feeling skin: confirmed in community reports, not seen on survo (reta-specific)
Loss of taste / food aversion: reported but milder than reta or tirz at equivalent loss levels
Sulfur burps: less common than on semaglutide
Route: SubQ
Injection site: abdomen or outer thigh, rotate sites
Storage: refrigerated 2-8°C, ~28 days after reconstitution. Lyophilized vials stored at -20°C long-term, room-temp shipping is fine short-term. Avoid freeze-thaw cycles.
Notes: Morning injection on a low-fat day reduces nausea (same pattern as reta/mazda). The glucagon-leaning balance means the first 2-4 weeks of any titration step run noticeably more nauseous than the equivalent step on tirz, reta, or even mazda, so do not rush. Allow vial to reach room temp before injecting once mixed. Use a fresh insulin syringe per draw, do not shake the vial (swirl gently to mix). Injection-site reactions (redness, small welt) are more frequent than on sema/tirz; rotate sites and ice the area beforehand if needed.