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Weight management

Survodutide

A dual agonist at GLP-1 and glucagon receptors. It sits right between pure GLP-1 (semaglutide) and the triple agonist (retatrutide).

5 min read 12 sources

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Survodutide vial with white powder and the black TPD label on a white podium, next to a large blue 3D peptide chain in a bright lab
Phase 3 · not approved

Summary

At a glance

Sources checked on 26 Oct 2026

Targets
2 receptors

GLP-1 and glucagon, each as an agonist according to ChEMBL12

Body weight in phase 3
-13.0 %

SYNCHRONIZE-1 at 76 weeks, highest study dose (placebo -5.4%)8

MASH improved in phase 2
62 %

Liver biopsy at 48 weeks, middle study dose (placebo 14%)2

Phase 3 on Survodutide
9 trials

6 of them completed, as of 26 Oct 2026. Three more are not recruiting yet11

  • Survodutide is a dual agonist: one molecule that binds to the receptors for GLP-1 and glucagon. An attached fatty acid makes one dose per week possible.123
  • In phase 3 (SYNCHRONIZE-1, 76 weeks, without diabetes) body weight fell by 13.0 percent on average at the highest study dose, by 5.4 percent on placebo. With type 2 diabetes (SYNCHRONIZE-2) it was 9.8 versus 3.9 percent.89
  • The liver has been studied in particular: in a phase 2 trial MASH improved in 43 to 62 percent depending on the dose, in 14 percent on placebo.2
  • The most common effects were gastrointestinal, mostly mild to moderate and mainly while the dose was being stepped up.892
  • Survodutide is not approved, ChEMBL lists phase 3 as the highest phase. Everything here describes the state of research, not a recommendation.12
Profile

Updated May 2026

Class
GLP-1 / glucagon dual agonist
Frequency
Once weekly

subcutaneous

Half-life
Several days

weekly dose

Form
Lyophilised powder

reconstituted with BAC water

Sizes
10 mg

1 size in the shop

Contents 16 sections
  1. At a glance
  2. What is Survodutide?
  3. How it works
  4. What you need
  5. Reconstitution
  6. Injection
  7. Dosing
  8. What the research shows
  9. Research status
  10. Side effects
  11. Lifestyle
  12. Storage
  13. Related compounds
  14. FAQ
  15. Glossary
  16. Sources

What is Survodutide?

Survodutide (development name BI 456906) is a dual agonist at GLP-1 and glucagon receptors. That places it right between the others: semaglutide hits only GLP-1, retatrutide three receptors and survodutide two, namely GLP-1 plus glucagon, but no GIP. The ratio is GLP-1-leaning (about 8 to 1), with the glucagon share in a supporting role.

It is injected once a week. Survodutide is not approved. The first results from the phase 3 SYNCHRONIZE programme were published in 2026. It ships as a freeze-dried powder you dissolve in bacteriostatic water before the first use.

Comparison

One, two or three receptors

Which receptors each compound targets, as stated in the TPD lexicon. Tap a card to open its entry.

Mono agonist Semaglutide GLP-1 GIP Glucagon 1 of 3 receptors Dual agonist Tirzepatide GLP-1 GIP Glucagon 2 of 3 receptors
Dual agonist Survodutide GLP-1 GIP Glucagon 2 of 3 receptors
Dual agonist Mazdutide GLP-1 GIP Glucagon 2 of 3 receptors Triple agonist Retatrutide GLP-1 GIP Glucagon 3 of 3 receptors

Simplified: more receptors does not automatically mean better, each path also brings its own effects. 12

How it works

The GLP-1 part does what you know from semaglutide and co.: it boosts the insulin response, slows gastric emptying and dampens appetite, the food noise gets quieter. The glucagon part comes in support and mainly raises energy expenditure and fat breakdown, especially in the liver.

Studies suggest this combination moves more on weight and especially on liver fat than GLP-1 alone. But because the focus clearly sits on GLP-1, the glucagon effect is milder than in the triple agonist retatrutide.

Where it acts

Two receptors, several organs

Tap a point or a card. Colour = receptor, grey = effect seen in trials.

  1. Brain

    Lower food intake (shown in mice)3

    GLP-1
  2. Liver

    MASH improved more often in a phase 2 trial, liver fat clearly lower2

    Glucagon
  3. Pancreas

    HbA1c fell more than on placebo in type 2 diabetes in phase 39

    GLP-1
  4. Body weight

    Clearly more weight loss than on placebo in phase 38

    Observed in trials
  5. Stomach and gut

    Most common side effects, mainly while the dose is being raised10

    Observed in trials

Targets in the ChEMBL database12

Compound CHEMBL5314776: two recorded mechanisms, all agonist with direct binding to the human receptor.

GLP-1 receptor
Gene
GLP1R
UniProt
P43220
ChEMBL
CHEMBL1784
Action
Agonist, direct binding
Glucagon receptor
Gene
GCGR
UniProt
P47871
ChEMBL
CHEMBL1985
Action
Agonist, direct binding
Translucent blue cells with golden yellow fat droplets, with blue 3D molecules docking onto receptors on their surface
Symbolic image.

What you need

Before you start, have everything ready. The list is short:

Supplies

5 things, numbered as in the picture

Tick off what you already have. Vial and BAC water are our real shop photos at the same size.

Survodutide vial and bacteriostatic water at the same size with the black TPD label, next to two U-100 insulin syringes, two alcohol swabs and a sharps container with a blue lid

  1. Survodutide vial

    The Survodutide vial with the freeze-dried powder

    In the shop

  2. Bacteriostatic water

    Bacteriostatic water to dissolve it

    In the shop

  3. U-100 insulin syringes

    U-100 insulin syringes for the injection (they also work for drawing the water, you just draw more often; a larger syringe is faster but not a must)

    Amazon (opens a new tab)

  4. Alcohol swabs

    Alcohol swabs for the vial cap and the skin

    Amazon (opens a new tab)

  5. Sharps container

    A sealable sharps container for used needles

As an Amazon associate we earn from qualifying purchases. Links open Amazon - no extra cost for you.

With everything clean and in one place, the rest is straightforward.

Reconstitution

The powder is dissolved in bacteriostatic water. How much water you add sets the concentration and therefore how many units you later draw on the insulin syringe for your dose.

Use the peptide calculator for exactly this: pick the water volume to instantly see the concentration and the units per dose. Roughly: less water means higher concentration and fewer units.

When dissolving, just add the bac water and let the powder dissolve. It does not matter if the water hits the powder directly. Swirling or shaking are both fine.

Step by step

Dissolving the powder

Four steps, the same for every vial size.

  1. 1Wipe the cap

    Clean the rubber stopper with an alcohol swab.

  2. 2Add BAC water

    Just add it, it does not matter if it hits the powder directly.

  3. 3Swirl or shake

    Until everything has dissolved, both are fine.

  4. 4Draw up

    With the U-100 insulin syringe.

Less water higher concentration fewer units on the syringe Example: 10 mg + 2 ml = 5 mg/ml

Injection

The injection is subcutaneous, into the fat layer under the skin. Common spots are the abdomen (keep about two finger-widths clear of the navel), the front and the inner side of the thigh, or the back of the upper arm.

The short version:

Injection

Where and at what angle

Pick a spot or switch the angle. Subcutaneous means: into the fat layer, not the muscle.

Rotate the spot each time, never the same one twice in a row.

90°More fat under the skin

Rule of thumb: where there is more fat under the skin, insert straight at 90 degrees. In lean people with little fat, 45 degrees, so the needle stays in the fat layer. Simplified diagram.

  1. Clean the spot with an alcohol swab and let it dry

  2. Pinch up a small fold of skin

  3. Insert the needle: at 90 degrees where there is more fat under the skin, at 45 degrees in lean people with little fat

  4. Inject slowly, wait a moment, then withdraw

  5. Put the needle straight into the sharps container

Rotate the site each time so the tissue does not get irritated. Never the same spot twice in a row.

Dosing

Dosing

Dosing, titration and syringe

Loading the dosing information …

  • Getting started and stepping up, drawn as a staircase
  • Units on the U-100 syringe for every step
  • How long one vial lasts

What the research shows

Survodutide is well documented but not approved. In the phase 2 obesity study (le Roux, 2024), weight dropped dose-dependently over 46 weeks, by nearly 15 percent on average at the highest dose and by up to about 19 percent among those who completed. In a liver study (Sanyal, 2024), MASH (a form of fatty-liver inflammation) improved in a large share of participants, far more often than on placebo. A smaller diabetes study also showed a clear drop in long-term blood sugar (HbA1c).

The first phase 3 results came out in 2026. In SYNCHRONIZE-1 (le Roux, NEJM 2026, 725 adults without diabetes) weight fell by 13.0 percent after 76 weeks on the higher dose, versus 5.4 percent on placebo. SYNCHRONIZE-2 tested people with type 2 diabetes, SYNCHRONIZE-MASLD fatty liver. The higher dose in the phase 3 programme was 6mg per week.

The individual studies with links are in the source block below.

Study results

What the trials measured

Interactive: switch tabs, tap points, show or hide arms. Arms are named relative to each other, no dosing advice.

Body weight at the end of the trial8910

Mean change in percent per trial

SYNCHRONIZE-18 Obesity without diabetes, 76 weeks
Placebo -5.4%
Lower phase 3 dose -12.2%
Highest study dose (6 mg) -13.0%
SYNCHRONIZE-29 Obesity with type 2 diabetes, 76 weeks
Placebo -3.9%
Lower phase 3 dose -8.2%
Highest study dose (6 mg) -9.8%
SYNCHRONIZE-MASLD10 Obesity with fatty liver, 48 weeks
Placebo -1.4%
Highest study dose (6 mg) -8.7%

Values for all participants as randomised (treatment-regimen estimand), as stated in the abstracts. SYNCHRONIZE-MASLD had only one Survodutide arm. The trials are not directly comparable.

Body weight after 46 weeks1

Mean change in percent, 387 people with overweight without diabetes

Phase 2 trial1 20 weeks of escalation, 26 weeks steady
Placebo -2.8%
Level 1 (lowest of the phase 2 trial) -6.2%
Level 2 -12.5%
Level 3 -13.2%
Level 4 (highest of the phase 2 trial) -14.9%

Values by planned treatment according to the abstract. From the second level on the effect rose only a little. 60 percent of participants completed the 46 weeks.

Liver after 48 weeks210

Share of participants, phase 2 trial with biopsy (293 people) and phase 3 trial SYNCHRONIZE-MASLD

MASH improved2 Without worsening of fibrosis
Placebo 14%
Lowest dose of the liver trial 47%
Middle dose of the liver trial 62%
Highest study dose (6 mg) 43%
Liver fat down by at least 30 percent2 Phase 2 trial
Placebo 14%
Lowest dose of the liver trial 63%
Middle dose of the liver trial 67%
Highest study dose (6 mg) 57%
Fibrosis improved by at least one stage2 Phase 2 trial
Placebo 22%
Lowest dose of the liver trial 34%
Middle dose of the liver trial 36%
Highest study dose (6 mg) 34%
Liver fat down by at least 30 percent10 SYNCHRONIZE-MASLD, MRI measurement
Placebo 29%
Highest study dose (6 mg) 69%

The phase 2 trial enrolled people with biopsy-confirmed MASH and fibrosis. The middle dose did best there, the authors describe the dose response as a curve. Values from SYNCHRONIZE-MASLD for all participants as randomised.

Long-term blood sugar HbA1c at 76 weeks9

Change in percentage points, SYNCHRONIZE-2, mean baseline 7.4 percent

SYNCHRONIZE-29 752 people with type 2 diabetes and obesity
Placebo -0.2 pp
Lower phase 3 dose -0.9 pp
Highest study dose (6 mg) -0.8 pp

Values as stated in the abstract. For HbA1c both doses were about level.

Glass model of a liver on a white table between Petri dishes, pipettes and a glass funnel
Symbolic image.

Research status

Where the research stands

From the first human trials to the phase 3 programme SYNCHRONIZE: the developer's registered trials testing Survodutide, with status, participants and results. As of 26 Oct 2026. 11

  1. Preclinical Cell assays and mice
  2. Phase 1 18 trials, 14 completed
  3. Phase 2 3 trials, 3 completed
  4. Phase 3 9 trials, 6 completed
  5. Approval not yet
11,801 participants in phase 3 Planned figures for running trials Not approved. ChEMBL lists Survodutide with phase 3 as the highest phase. The first phase 3 results were published in 2026.12
Show all 12 phase 2 and 3 trials on a timelineHide timeline 9 completed 3 running 6 with results
Phase 2
Phase 3

Bar: start to primary endpoint (planned for running trials). Green = completed, blue = progress until 26 Oct 2026. Phase 1: 18 trials on safety and pharmacokinetics, not shown as bars.

Side effects

Like the whole class, gastrointestinal effects come first: nausea, fullness, sometimes diarrhoea or constipation. In the studies this was clearly dose-dependent and well manageable through the stepwise titration. The glucagon share is exactly why you ease in slowly and do not go up too fast.

Tolerability

Gastrointestinal effects in the trials

Out of 100 participants per group, how many had the event. SYNCHRONIZE over 76 weeks, liver trial over 48 weeks.

48 of 100 Placebo
81 of 100 Lower phase 3 dose
90 of 100 Highest study dose (6 mg)
Event PlaceboLower phase 3 doseHighest study dose (6 mg)
Gastrointestinal effects, SYNCHRONIZE-18 48%81%90%
Gastrointestinal effects, SYNCHRONIZE-29 39%73%78%
Nausea, liver trial2 23%0%0%
Diarrhoea, liver trial2 23%0%0%
Vomiting, liver trial2 4%0%0%

Values from the abstracts. The complaints were mostly mild to moderate and occurred mainly during escalation. In the liver trial the dose was raised quickly over 24 weeks. Serious events there were about as common as on placebo, 8 versus 7 percent.892

Lifestyle

Survodutide takes the hunger away, the rest is on you. A few things get more out of the research phase and keep you healthy:

  1. Enough protein

    If you eat little, make the little you eat protein-rich, or you lose muscle along with fat.

  2. Drink enough

    With low appetite you often drink less without noticing. The risk of dehydration then goes up.

  3. Resistance training

    Keeps muscle mass while the weight comes off.

  4. Eat slowly

    With delayed gastric emptying you fill up faster, big portions sit heavy.

White running shoes, a glass bottle of water and a bowl with eggs and spinach on a light wooden bench

Alcohol and very fatty meals make the nausea noticeably worse, especially early on.

Storage

The undissolved powder is robust, normal room temperature (around 20 to 25 degrees) is fine, ideally kept in the dark. Once dissolved, the solution goes into the fridge (2 to 8 degrees) and stays stable there for at least 4 to 6 months with barely any loss of potency, in practice considerably longer. The bacteriostatic water brings a preservative that keeps the dissolved form stable for longer.

Shelf life

How long it keeps

Undissolved (powder) Room temperature, around 20 to 25 degrees, dark

Robust, no fridge needed.

Dissolved (mixed) Fridge, 2 to 8 degrees

At least 4 to 6 months with barely any loss of potency. The bacteriostatic water brings a preservative.

  • Keep it dark
  • Dissolved: 2 to 8 degrees
  • Note the mixing date on the vial
Nine vials with white powder and blue caps in the door shelf of a bright fridge
Powder dark at room temperature, once dissolved into the fridge (2 to 8 degrees), stable there for at least 4 to 6 months. Symbolic image.

Related

Related compounds

Same receptors or a different path: all in the TPD lexicon.

Survodutide
Mazdutide Same receptors, different structure Retatrutide Triple agonist, adds GIP Tirzepatide GLP-1 and GIP Semaglutide GLP-1 only, comparator in a phase 2 trial Orforglipron GLP-1, as a tablet Cagrilintide Different path: amylin

FAQ

Common questions about Survodutide

Short answers, each backed by the sources below.

Is Survodutide approved?

No. ChEMBL lists Survodutide with phase 3 as the highest phase. The first phase 3 trials (SYNCHRONIZE-1, SYNCHRONIZE-2 and SYNCHRONIZE-MASLD) are finished and were published in 2026, others are still running. The information here describes the state of research and is not a recommendation for use.128910

How does Survodutide differ from Semaglutide and Retatrutide?

The receptors. Semaglutide acts only on the GLP-1 receptor, Survodutide also on the glucagon receptor, Retatrutide additionally on GIP. The glucagon part acts mainly in the liver, which is why Survodutide is also tested in fatty liver. In a phase 2 trial in type 2 diabetes the higher levels lowered weight more than semaglutide after 16 weeks.1237

What did the phase 3 trials show?

In SYNCHRONIZE-1 (without diabetes) weight fell by 12.2 and 13.0 percent after 76 weeks, by 5.4 percent on placebo. In SYNCHRONIZE-2 (with type 2 diabetes) it was 8.2 and 9.8 versus 3.9 percent, HbA1c fell by 0.9 and 0.8 percentage points. In SYNCHRONIZE-MASLD liver fat fell by at least 30 percent in 68.5 percent, on placebo in 28.6 percent.8910

What is known about the liver?

In a phase 2 trial with biopsy MASH improved without worsening of fibrosis in 43 to 62 percent depending on the dose, in 14 percent on placebo. Fibrosis improved in 34 to 36 versus 22 percent. A study in liver cirrhosis tested uptake and tolerability. Two large phase 3 trials on MASH are still running.2611

How high were the doses in trials?

The highest study dose was 6 mg per week, in the liver trial and the phase 3 programme. All trials raise the dose in steps over weeks. In the phase 2 trial in overweight the effect rose only a little from the second level on. The entry describes the same principle: start low and only increase until an effect is noticeable. This is not a dosing recommendation.281

Which side effects were seen?

Mainly gastrointestinal effects, mostly mild to moderate. In SYNCHRONIZE-1 80.9 and 89.7 percent had them, 47.9 percent on placebo. In the liver trial nausea, diarrhoea and vomiting were clearly more common with Survodutide than with placebo. The trials describe the complaints mainly during escalation.8210

Which trials are still running?

Three of the listed phase 3 trials are still recruiting: LIVERAGE on MASH with fibrosis (planned end 2031), LIVERAGE-Cirrhosis on MASH with cirrhosis and a trial on blood sugar in type 2 diabetes. The large cardiovascular safety trial with 5,531 participants is finished, results had not been published by October 2026.11

Glossary

Terms explained briefly

Dotted words in the text open these explanations directly.

Agonist
A substance that binds to a receptor and activates it, like the body's own messenger. A dual agonist activates two different receptors.
Fibrosis
Scarring of tissue. In the liver it is graded in stages, the last stage is cirrhosis.
GLP-1
Glucagon-like peptide 1: gut hormone that releases insulin, slows gastric emptying and signals fullness in the brain.
Glucagon
Hormone from the pancreas that acts mainly in the liver. It releases stored sugar and promotes the breakdown of fat.
HbA1c
Long-term blood sugar: reflects average blood sugar over the past eight to twelve weeks.
Lyophilisate
Freeze-dried powder. Without water a peptide keeps much longer.
MASH
Metabolic dysfunction-associated steatohepatitis, fatty liver with inflammation, formerly mostly called NASH. It can lead to scarring (fibrosis).
Placebo
Dummy preparation without active substance. Comparing against it shows what is due to the substance itself.
Receptor
Protein on the cell surface that a messenger docks onto. Only then does the cell respond.
Subcutaneous
Into the fat layer just under the skin.
Trial phases
Phase 1 tests tolerability in a few people, phase 2 looks for the dose, phase 3 confirms benefit and safety in many. After that, approval can be requested.

Evidence

Sources

Show all 12 sourcesHide sources 10 Studies1 Trial registry1 Database checked 26 Oct 2026

Studies

  1. Phase 2 trial in overweight without diabetes

    le Roux et al., The Lancet Diabetes & Endocrinology, 2024

    DOI 10.1016/S2213-8587(23)00356-X PMID 38330987 NCT04667377
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  2. Phase 2 trial in MASH and liver fibrosis

    Sanyal et al., New England Journal of Medicine, 2024

    DOI 10.1056/NEJMoa2401755 PMID 38847460 NCT04771273
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  3. Discovery and pharmacology in cells and mice

    Zimmermann et al., Molecular Metabolism, 2022

    DOI 10.1016/j.molmet.2022.101633 PMID 36356832
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed, PubMed Central (Volltext)
  4. First phase 1 studies in healthy adults and overweight

    Jungnik et al., Diabetes, Obesity and Metabolism, 2023

    DOI 10.1111/dom.14948 PMID 36527386 NCT03591718
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  5. Phase 1 study in men in Japan

    Yazawa et al., Diabetes, Obesity and Metabolism, 2023

    DOI 10.1111/dom.15064 PMID 36974349 NCT04384081
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  6. Study in liver cirrhosis: uptake and tolerability

    Lawitz et al., Journal of Hepatology, 2024

    DOI 10.1016/j.jhep.2024.06.003 PMID 38857788 NCT05296733
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  7. Phase 2 trial in type 2 diabetes, versus semaglutide

    Blüher et al., Diabetologia, 2024

    DOI 10.1007/s00125-023-06053-9 PMID 38095657 NCT04153929
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  8. Phase 3 trial SYNCHRONIZE-1 in obesity

    le Roux et al., New England Journal of Medicine, 2026

    DOI 10.1056/NEJMoa2600751 PMID 42253238 NCT06066515
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  9. Phase 3 trial SYNCHRONIZE-2 in obesity with type 2 diabetes

    Wharton et al., New England Journal of Medicine, 2026

    DOI 10.1056/NEJMoa2607219 PMID 42820639 NCT06066528
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed
  10. Phase 3 trial SYNCHRONIZE-MASLD in fatty liver

    Kaplan et al., Nature Medicine, 2026

    DOI 10.1038/s41591-026-04479-3 PMID 42252333 NCT06309992
    Checked 26 Oct 2026 via doi.org, Crossref, PubMed

Trial registry

  1. All trials on ClinicalTrials.gov

    ClinicalTrials.gov, U.S. National Library of Medicine

    Checked 26 Oct 2026 via ClinicalTrials.gov API v2

Database

  1. Mechanism, targets and development status in ChEMBL

    ChEMBL, EMBL-EBI (CHEMBL5314776)

    Checked 26 Oct 2026 via ChEMBL

In the shop

Survodutide in the catalog

Sizes, prices and shipping times are on the product page.

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