Carl read the papersWhat it actually is
Survodutide is a synthetic peptide that activates the glucagon receptor and the GLP-1 receptor. Boehringer Ingelheim licensed it from Zealand Pharma and runs the whole programme.
It is one of the furthest-along drugs of its type, with finished phase 3 trials in obesity, obesity with type 2 diabetes and fatty liver disease. It is still investigational: the October 2026 NEJM paper still calls it that, and we found no approval anywhere.
How it’s thought to work
- GLP-1 receptor — Appetite down, fullness up, better blood sugar after meals. The same lever as semaglutide.
- Glucagon receptor — Acts directly on the liver to burn fat and make less of it, which is why survodutide's liver results stand out.
- Liver fat — In SYNCHRONIZE-MASLD, 84% of people who stayed on 6.0 mg cut liver fat by at least 30%, against 24% on placebo.
- Slow escalation — Phase 2 took 20 weeks to reach full dose. Stomach side effects are worst while the dose is climbing.
What the research says
Strong. SYNCHRONIZE-1 (phase 3, 725 adults without diabetes, 76 weeks) found weight change of -12.2% on 3.6 mg and -13.0% on 6.0 mg against -5.4% on placebo, counting everyone who started, including people who stopped. SYNCHRONIZE-2 (752 adults with type 2 diabetes) found -8.2% and -9.8% against -3.9%. The liver work is the headline: in a phase 2 trial in MASH, up to 62% improved on biopsy against 14% on placebo, and the phase 3 liver-fat trial (SYNCHRONIZE-MASLD, 216 adults) hit both its goals.
- SYNCHRONIZE-1 (n=725, 76 wks): -12.2% (3.6 mg), -13.0% (6.0 mg), -5.4% placebo.
- SYNCHRONIZE-2 (type 2 diabetes, n=752): -8.2% and -9.8% vs -3.9%; HbA1c down about 0.8 to 0.9 points.
- Phase 2 MASH (n=293, 48 wks): MASH improved in 43 to 62% across doses vs 14% on placebo.
- GI side effects in 81% (3.6 mg) and 90% (6.0 mg) vs 48% on placebo in SYNCHRONIZE-1.
Reported protocols
These are the doses the peptide community actually reports running (Reddit & forums), alongside published research — logged for education, not as a recommendation to use.
| Parameter | Commonly reported range |
|---|---|
| Trial dose | Weekly, escalated to 3.6 or 6.0 mg in phase 3; phase 2 tested 0.6 to 4.8 mg after a 20-week climb |
| Community dose | Forum users report starting around 0.25 to 0.6 mg weekly and climbing slowly, with reports at 1.2, 1.8, 2 and 2.4 mg and a few at 4 to 4.2 mg, mostly stacked with tirzepatide |
| Frequency | Once weekly |
| Route | Subcutaneous |
| Cycle | Trials ran 46 to 76 weeks continuously |
| Community tip | Some users describe the effect as quiet: less food noise and changed cravings rather than a strong feeling. One reported mild nausea about 24 hours after stepping up a dose. |
Common use cases
| Goal | Community protocol notes |
|---|---|
| Weight loss without diabetes | the SYNCHRONIZE-1 population, 3.6 or 6.0 mg weekly in trials |
| Weight plus fatty liver | where survodutide's data are strongest |
| Added to tirzepatide | forum pattern only, untested in trials |
Mixing it (reconstitution)
Freeze-dried peptides must be reconstituted with bacteriostatic water before they can be measured. Carl’s calculator turns “mg in the vial + ml of water + target dose” into “units on the syringe” — and tells you how long the vial lasts.
→ Open the Reconstitution Calculator
Injection & handling
Subcutaneous, once weekly, rotating sites. The trials climbed slowly (20 weeks to full dose in phase 2) and the forum habit is the same: start low, often 0.25 to 0.6 mg, and only step up once the last step has settled. Stomach side effects are worst while the dose is climbing. Reconstituted, keep it cold.
Stacks it appears in
- With tirzepatide — The most common forum stack, adding the glucagon lever to a GLP-1/GIP drug. No trial data supports it.
- Instead of retatrutide — Forum users call tirzepatide plus survodutide a budget version of retatrutide. Retatrutide already includes the glucagon lever, so adding survodutide on top doubles up rather than adding something new.
Sources
- SYNCHRONIZE-1, NEJM 2026 (PMID 42253238)
- SYNCHRONIZE-2, NEJM 2026 (PMID 42820639)
- SYNCHRONIZE-MASLD, Nat Med 2026 (PMID 42252333)
- Phase 2 obesity, Lancet Diabetes Endocrinol 2024 (PMID 38330987)
- Phase 2 MASH, NEJM 2024 (PMID 38847460)
- SYNCHRONIZE-1/-2 design, Obesity 2025 (PMID 39495965)
- ClinicalTrials.gov survodutide phase 3 listing (LIVERAGE NCT06632444)
- Pemvidutide MASLD trial, J Hepatol 2025 (PMID 39002641)
- Retatrutide phase 2, NEJM 2023 (PMID 37366315)
- GLP-1 Forum, 'Any current Survo users or stackers?'
- GLP-1 Forum, 'Survo is weird.' thread
- SAHPRA, Peptide Products: Public Information (published 26 May 2026)
- WADA 2026 Prohibited List (S0 non-approved substances; S6.B specified stimulants)
