Survodutide
A weekly weight-loss shot in trials that adds a liver-fat-burning glucagon arm to the GLP-1 effect. About 16 percent off at 76 weeks.
What it is
Survodutide is for people who want weight loss close to tirzepatide's and have a fatty liver to fix at the same time. The GLP-1 half quiets appetite; the glucagon half raises how much you burn at rest and works directly on liver fat, which is why its liver results stand out. It is not approved or sold yet, so anything you buy is an unlabelled research product.
The person it makes sense for is someone with weight to lose and a fatty liver (MASH or NAFLD on an ultrasound or elevated liver enzymes), who wants one weekly shot to work on both, and who understands they are using a trial drug outside a trial. People who just want maximum weight loss have better-proven, prescribable options in tirzepatide. People who are curious about glucagon agonism but have a heart rhythm problem should not be the ones to test it.
The GLP-1 side shows first: appetite drops in the first couple of weeks at the low doses, with nausea tracking each step up. Weight loss in the phase 3 obesity trial averaged about 16.6 percent over 76 weeks on the top 6 mg dose, which is between semaglutide and tirzepatide. The glucagon side is quieter to feel but shows on labs, as liver enzymes and liver fat come down over months, and in the phase 2 liver trial most people on the top dose had their MASH improve. The cost of that arm is a higher resting heart rate, typically a handful of beats, that you will notice on a watch. Expect the weight to come off steadily for a year, not in a sprint.
Titration is not optional with a glucagon agonist. The trial schedule starts at 0.6 mg once a week and steps every two weeks: 0.6, 1.2, 1.8, 2.4, 3.6, 4.8, with some arms going to 6 mg. Hold at any step where nausea is bad rather than pushing through. Inject subQ in the belly or thigh on the same day each week. The common mistake is treating it like semaglutide and skipping steps, which with the glucagon arm means vomiting and a pounding heart rather than just queasiness. On supply: a 10 mg vial in 1 ml is 10 mg/ml, so 2.4 mg is 24 units and 6 mg is 60; the first 12 weeks of titration use about 29 mg, roughly three vials, and the 4.8 mg maintenance dose burns a vial every two weeks.
The evidence is strong for a drug that is not yet approved: phase 2 weight loss of 12.5 to 14.9 percent at 46 weeks, the SYNCHRONIZE-1 phase 3 obesity result of about 16.6 percent at 76 weeks, and a phase 2 MASH trial where up to about 62 percent of people on 4.8 mg improved without their fibrosis worsening. The FDA gave it Breakthrough Therapy and Fast Track status for the liver use, which speeds review and is not approval. The gap is long-term safety data and the heart-rate question at scale.
If you can get tirzepatide prescribed, that is the better-proven route to a similar amount of weight loss with a label, a pharmacy and a doctor. If you want the strongest gray-market option, retatrutide is further along in popularity and adds a GIP arm. Survodutide earns its place only when the liver is the reason. Skip it with any arrhythmia or heart disease, a history of pancreatitis, a thyroid cancer history, or type 1 diabetes, and skip it entirely if you are pregnant or trying.
What people use it for
Weight loss
Most evidenceThe SYNCHRONIZE-1 phase 3 trial in adults with obesity reported about 16.6 percent average weight loss over 76 weeks on the top 6 mg dose, after phase 2 showed 12.5 to 14.9 percent at 46 weeks depending on dose. That puts it above semaglutide and below tirzepatide, with the usual GLP-1 drop-offs for nausea during titration.
Fatty liver (MASH)
Some evidenceIn a phase 2 trial in people with MASH, up to about 62 percent of those on 4.8 mg saw their liver disease improve without fibrosis getting worse, a result strong enough for FDA Breakthrough Therapy status. The glucagon arm acting directly on liver fat is the reason. Phase 3 liver trials are what will settle it.
Burning more at rest
Some evidenceGlucagon receptor agonism raises resting energy expenditure and liver fat oxidation, which is the mechanistic reason to accept the higher heart rate and extra nausea over a plain GLP-1. The size of the extra burn in people is modest and hard to feel; the liver and weight results are where it shows.
How people use it
Safety, in brief
Things people sometimes notice
- Nausea, worst in the week after each dose step
- Vomiting or diarrhoea at the higher steps
- Early fullness and a flat appetite
- A resting heart rate a few beats higher than your baseline
The full picture — stop signs and who should talk to a doctor first — is on the dosing guide.
Sources
The labels and studies behind this page. Each link opens the original on PubMed, DailyMed or ClinicalTrials.gov.
- Survodutide Once Weekly for the Treatment of Adults with Obesity
- Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial
- A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis
- BI 456906: Discovery and preclinical pharmacology of a novel GCGR/GLP-1R dual agonist with robust anti-obesity efficacy