BI 456906
An investigational once-weekly injection that activates the glucagon and GLP-1 receptors. Like other GLP-1 drugs it curbs appetite; its glucagon action works mainly in the liver, where it cut liver fat in trials.
Sport status follows the WADA Prohibited List in force since January 1, 2026; athletes should confirm with their anti-doping organization. Checked October 5, 2026. Status of every compound.
Survodutide binds and switches on two receptors: GLP-1, which curbs appetite and slows stomach emptying, and glucagon, a hormone that acts mainly on the liver. It was designed after oxyntomodulin, a gut hormone that acts on both. In mice it cut weight more than semaglutide by raising energy use as well as lowering food intake; in people, falls in blood amino acids and glucagon showed both receptors were engaged.
TrialMainly from studies in people.
Whether the glucagon action raises energy use in people, as in mice, isn’t established. Glucagon can speed the heart, and a heart safety trial and a detailed heart-rhythm study are still under way.
SYNCHRONIZE-1, NEJM 2026
Phase 3 maintenance doses of 3.6 or 6.0 mg once weekly, reached by stepping up from a low dose, with pauses or slower steps allowed for stomach side effects. At 76 weeks weight fell 12.2% and 13.0% vs 5.4% on placebo, counting everyone who started.
le Roux 2024
Phase 2 tested 0.6, 2.4, 3.6 and 4.8 mg weekly: 20 weeks of step-ups every 2 weeks, then 26 weeks at the assigned dose. Mean loss was 14.9% at 4.8 mg vs 2.8% on placebo.
Sanyal 2024
MASH (fatty liver with inflammation) phase 2: 2.4, 4.8 or 6.0 mg weekly for 48 weeks, including a 24-week fast step-up. MASH improved without worse scarring in 47%, 62% and 43% vs 14% on placebo.
Continuous, shown over 26 weeks
The ways Survodutide is most often run, each tagged with where it comes from.
Stepped up from a low dose, with pauses allowed for stomach side effects. Mean loss 13.0% counting everyone who started (SYNCHRONIZE-1); 9.8% with type 2 diabetes (SYNCHRONIZE-2).
Mean loss 12.2% counting everyone (SYNCHRONIZE-1); 8.2% with type 2 diabetes (SYNCHRONIZE-2).
Adults with obesity and fatty liver with inflammation or scarring. Liver fat fell by 30% or more in 84.2% vs 24.3% on placebo, if everyone had stayed on treatment.
24 weeks of fast step-ups, then 24 weeks at the assigned dose. MASH improved without worse scarring in 43–62% vs 14% on placebo.
Injected under the skin once a week in trials, from prefilled syringes. The belly, thigh or upper arm are the usual sites, rotated each week.
No label or published trial rule yet. Common practice is to take the next dose on schedule without doubling up. For comparison, the Wegovy label restarts at a lower dose after 2+ missed doses.
Doses rise from a low start over several months. In phase 3, people with bad stomach symptoms could skip 1–2 doses, and after reaching 3.6 mg (up to week 32) could delay a step or drop one level for 2–4 weeks.
TrialPhase 2: mean loss 14.9% on 4.8 mg vs 2.8% on placebo.
TrialSYNCHRONIZE-MASLD: 84.2% had liver fat fall by 30% or more vs 24.3% on placebo, and weight fell 12.2% vs 1.0%, if everyone had stayed on treatment.
TrialSYNCHRONIZE-1, counting everyone who started: 12.2% (3.6 mg) and 13.0% (6.0 mg) vs 5.4% on placebo. Boehringer reports up to 16.6% vs 3.2% if everyone had stayed on treatment.
TrialGI side effects (SYNCHRONIZE-1: 81% at 3.6 mg, 90% at 6.0 mg vs 48% placebo)
Mostly mild to moderate and during step-ups. The trials paused doses or slowed the step-up when needed.
Nausea 66%, diarrhea 49%, vomiting 41% (MASH phase 2, all doses; placebo 23%, 23%, 4%)
That trial used fast step-ups. Ongoing vomiting or diarrhea needs medical advice; stay hydrated.
Stopping because of GI side effects (19% vs 2.9% in SYNCHRONIZE-1; 18% vs 1.2% in SYNCHRONIZE-2)
Most stopped during the step-up phase.
Heart and blood-vessel side effects (phase 1: 6 of 80 people stopped for them during a 6-week step-up)
Report palpitations, a racing pulse at rest or dizziness.
Severe belly pain that won’t go away, signs of allergy, a racing heart at rest or fainting, or dehydration (dizziness, very little urine). Get medical help.
No product label covers survodutide, so these come from human studies and from precautions based on how it works. Most important first.
Trial: seen in human studies, or a group those studies left out. Precaution: follows from how it works or from a related drug, and hasn’t been tested. This isn’t a complete list: a pharmacist or doctor can check a specific medicine or condition.
Usually run on its own.
5 key published human studies, with how many people took part. Animal studies aren’t listed here.
Weight fell 12.2% and 13.0% vs 5.4% on placebo in adults with obesity without diabetes; GI side effects in 80.9% and 89.7% vs 47.9%.
le Roux et al., N Engl J Med 2026 (SYNCHRONIZE-1), PMID 42253238
In adults with obesity and type 2 diabetes, weight fell 8.2% and 9.8% vs 3.9% on placebo, and HbA1c 0.9 and 0.8 points vs 0.2.
Wharton et al., N Engl J Med 2026 (SYNCHRONIZE-2), PMID 42820639
In obesity with at-risk fatty liver, liver fat fell 30% or more in 68.5% vs 28.6% on placebo and weight fell 8.7% vs 1.4%, counting everyone who started.
Kaplan et al., Nat Med 2026 (SYNCHRONIZE-MASLD), PMID 42252333
MASH improved without worse fibrosis in 47%, 62% and 43% vs 14% on placebo in biopsy-proven MASH with F1–F3 fibrosis.
Sanyal et al., N Engl J Med 2024, PMID 38847460
Weight fell 6.2%, 12.5%, 13.2% and 14.9% vs 2.8% on placebo in adults with overweight or obesity without diabetes.
le Roux et al., Lancet Diabetes Endocrinol 2024, PMID 38330987
Phase 3 results so far cover about 1,700 adults treated for 48–76 weeks in three trials, plus Phase 2 trials in obesity and MASH (fatty liver with inflammation). The heart safety trial, a detailed heart-rhythm study and MASH outcome trials are still running, and the Phase 3 step-up schedule hasn’t been published in detail. Nothing is known about products or dosing outside the trials.
| Vial | Water | Common dose | Draw | Strength | Action |
|---|---|---|---|---|---|
| 10 mg | 1 mL | 3.6 mg | 36 units (0.36 mL) | 10 mg/mL |
No branded product exists; phase 3 trials used prefilled syringes. With 1 mL of water in a 10 mg vial, each 10 units holds 1 mg, so 3.6 mg is 36 units.
Syringe units for common doses at different water volumes. Select a cell to open it in the calculator.
| Dose | Water added | ||
|---|---|---|---|
| 1 mL | 2 mL | 3 mL | |
| 0.6 mg | |||
| 1 mg | |||
| 1.5 mg | |||
| 2.5 mg | |||
| 3.6 mg | |||
| 4 mg | |||
| 6 mg | |||
U-100 insulin syringe: 100 units is 1 mL. Draws over 100 units show in mL. Faded values are under 2 units, which is hard to measure. Check that your vial holds the larger volumes.
Every compound side by side: the half-life chart and the storage chart.
An investigational once-weekly injection that activates the glucagon and GLP-1 receptors. Like other GLP-1 drugs it curbs appetite; its glucagon action works mainly in the liver, where it cut liver fat in trials.
Survodutide binds and switches on two receptors: GLP-1, which curbs appetite and slows stomach emptying, and glucagon, a hormone that acts mainly on the liver. It was designed after oxyntomodulin, a gut hormone that acts on both. In mice it cut weight more than semaglutide by raising energy use as well as lowering food intake; in people, falls in blood amino acids and glucagon showed both receptors were engaged. Whether the glucagon action raises energy use in people, as in mice, isn’t established. Glucagon can speed the heart, and a heart safety trial and a detailed heart-rhythm study are still under way.
Not approved anywhere. Phase 3 obesity results came out in 2026 (SYNCHRONIZE-1 in June, SYNCHRONIZE-2 on October 1), and Boehringer Ingelheim had not announced a filing as of early October 2026. FDA has granted Fast Track and Breakthrough Therapy designations; MASH trials are ongoing.
From human studies (SYNCHRONIZE-1, NEJM 2026): Phase 3 maintenance doses of 3.6 or 6.0 mg once weekly, reached by stepping up from a low dose, with pauses or slower steps allowed for stomach side effects. At 76 weeks weight fell 12.2% and 13.0% vs 5.4% on placebo, counting everyone who started. le Roux 2024: Phase 2 tested 0.6, 2.4, 3.6 and 4.8 mg weekly: 20 weeks of step-ups every 2 weeks, then 26 weeks at the assigned dose. Mean loss was 14.9% at 4.8 mg vs 2.8% on placebo. These are the amounts sources reference, not recommendations.
There’s no single right amount, because the water only sets the strength. With 1 mL of bacteriostatic water in a 10 mg vial, the strength is 10 mg/mL, so 3.6 mg is 36 units on a U-100 insulin syringe. More water makes small doses easier to measure. The dose chart above shows other volumes.
No product label covers survodutide, so these come from human studies and from precautions based on how it works. History of medullary thyroid cancer or MEN 2: Excluded from SYNCHRONIZE-1, including a family history; MEN 2 is an inherited tumor syndrome. Approved GLP-1 drugs such as semaglutide are ruled out for this group because of thyroid C-cell tumors in rodents. History of pancreatitis: Excluded from SYNCHRONIZE-1, as were people with raised pancreatic enzymes. Pancreatitis, sometimes fatal, is a listed risk of approved GLP-1 drugs such as semaglutide. Severe gastroparesis or stomach outlet blockage: Excluded from SYNCHRONIZE-1. In that trial, stomach and gut side effects affected 81–90% of people on survodutide vs 48% on placebo. The “Who should avoid it” section lists 3 more groups.
Before mixing: Freezer for long-term storage; keep the vial sealed, dry and out of light. Fridge (2–8 °C) after mixing; use within about 4 weeks. This is common practice; no product label covers it.
Probably. Not named on WADA’s 2026 list, but its S0 rule bans drugs with no current human approval anywhere, at all times.
Yes. The human studies section lists 5 published studies. The largest, from 2026, included 752 people. In adults with obesity and type 2 diabetes, weight fell 8.2% and 9.8% vs 3.9% on placebo, and HbA1c 0.9 and 0.8 points vs 0.2.
For the protocol details
For how it works, who should avoid it and the limits of the evidence