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Metabolic & weight

Survodutide

Also called BI 456906

Survodutide is an experimental weekly shot that acts on both the glucagon and GLP-1 receptors. It is being developed by Boehringer Ingelheim (with Zealand Pharma) for obesity and fatty liver disease. In 2026 phase 3 trials it produced up to about 16.6% weight loss.

Late-stage trialsTested in large human trials (phase 2b/3) but not yet approved in the US.

All printable flashcards

Illustrative chain. The exact sequence has not been published in a source we could verify.

Overview

Survodutide is an experimental weekly shot that acts on both the glucagon and GLP-1 receptors. It is being developed by Boehringer Ingelheim (with Zealand Pharma) for obesity and fatty liver disease. In 2026 phase 3 trials it produced up to about 16.6% weight loss.

How it works

Established in trials as a dual glucagon and GLP-1 receptor agonist. GLP-1 action lowers appetite; glucagon action is proposed to increase energy use and fat burning in the liver. This liver effect is why it is also being tested for MASH (fatty liver disease with inflammation), where FDA has granted Breakthrough Therapy designation.

What research shows

  • Phase 2 RCT (n=387, 46 weeks): weight change −6.2% (0.6 mg) to −14.9% (4.8 mg) vs −2.8% placebo; 75% had GI side effects on drug.
  • SYNCHRONIZE-1 phase 3 RCT in obesity without diabetes (76 weeks): −15.3% (3.6 mg) and −16.6% (6.0 mg) vs −3.2% placebo (efficacy estimand).
  • SYNCHRONIZE-2 phase 3 RCT in obesity with type 2 diabetes (n=755, 76 weeks): up to −13.1% vs −3.1% placebo; HbA1c down up to 1.21 points.
  • MRI substudy (n=75): visceral and liver fat fell more than other tissue; no more than about 10% of weight lost was muscle.

Doses studied in people

Study or labelDose usedSource
Phase 2 dose-finding RCT in obesity (n=387)0.6, 2.4, 3.6, or 4.8 mg once weekly, subcutaneous; 20-week escalation then 26-week maintenance1
SYNCHRONIZE-1 and -2 phase 3 RCTs3.6 mg or 6.0 mg once weekly, subcutaneous, 76 weeks3

No approved dose exists; listed doses come from published phase 2 and phase 3 trials only.

Read this first: these are the amounts given to participants in published studies or written on official prescribing labels, reported for reference. They are not recommendations. Trial doses were chosen for specific patients under medical supervision, and a dose that is safe in one person can be harmful in another.

Weekly protocol

How the schedule looks week by week. Each chart says where it comes from: a prescribing label, a clinical trial, or a protocol commonly reported online.

Phase 2 dose-finding trial (4.8 mg arm)

Clinical trial

One week

D1D2D3D4D5D6D7

Once weekly · Subcutaneous injection

Syringe units (U-100)

Dose by week

Stepped up every 2–4 weeks to 4.8 mgEscalation · wk 1–20
4.8 mgMaintenance · wk 21–46

Supplies for one course (estimate)

Counts only. This site does not sell or link to supplies.

Course
46 weeks (20-week escalation, 26-week maintenance)
Note
The step-by-step escalation schemes are in the paper's appendix; dosing was fixed in weeks 1–10 and flexible in weeks 11–20. Other arms targeted 0.6, 2.4 or 3.6 mg. Investigational.
Source
le Roux CW et al. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: phase 2 trial. Lancet Diabetes Endocrinol 2024;12:162–73

Reference only, not a recommendation. Label and trial schedules were set for specific patients under medical supervision. Use the calculator only to understand the arithmetic.

Vial math

Many research vials hold 5 or 10 mg of powder. This table shows how much ends up in each mark on a U-100 insulin syringe for common amounts of added liquid. It is arithmetic only, not a dose.

VialLiquid addedConcentrationPer unit (0.01 mL)
5 mg1 mL5 mg/mL50 mcgOpen in calculator
5 mg2 mL2.5 mg/mL25 mcgOpen in calculator
5 mg3 mL1.67 mg/mL16.7 mcgOpen in calculator
10 mg1 mL10 mg/mL100 mcgOpen in calculator
10 mg2 mL5 mg/mL50 mcgOpen in calculator
10 mg3 mL3.33 mg/mL33.3 mcgOpen in calculator

More sizes: all vial sizes · How this works: Syringes and units · Reconstitution guide.

Safety

  • GI side effects (nausea, vomiting, diarrhea, constipation) were the most common, mostly mild to moderate and highest during dose escalation.
  • GI-related discontinuation was high in phase 3: 17.8% (3.6 mg) and 20.2% (6.0 mg) vs 2.9% placebo in SYNCHRONIZE-1; 18% vs 1.2% in SYNCHRONIZE-2.
  • About 40% of all participants (drug and placebo alike) did not complete the phase 2 trial (60% completion).
  • Cardiovascular and long-term safety not yet established; outcome trial pending.

Report side effects of any drug or product to the FDA through MedWatch. For a possible poisoning in the US, call Poison Control at 1-800-222-1222.

History

Discovered by Zealand Pharma and licensed to Boehringer Ingelheim. The phase 2 obesity trial was published in Lancet Diabetes & Endocrinology in 2024. Phase 3 SYNCHRONIZE-1 (obesity) topline results came in April 2026. SYNCHRONIZE-2 (obesity with type 2 diabetes) was presented at EASD and published in NEJM on October 1, 2026, alongside a SYNCHRONIZE-1 body-composition substudy. MASH (LIVERAGE) and cardiovascular outcome results are still pending.

Common questions

Is survodutide FDA-approved?

No. It is still investigational, with phase 3 trial results reported in 2026 23.

How does survodutide work?

It activates both the glucagon and GLP-1 receptors 1. The GLP-1 part lowers appetite, while the glucagon part is thought to increase energy use and fat burning in the liver 1.

What does the research show?

In SYNCHRONIZE-1, people without diabetes lost 15.3% (3.6 mg) and 16.6% (6.0 mg) of body weight over 76 weeks vs 3.2% on placebo 2. In people with type 2 diabetes, weight loss reached 13.1% vs 3.1% on placebo 3.

What doses were studied?

Phase 2 tested 0.6 to 4.8 mg once weekly 1, and phase 3 trials used 3.6 mg or 6.0 mg once weekly by injection for 76 weeks 3. There is no approved dose; these are trial doses only.

What are the side effects?

Stomach side effects such as nausea and vomiting were most common, mostly mild to moderate 2. In SYNCHRONIZE-1, about 18% to 20% stopped because of them vs 2.9% on placebo 2.

Does survodutide cause muscle loss?

In an MRI substudy of 75 people, belly and liver fat fell more than other tissue, and no more than about 10% of weight lost was muscle 3.

Related compounds

Metabolic & weightLate-stage trialsFlashcard

Mazdutide

IBI362 · LY3305677

Mazdutide is a weekly shot that acts on both the GLP-1 and glucagon receptors.

Metabolic & weightLate-stage trialsFlashcard

Retatrutide

LY3437943 · triple agonist

Retatrutide is an experimental weekly shot from Eli Lilly that acts on three hormone receptors: GIP, GLP-1, and glucagon.

Metabolic & weightFDA-approvedFlashcard

Semaglutide

Wegovy · Ozempic

Semaglutide is a long-acting copy of the gut hormone GLP-1.

Sources

  1. le Roux CW et al. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: phase 2 trial. Lancet Diabetes Endocrinol 2024;12(3):162-173 Journal
  2. Survodutide delivers 16.6% weight loss in major phase 3 obesity trial (PharmaTimes, Apr 2026) Journal
  3. Dual agonist survodutide delivers up to 13.1% weight loss in T2D (AJMC, Oct 2026; NEJM publication) Journal

Last reviewed 2026-10-25 · How we research · Found an error? See our corrections policy.