Library / Peptides / Weight Management / Survodutide
Emerging evidence · Grade B

Survodutide

Survodutide (BI 456906)
Evidence
Emerging
Route
Subcutaneous injection
Frequency
Once weekly
Category
Weight Management
TL;DR
Survodutide is an experimental weekly injection that works in two ways: it reduces appetite (like Ozempic) and also revs up your metabolism to burn more fat (a newer addition). Early trials show it may produce substantial weight loss and also help with fatty liver disease. It is not yet approved and is only available in clinical trials.
Part 01 · How it works

Mechanism.

Survodutide is an investigational dual agonist of the glucagon-like peptide-1 (GLP-1) receptor and the glucagon receptor, developed by Boehringer Ingelheim. It combines GLP-1-mediated appetite suppression and slowed gastric emptying with glucagon-driven increases in energy expenditure and hepatic fat mobilization. It is being studied for obesity and non-alcoholic steatohepatitis (NASH/MAFLD) in phase II/III trials.

If GLP-1 agonists work by putting a lid on your appetite (less food in), survodutide adds a second mechanism by turning up your cellular furnace (more energy burned). It is like both reducing the amount of wood you put on the fire and simultaneously making the fire burn hotter.

Mechanism · technical
Survodutide activates both GLP-1 receptors (reducing appetite, increasing satiety, slowing gastric emptying, improving glycemic control) and glucagon receptors (increasing hepatic glucose output acutely, but more importantly driving thermogenesis, lipolysis, and fat oxidation via brown adipose tissue activation). This dual mechanism theoretically produces greater weight loss than GLP-1 monotherapy alone by simultaneously reducing caloric intake and increasing caloric expenditure.
Part 02 · Dosing & administration

How it's taken.

Values below describe how Survodutide has been administered in published trials and labeling. Provided for educational purposes only — this is not medical advice and not instructions for self-administration. Consult your healthcare provider before making any health decision.

Standard dose
0.3 mg → titrate to 4.8 mg or 6.0 mg
Subcutaneous injection · Once weekly
Duration
Ongoing as prescribed

GLP-1/glucagon receptor dual agonist by Boehringer Ingelheim. Phase 3 trials for obesity and MASH. Not yet FDA-approved. Titration required over weeks.

Need help with reconstitution?

Use the free peptide calculator for dilution, unit conversion, and injection volume.

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Part 03 · Safety

Side effects, rare serious events, who shouldn't.

Reported side effects
Nausea, vomiting, diarrhea, and decreased appetite (class effects consistent with GLP-1 agonists). The glucagon component may increase fasting glucose in people with diabetes if not managed. Potential for hypoglycemia when combined with insulin or sulfonylureas. Gallbladder events have been noted in the drug class.
Absolute · do not use
×
Personal or family history of medullary thyroid carcinoma
×
Multiple endocrine neoplasia syndrome type 2 (MEN2)
×
Pregnancy or breastfeeding
×
Children under 18
×
Known hypersensitivity to survodutide or any component
×
History of pancreatitis
×
Severe gastrointestinal disease (gastroparesis)
Interactions
Insulin
Increased risk of hypoglycemia; insulin dose reduction likely required
Major
Sulfonylureas
Additive hypoglycemic effect; dose reduction may be necessary
Major
Oral medications with narrow therapeutic index
GLP-1/glucagon dual agonism delays gastric emptying, potentially altering absorption of oral medications
Moderate
Other GLP-1 receptor agonists
Additive GI and pancreatic effects; should not be combined
Major
Labs to monitor
HbA1c
Baseline and every 3 months
GLP-1/glucagon dual agonist — glycemic monitoring
Lipase & Amylase
Baseline and every 3 months
Pancreatitis screening (GLP-1 class concern)
CMP (Comprehensive Metabolic Panel)
Baseline and every 3 months
Liver function (MASH indication); kidney function
ALT & AST
Baseline and monthly
Specific liver enzymes for MASH/NASH monitoring
Lipid Panel
Baseline and every 3 months
Glucagon component affects lipid metabolism
Thyroid Panel (TSH, Free T4)
Baseline and every 6 months
GLP-1 class thyroid concern
Part 04 · Evidence

How strong is the evidence?

Scores derived from rating, indexed studies, regulatory status, and catalogued safety data for this peptide. Curated per-peptide scoring replaces this when available.

74
Grade B
Grade B. Signal is real but maturing. Treat results as directional until larger or independent replications land.
Clinical efficacy
Emerging signal across multiple indexed studies; effect sizes still firming up.
68
Study quality
3 indexed studies in our dataset. Designs vary — see Research log for per-study grades.
79
Regulatory clarity
FDA-approved for at least one indication.
90
Safety profile
Based on 7 documented contraindications, 4 interactions, 6 lab checkpoints.
84
Long-term data
Long-horizon data not yet available outside research settings.
48
Part 05 · Research log

Every study we cite.

Each study with its published finding and a plain-language note on limitations or funding.

01
2023
0
Survodutide for the treatment of overweight and obesity: phase II dose-finding trial
Phase II data showed dose-dependent weight loss up to 18.7% from baseline over 46 weeks at the highest dose, with GI side effects being the primary dose-limiting factor.
Phase II trial, not powered for cardiovascular or long-term outcomes. Industry-sponsored (Boehringer Ingelheim).
PMID 37556352 ↗
02
2022
0
Dual GLP-1/glucagon receptor co-agonism in NASH: mechanistic rationale and early data
Preclinical and early clinical data support that glucagon receptor activation reduces hepatic lipid accumulation and fibrosis, complementing GLP-1 effects on insulin sensitivity.
Largely mechanistic and preclinical; NASH-specific phase III results pending.
PMID 35283338 ↗
03
2024
0
BI 456906 phase II NASH trial: liver fat and fibrosis outcomes
Interim results showed significant reductions in liver fat content (MRI-PDFF) and ALT normalization in patients with biopsy-confirmed NASH after 24 weeks of survodutide treatment.
Surrogate endpoints used; histologic NASH resolution and fibrosis regression as primary endpoints for full trial still pending publication.
PMID 38467103 ↗
Part 06 · Cost & access

Where you can get it.

Regulatory status
Investigational. Not FDA-approved as of 2025. Phase III trials ongoing for obesity and NASH. No compassionate use pathway available to general public.
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Part 07 · Your appointment

Questions to bring.

01
How does survodutide compare to tirzepatide or semaglutide for weight loss in terms of efficacy and side effects?
02
Is survodutide available in any trials I might qualify for given my metabolic history?
03
Does the glucagon component pose any risk for people with or without diabetes?
04
What is the expected approval timeline and how does it compare to already-approved agents?