SS-31 (elamipretide)
Peptide that binds mitochondrial cardiolipin
Experimental material. Read before using anything from here.
Nothing on this page is a medical recommendation, prescription or treatment plan. It is an organized translation of protocols circulating in research communities and, where it exists, of what published trials tested. The two are marked differently — and they are not equivalent.
Most of the compounds here have no FDA approval for human use. Several are sold labeled "research use only", which means they have not gone through purity, sterility or dosage controls for human consumption. A community-reported dose is not a validated dose: it is what someone reported having done.
Talk to a licensed health professional before considering any of these compounds. If you already use one and feel anything unexpected, seek care — do not wait for the next routine test.
Summary
Synthetic four-amino-acid peptide. It migrates to the inner mitochondrial membrane and binds to a phospholipid called cardiolipin, which is the structural scaffold where the mitochondrion organizes its energy-producing machinery. It reached clinical trials as elamipretide.
Quick reference
- Route
- Subcutaneous. The Forzinity package insert and the TAZPOWER trial used daily SC dosing.
- Trial dose
- 40 mg SC 1×/day was the arm studied, now the recommended Forzinity dose for ≥30 kg.
- Frequency
- 1×/day, at the same time, per the package insert.
- Status
- FDA-approved only for Barth syndrome. Everything else is investigational.
Dose references
| Population | Dose | Route | Notes |
|---|---|---|---|
| Patients ≥30 kg | 40 mg | Subcutaneous, 1×/day | Same time each day. Skip a missed dose; do not double up. |
| Adults with severe renal impairment (eGFR <30 mL/min, not on dialysis) | 20 mg | Subcutaneous, 1×/day | Per FDA label dose adjustment. |
| Adults with eGFR <30 mL/min and on dialysis | Not defined | — | Insufficient information for a dosing regimen per label. |
| Patients <30 kg | Not approved | — | Safety and effectiveness not established. |
Forzinity does not require reconstitution
| Vial size | BAC water added | Final concentration | Volume per 5 mg | Volume per 40 mg trial-context dose |
|---|---|---|---|---|
| 10 mg | 1.0 mL | 10 mg/mL | 0.50 mL (50 units U-100) | 4.0 mL total; split draws required |
| 10 mg | 2.0 mL | 5 mg/mL | 1.00 mL (100 units U-100) | 8.0 mL total; impractical for 40 mg |
| 50 mg | 2.5 mL | 20 mg/mL | 0.25 mL (25 units U-100) | 2.0 mL total; split draws required |
| 50 mg | 5.0 mL | 10 mg/mL | 0.50 mL (50 units U-100) | 4.0 mL total; split draws required |
SS-31 Timeline & What to Monitor
| Time point | Endpoint reviewed | Result reported |
|---|---|---|
| Week 12 (randomized period) | 6-minute walk distance, BTHS-SA fatigue score | No statistically significant difference vs placebo |
| Week 36 (OLE) | Cardiac stroke volume, exploratory functional outcomes | Reported improvement from baseline |
| Week 64–76 (OLE vs natural-history controls) | 6MWT | +79.7 m at week 64 (P = 0.0004); +91.0 m at week 76 (P = 0.0005) |
| Week 168 (OLE) | 6MWT (cumulative from OLE baseline) | +96.1 m (P = 0.003); knee extensor strength improved (basis for the FDA accelerated approval) |
SS-31 vs MOTS-c vs NAD+ vs CoQ10
| Compound | How it works | Strongest evidence | FDA approval |
|---|---|---|---|
| SS-31 / elamipretide | Binds cardiolipin in inner mitochondrial membrane; stabilizes cristae and ETC | Phase 2/3 in Barth syndrome (TAZPOWER) → FDA-approved as Forzinity | Yes, Barth syndrome only (Sept 2025) |
| MOTS-c | Mitochondrial-derived peptide; AMPK pathway signaling, metabolic regulation | Preclinical and small human studies; no Phase 3 outcome trial | No |
| NAD+ / NMN / NR (precursors) | Raises NAD+ levels supporting sirtuin and metabolic enzymes | Several small human trials; mixed efficacy signals | No (sold as supplements / research compounds) |
| CoQ10 / Ubiquinol | Electron carrier in ETC; antioxidant function | Long history; mixed clinical results across indications | No (sold as supplement) |
Storage and handling
The rules below apply to practically every lyophilized peptide in this reference. Where a compound has its own requirement, it appears in the table in the previous section.
- Lyophilized powder, sealed: refrigerator, between 2 and 8 °C, protected from light. Many tolerate room temperature for short transport periods, but that is tolerance, not a recommendation.
- After reconstitution: always refrigerated, between 2 and 8 °C. The stability window drops to days or a few weeks, depending on the compound.
- Never freeze after reconstituting. The freeze–thaw cycle degrades the peptide.
- Do not shake. Swirl the vial slowly. Shaking breaks the peptide chain.
- Bacteriostatic water down the wall of the vial, in a slow stream, not squirted directly onto the powder.
- Cloudy solution, with particles or a color change: discard. There is no recovery.
Lab tests and monitoring
This list is the one that appears recurrently in the source, with small variations by compound. It serves as a starting point for a conversation with a professional — not as a substitute for that conversation.
- Before starting: complete blood count, comprehensive metabolic panel, lipid panel, fasting glucose and HbA1c, TSH and free T4, blood pressure and resting heart rate.
- Depending on the compound: IGF-1 (GH axis), lipase and amylase (VIP and the incretin agonists), serum copper and ceruloplasmin (GHK-Cu and blends containing it), CRP.
- Reassessment: most protocols review between week 4 and week 8, and then every 8–12 weeks.
- Do not wait for the routine lab test in the face of abdominal pain, visual changes, a change in a mole, shortness of breath, asymmetric swelling or any new and persistent symptom. That is a reason to seek care, not a spreadsheet item.
Evidence limits
Data source: peptidedosingprotocols.com, accessed on September 3, 2026. Translation and organization in Portuguese are original work. No primary source (PubMed, trial registry, package insert) was checked in building this page — the check was against the secondary source, and that alone.