SS-31
Elamipretide · Szeto-Schiller Peptide 31 · Bendavia
SS-31 binds selectively to cardiolipin within the mitochondrial inner membrane. It stabilizes cristae and the supercomplexes of the electron transport chain, lowers mitochondrial reactive oxygen species and improves the efficiency of ATP synthesis without altering membrane potential.
Not medical advice. Educational reference only.
- Typical dose
- 40 mg intravenously, or 40 mg subcutaneously daily
- Route
- Subcutaneous injection; intravenous injection
- Storage
- Refrigerate the mixed solution at 2–8 °C; use within 28 days.
What is SS-31?
SS-31, or elamipretide, is a four-amino-acid peptide that accumulates selectively at the inner membrane of mitochondria. Its sequence is D-Arg-2′6′-Dmt-Lys-Phe-NH2, and Bendavia is another development name. FDA Breakthrough Therapy designation has been part of its development for primary mitochondrial myopathy and for Barth syndrome. Phase III investigations in heart failure, including PROGRESS-HF, and primary mitochondrial myopathy found significant improvements in function. Forzinity received accelerated FDA approval on 2025-09-19 for patients with Barth syndrome weighing at least 30 kg. That approval relied on knee extensor strength as an intermediate endpoint and requires a confirmatory trial; it does not extend to every research preparation of SS-31.
Mechanism of action
SS-31 binds selectively to cardiolipin within the mitochondrial inner membrane. It stabilizes cristae and the supercomplexes of the electron transport chain, lowers mitochondrial reactive oxygen species and improves the efficiency of ATP synthesis without altering membrane potential.
Targets: Cardiolipin (inner mitochondrial membrane) · Electron transport chain
Research indications
Energy Metabolism
EffectiveMitochondrial research examines improved bioenergetic function and production of ATP.
Metabolic Health
EffectivePotential metabolic effects include better sensitivity to insulin and improved glucose handling.
Longevity Markers
ModerateEarly investigations examine possible changes in markers of aging at the cellular level.
Interactions
Medications
CautionConsult your prescriber before combining treatment with any medication.
BPC-157
CompatibleNAD+
CompatibleVitamin D
Compatible
How to reconstitute and inject
Diluent: Use only bacteriostatic water; avoid saline because precipitation can occur.
- Let your refrigerated SS-31 vial stand for 15–20 minutes so it reaches room temperature before mixing.
- Disinfect the rubber stopper using an alcohol swab. Wait for all of the alcohol to air-dry.
- Measure the calculated bacteriostatic water volume with a sterile syringe. Use BAC water only; saline can lead to precipitation.
- Deliver the water slowly against the vial’s inner wall. Keep the stream from striking the powder directly.
- Mix by gently rotating the vial in circles. Avoid vigorous shaking, which can break down the peptide.
- Wait 2–3 minutes until dissolution is complete. Inspect the liquid for a clear appearance without color.
- Measure your calculated dose in an insulin syringe for administration beneath the skin.
- Choose your abdomen, upper arm or thigh for subcutaneous administration. Change sites between injections to help prevent lipodystrophy.
- Keep the mixed vial at 2–8 °C in the refrigerator. Use the solution within 28 days of preparation.
What to expect
- Week 1–2
- Early effects may emerge during adaptation. Watch for unwanted reactions throughout this period.
- Week 2–4
- The principal effects may begin to appear. Make dose changes only with guidance from your healthcare provider.
- Week 4–8
- The main effects are expected to be more established. Review your progress with a healthcare professional.
- Week 8+
- Assess the results with your provider before deciding whether to continue, cycle treatment or alter the dose.
Side effects and safety
- Bruising, redness or mild pain around the injection area
- Possible allergic reactions; discontinue use if you develop hives or a rash
SS-31: approved in the US.
Regulatory status
US
ApprovedFDA — Forzinity (elamipretide) injection; accelerated approval 2025-09-19 for Barth syndrome in patients weighing at least 30 kg
- Rx required
- Yes
- Telehealth
- N/A
- Checked on
Frequently asked questions
What research questions concern SS-31?
Research examines mitochondrial function, bioenergetics and related metabolic effects. SS-31 concentrates in mitochondrial membranes and binds cardiolipin, with proposed benefits for cristae organization and electron transport. Research in heart failure and mitochondrial myopathy should be considered separately from the specific Barth syndrome approval.
Which amounts occur in research discussions?
Clinical research discussions include 40 mg by intravenous administration or 40 mg daily beneath the skin. The low starting and titrated standard schedules give no numeric amount and leave the route and frequency protocol-dependent. The approximate half-life is 1.5 hours after injectable use. These research descriptions do not replace product-specific prescribing instructions.
What safety limitations remain?
Dose, route and individual response affect tolerability. Injection-area reactions and possible allergy require attention, while adverse effects for every experimental formulation are not fully characterized in humans. Consult a clinician before use, begin only at the lowest clinician-directed dose and report unexpected symptoms promptly.
References
Cell-permeable peptide antioxidants targeted to inner mitochondrial membrane (2006)
Elamipretide in patients with heart failure with a reduced ejection fraction: EMBRACE-HF (2020)
Elamipretide: A Review of Its Structure, Mechanism of Action, and Therapeutic Potential. (2025)
Serendipity and the discovery of novel compounds that restore mitochondrial plasticity. (2014)
Chatfield KC et al. — Elamipretide Barth syndrome (JACC 2019) (2019)
Elamipretide (SS-31) studies on ClinicalTrials.gov (2024)