SS-31

• Week 1-2: Little felt at first; shot-site redness is common
• Week 2-4: Some report subtle gains in energy and recovery
• Week 4-8: Old mice ran longer; store course ends after week 8
• Week 8-12: Break: judge if your energy and recovery changed
• Side effects: Shot-site redness is common; stop for any allergic reaction

More on each stage

Week 1-2

Most people feel little at first. Each shot peaks in your blood within an hour, and half of it is gone every 3 to 4 hours. In older adults, one IV dose raised hand-muscle energy capacity right after the drip. Redness or itching where you inject is common from the start.

Week 2-4

Community users describe effects as gradual and subtle: steadier energy, mainly during exercise, and better recovery. Judge by how you train and recover, not by one good day. Community users mostly report few side effects at these doses.

Week 4-8

In old mice, 8 weeks of SS-31 improved how the heart relaxes and how long they could run. In people with Barth syndrome, leg strength rose over longer daily use. The store course ends after week 8 (56 doses, about 3 vials).

Week 8-12

You are on your 8-week break. In old mice the heart benefit held for 2 weeks after stopping. Use the break to judge whether your energy and recovery changed. If you noticed nothing during a full round, another round is unlikely to help.

Side effects

Most often redness, itching, pain, hardness, or hives where you inject. Stop and get help right away for any sign of an allergic reaction: swelling of the face or throat, trouble breathing, or a widespread rash.

Based on what people report in the community sources below. Results vary, and many responses are anecdotal.

• Muscle strength in Barth syndrome

  FDA-labeled

  The FDA approved SS-31 (as Forzinity, 40 mg a day) to improve muscle strength in Barth syndrome, a rare inherited mitochondrial disease. Leg strength rose during long-term daily use.12

• Muscle energy in older adults

  Clinical trial

  In 39 adults aged 60-85, one 2-hour IV dose raised the energy (ATP) capacity of a hand muscle by 27% versus 12% on placebo.4

• Stamina in aging muscle

  Animal/lab study

  In 27-month-old mice, one dose restored muscle energy production to young levels within an hour and made the muscle more fatigue-resistant. Eight days of daily doses let them run longer.5

• Aging heart

  Animal/lab study

  In 24-month-old mice, 8 weeks of SS-31 reversed age-related stiffening of the heart (how well it relaxes and fills) and the mice ran longer on a treadmill.6

• Daytime energy and workout recovery

  Community report

  Some community users report steadier energy, especially during exercise, and better recovery. They describe it as gradual and subtle.15

What it has been studied for

• Barth syndrome, a rare inherited mitochondrial disease (approved to improve muscle strength; 12 patients; accelerated approval)1FDA-labeled
• Primary mitochondrial myopathy, a group of muscle diseases (a small trial improved walking at day 5)3Clinical trial
• Heart failure (one infusion changed heart size measures)3Clinical trial
• Age-related decline in muscle energy (39 older adults, one IV dose)4Clinical trial
• Aging muscle and aging heart56Animal/lab study
• Kidney and heart injury from blocked blood flow, and a Parkinson's model7Animal/lab study

SS-31 (also called elamipretide) is a small lab-made peptide, only 4 building blocks (amino acids) long. Inside each cell are mitochondria, tiny power plants that make energy. SS-31 slips into cells and settles on the inner wall of these power plants. There it holds onto a special fat (cardiolipin) that keeps the energy machinery in one piece. In lab and animal studies, the power plants then made energy more efficiently and leaked less harmful oxygen waste. It acted mainly on damaged or ageing power plants.

Peak

30 minutes to 1 hour after an injection under the skin. About 92% of the dose reaches the blood, whether you inject the belly or the thigh.

Half-life

About 3 to 4 hours in the blood.

Cleared

Broken down into inactive pieces and passed in urine: about 100% of a dose was recovered within 48 hours in people with normal kidneys. Because it clears quickly, it barely builds up with daily shots. Kidney disease raises blood levels. These figures come from studies at higher doses; blood levels rise in step with dose from 2 to 80 mg.

Half-life is how long it takes the body to remove half of a dose.13

Once a day. In the morning, at the same time each day. Some people time it before a workout instead. Every day (7 days a week). Units are for a 50 mg vial mixed with 2 mL water (25 mg per mL).

• Lower end · low-frequency maintenance

  0.5-1 mg, 3-5 times per week

  A lower-frequency maintenance protocol some use for long-term mitochondrial support rather than daily dosing.15

• Most common · community anti-aging range

  1-5 mg once daily

  The community anti-aging dose range, adapted from rough allometric scaling of mouse studies — far below the 40 mg daily FDA-labeled Barth syndrome dose.15

• Standard protocol (not tested in trials)

  1-5 mg under the skin once a day for 4-8 weeks, then a break. The store dose of 2.5 mg each morning for 8 weeks fits this pattern.15

• Low-dose maintenance

  0.5-1 mg under the skin 3-5 times a week, for 8-12 weeks with breaks.15

• Exercise performance

  2-5 mg under the skin once a day or before exercise, for 4-8 weeks.15

Research protocols

• FDA label: Barth syndrome (Forzinity)

  40 mg under the skin once a day, at the same time each day, for people weighing at least 30 kg. 20 mg a day for adults with severe kidney disease not on dialysis. That is 16 times the store dose.1

• Barth syndrome trial

  40 mg under the skin daily for 12 weeks against 12 weeks of placebo, with a 4-week washout between. Then open-label use for up to 192 weeks.1

• Older adults, muscle energy (doctor-given)

  One IV drip of 0.25 mg per kg of body weight per hour for 2 hours (about 35 mg for a 70 kg adult).4

• Old mice (muscle and heart)

  3 mg per kg, injected once (muscle energy) or daily for 8 days (endurance). In the heart study, 3 mg per kg a day by a pump under the skin for 8 weeks.56

• Converting the mouse dose to a person (math estimate, not a tested human dose)

  The FDA body-surface method divides a mouse dose by 12.3. That turns 3 mg per kg into about 0.24 mg per kg, or roughly 17 mg for a 70 kg adult. Community doses of 1-5 mg sit well below this estimate.135

Forzinity is FDA-approved only for Barth syndrome (a rare genetic mitochondrial disorder). Community anti-aging use in healthy people is off-label and extrapolated from disease-state data. Whether community doses achieve meaningful mitochondrial effects in healthy users is unknown.

Dosing guidance built from the cited research and community reports. It is not a prescription.

1. 1
2. 2
3. 3
4. 4
5. 5
6. 6
7. 7
8. 8
9. 9
10. 10
11. 11
12. 12
13. 13
14. 14
15. 15
16. 16

On: 8 weeks Break: 8 weeks

A full course at the store pace takes 3 vials. A mixed vial keeps for up to 90 days.

Why the break helps

No study has tested whether breaks help with SS-31. In the Barth syndrome studies, patients took a much higher dose every day for more than 3 years. The break is a community habit with two practical reasons. First, it lets you judge whether SS-31 is doing anything for you, because energy changes are subtle and easy to imagine. Second, it limits nonstop use of a compound with no long-term safety data in healthy people. In studies longer than 30 days, a type of white blood cell (eosinophils) often rose and peaked around day 90, without symptoms. Counts went back to normal after stopping, or after 6 to 12 months of continued use.

Common

• Redness, pain, hardness, itching, bruising, or hives where you inject. In the Barth trial at 40 mg, every patient had redness, compared with 1 in 4 on placebo.

  What to do Rotate sites every day. The FDA label says these can be treated with an antihistamine pill or a steroid cream such as hydrocortisone. If reactions keep getting worse, stop.

• Headache, and less often mild nausea or tiredness. A peptide wiki that summarizes the clinical trials lists headache in 10-30% of people and nausea or tiredness in 1-10%. The FDA label for the 40 mg brand lists only injection-site reactions, and community users at 1-5 mg mostly report few side effects.

  What to do Drink water and rest. If it is severe or does not settle within a week or two, stop and talk to a doctor.

Stop and get help

• Allergic reaction: swelling of the face, lips, or throat, trouble breathing, wheezing or cough, or feeling faint. The label warns this can happen minutes to months after starting.

  What to do Stop SS-31 and call 911 (or your local emergency number) right away. Do not take it again.

• A rash that spreads beyond the injection spot or appears elsewhere on the body

  What to do Stop SS-31 and see a doctor. A rash away from the shot can be an allergic reaction.

• Infection at the injection site: redness that spreads, heat, pus, red streaks, or fever

  What to do Stop injecting and see a doctor the same day.

Do not use if

• You have ever had a serious allergic reaction to SS-31 (elamipretide).
• You have kidney disease: your kidneys clear SS-31, and severe kidney disease more than doubles blood levels. For severe kidney disease the label halves the dose. It gives no dose for people on dialysis, because SS-31 has not been studied in them. Ask your doctor first.
• You are pregnant, trying to get pregnant, or breastfeeding: there is no human safety data.
• You are under 18.

Sources2131416

Storage

Keep it

Keep the mixed vial in the fridge (2-8 °C / 36-46 °F), away from light. Do not freeze it, and never leave it in a hot car.

How long

Use within 90 days of mixing. A mixed vial kept in the fridge holds its strength for 60-90 days, then slowly starts to lose potency. Wipe the rubber top with an alcohol swab before every draw.

Drawing your dose

Syringe: a 0.5 mL (50-unit) U-100 insulin syringe.

1. With this mix, every 1 unit line on a U-100 insulin syringe holds 0.25 mg (250 mcg). Draw to the 10-unit line for 2.5 mg. Draw to 4 units for 1 mg, or 20 units for 5 mg.
2. Look at the vial before each draw. Do not use it if it is cloudy or has specks in it.
3. Hold the syringe at eye level, flick out air bubbles, and push the plunger back to the exact line.
4. Pinch a fold of skin, insert the needle at 45 to 90 degrees, push slowly, and wait a few seconds before pulling out.
5. Do not mix anything else into the same syringe. Use a new sterile syringe every time and never share one.
6. Missed a dose? Skip it and take the next one at the usual time. Do not double up.
7. Redness and stinging where you inject are very common with SS-31. Some community users hold a cold pack on the spot before injecting to dull the sting.

• MOTS-c

  Part of the store's Prime and Apex stacks. MOTS-c is a signal peptide made from the mitochondria's own DNA that tunes how muscle handles metabolic stress, while SS-31 shores up the mitochondria's inner wall: two different angles on cell energy. Exercise raised MOTS-c about 12-fold in human muscle, and MOTS-c doubled treadmill running in old mice. They have not been tested together.85

• NAD+

  Part of the store's Apex stack. NAD+ is a helper molecule at the center of how cells make energy, and levels may be 10-80% lower with age. SS-31 protects the energy machinery; NAD+ is one of the molecules that machinery runs on. Human trials of NAD+ boosters show they raise NAD+ levels. They have not been tested together.9

• CJC-1295 No DAC / Ipamorelin

  Part of the store's Prime and Apex stacks. The blend pairs CJC-1295 No DAC, a lab-made copy of the hormone GHRH, with Ipamorelin, a growth-hormone-releasing peptide. A review of these drug classes reports that GHRH copies and growth-hormone-releasing peptides boost the body's own growth-hormone release more when used together. SS-31 works on the mitochondria instead. They act on unrelated systems and have not been tested together.101112

Interactions

• Metformin (a common diabetes drug)

  In lab tests SS-31 blocks MATE1, a kidney pump that helps clear metformin from the body. No human study has checked whether this raises metformin levels.

  What to do Ask the doctor who prescribes your metformin before starting.

• Aspirin, clopidogrel, or heparin (blood thinners)

  Low. In human studies, SS-31 given by IV did not change how these drugs worked.

  What to do No change needed, but tell your doctor you take SS-31.

• Any medicine cleared by the kidneys, if you have kidney disease

  Kidney disease raises SS-31 blood levels and its breakdown products much more.

  What to do Ask your doctor before using SS-31.

Videos

• SS-31 (Elamipretide): Mitochondrial Peptide - Benefits, Dose, Frequency, CyclesQuinn Stillson MD · 2025
• The BEST Peptides for Mitochondrial Health (MOTS-c, NAD+, SS-31 Explained)Dr. Jones, DC · 2026

Sources

1. 1FDA label: Forzinity (elamipretide) injection, revised 9/2025Drug label
2. 2FDA news release 2025: accelerated approval of Forzinity (elamipretide, SS-31) for Barth syndromeReference
3. 3FDA briefing document, Cardiovascular and Renal Drugs Advisory Committee, October 10, 2024 (elamipretide: pharmacokinetics and other trials)Review
4. 4Roshanravan et al., PLoS One 2021 (single IV dose in 39 older adults)Clinical trial
5. 5Siegel et al., Aging Cell 2013 (SS-31 in aged mouse muscle)Study
6. 6Chiao et al., eLife 2020 (SS-31 reverses heart aging in old mice)Study
7. 7Szeto, Br J Pharmacol 2014 (cardiolipin-targeting SS-31 review)Review
8. 8Reynolds et al., Nat Commun 2021 (MOTS-c, exercise, and physical decline)Study
9. 9Freeberg et al., J Gerontol A 2023 (NAD+-boosting supplements in humans, review)Review
10. 10Sigalos & Pastuszak, Sex Med Rev 2018 (safety and efficacy of GH secretagogues, review)Review
11. 11Cayman Chemical: CJC-1295 (no DAC, Modified GRF 1-29) product sheetReference
12. 12Raun et al., Eur J Endocrinol 1998 (Ipamorelin, the first selective GH secretagogue)Study
13. 13FDA Guidance 2005: Estimating the Maximum Safe Starting Dose (animal-to-human conversion)Reference
14. 14FDA: Drugs that interact with CYP enzymes and transporters (metformin as a MATE1 substrate)Reference
15. 15Peptide Protocol Wiki: SS-31 community protocols (30 reports)Community
16. 16Peptide Protocol Wiki: SS-31 side effectsCommunity

Where people discuss it

• r/Peptides (subreddit)
• Peptide Protocol Wiki — SS-31 community (30 reports)

Some peptides, like semaglutide (Ozempic and Wegovy), are FDA-approved medicines. Most of the peptides people research are not. That label sounds like the FDA tested something and turned it down. Usually it means something else: nobody has paid for the studies the FDA needs to see. Here is why.

The FDA doesn’t test drugs. Companies do.

The FDA does not run its own drug tests. A company that wants to sell a new medicine has to test it first, and pay for it. It studies the drug in animals, then in people: first 20 to 100 volunteers, then a few hundred, then up to 3,000. Then it sends all the results to the FDA. FDA scientists review them and decide whether the benefits outweigh the risks.

So approval always starts with a company asking for it. If no company applies, the FDA has nothing to review, however promising the research looks.

Those studies cost about a billion dollars

A study in the medical journal JAMA estimated that bringing one new drug to market costs a typical company about $1.1 billion. That figure includes the money spent on drug ideas that failed along the way, because many drugs that start human testing never make it.

A patent is how a company earns that money back

A patent is a right the government gives an inventor. For up to 20 years from the day the inventor applies, nobody else may make or sell the invention without permission.

For a drug company, that right is what makes the billion-dollar bet worth it. While the patent lasts, the company is the only seller, so it can charge enough to pay back the studies and the failures. When the patent runs out, other companies can sell cheap copies, called generics, and the price drops.

The FDA adds a shorter shield of its own. For 5 years after a brand-new drug is approved, no copycat version can apply for approval. That helps, but it is much shorter than a patent can last.

Why most peptides can’t be patented

To get a patent, an invention has to be new, and it has to be something people made, not something found in nature. Most popular peptides fail one test or both.

They come from nature. Many are copies or small pieces of molecules your body already makes. KPV is a 3-building-block piece of the hormone that tans your skin. BPC-157 is copied from a protein in stomach juice. In 2013 the US Supreme Court ruled that something that exists in nature, like a human gene, cannot be patented just because someone found it and pulled it out.

They aren’t new anymore. Many were first described in research papers decades ago. Scientists were already testing KPV in the 1980s. Once something has been published, it no longer counts as new, so nobody can patent it now, and any patents from back then have long since run out.

Without a patent, a company that paid for the studies would soon face rivals selling the same peptide without having paid for any research. Few companies will spend a billion dollars on a product anyone can copy. So nobody goes first, and the large human studies never happen.

The workaround: change the molecule

Drug companies do make peptide medicines, but they change the peptide first. A changed molecule is a new invention, so it can be patented. Semaglutide is a lab-made version of GLP-1, a gut hormone your body releases after meals, changed so one shot lasts a week. Tesamorelin (Egrifta) is the body’s own growth-hormone signal with a small fatty chain added. Both went through the full studies, and both are FDA-approved.

The natural versions, and the many peptides nobody has changed and patented, stay where they are: studied in labs and animals, used by the biohacking community, and never put through large human trials.

What this means for you

When a peptide is “not FDA-approved,” it usually means no company has paid for the large human studies. It does not mean the FDA tested it and found it harmful.

It also does not mean it is proven safe or proven to work. Without those studies, nobody knows the best dose for sure, or what rare or long-term side effects it may have. And the FDA does not check research peptides for purity or strength the way it checks approved medicines. That is why this page labels every finding by the kind of study behind it, and lists who should not use it.

Sources for this section

1. 1FDA: How drugs are developed and approved (the FDA does not test drugs; companies submit the evidence)
2. 2FDA: The drug development process, step 3: clinical research (study sizes for each phase)
3. 3Wouters, McKee & Luyten, JAMA 2020, corrected 2022: median cost to bring a new drug to market, $1.14 billion
4. 4US patent law, 35 U.S.C. § 154: a patent lasts 20 years from the filing date
5. 5FDA: Frequently asked questions on patents and exclusivity (5-year new chemical entity exclusivity)
6. 6US Supreme Court, Association for Molecular Pathology v. Myriad Genetics (2013): naturally occurring genes cannot be patented