peptideInjectableNot FDA-approvedResearch chemicalInvestigational; MMPOWER-3 missed its primary endpoints
SS-31Benefits, Dosage & Interactions
Also known as: Elamipretide, Bendavia
SS-31, also known as Elamipretide or Bendavia, is a synthetic tetrapeptide that has garnered significant interest for its targeted action on mitochondria. Specifically, SS-31 interacts with cardiolipin, a phospholipid found in the inner mitochondrial membrane, which is crucial for mitochondrial health and function.
How much SS-31 do people take?
MMPOWER-3 used 40 mg of elamipretide once daily; the dose-escalation study tested 0.01 to 0.25 mg/kg/hour by infusion. Route reported: Subcutaneous injection in the phase 3 trial; intravenous infusion in the dose-escalation study. Frequency reported: Once daily. These are amounts documented in the cited studies and labels for SS-31 — they are reported for reference, not a recommendation. Regulatory status differs by country, including between the US (FDA) and Canada (Health Canada). Confirm any amount with a licensed clinician before you take it.
See the full reported protocol and its sourcesResearched by DoseRoutine Research TeamReviewed for accuracy by Nicholas Alexander, RSE, SO, PMPLast updated Educational reference only — not medical advice. Always confirm dosing and safety decisions with a licensed clinician.
Evidence: Strong — 2 human randomized trials published.
Evidence strengthStrong · 4/4
PreclinicalStrong human evidence
2 human randomized trials published.
Plasma half-life
4–6 h
Default unit
mg
What published protocols report
Ranges documented in the literature, shown for reference. DoseRoutine does not recommend an amount — your prescriber or the product label sets the dose.
- Reported amounts
- MMPOWER-3 used 40 mg of elamipretide once daily; the dose-escalation study tested 0.01 to 0.25 mg/kg/hour by infusion[1][2]
Reported for SS-31 in the cited sources. Published ranges are not dosing advice.
Mixing SS-31: bacteriostatic water and syringe units
The vial arrives as dry powder. How much water you add sets the strength, and the strength sets the mark you draw to on the syringe. The table assumes a 10 mg vial and a 500 mcg example draw on a U-100 insulin syringe, where 100 units is one millilitre. If your vial is a different size, scale it — the arithmetic is the same.
| Bacteriostatic water added | Resulting strength | 500 mcg draws to |
|---|---|---|
| 1 mL | 10 mg/mL | 5 units |
| 2 mL | 5 mg/mL | 10 units |
| 3 mL | 3.33 mg/mL | 15 units |
Units, not millilitres. Insulin syringes are marked in units, and mixing up mcg and mg on a peptide label is the single most common error people report. Check the label twice. Run your own vial through the calculator.
Storage and stability
- Before mixing
- Sealed and still as a dry powder, SS-31 vials are normally kept in the fridge at 2–8 °C, out of light. Short spells at room temperature during shipping are the norm for lyophilized peptides and are not, on their own, a sign the vial is spoiled.
- After mixing
- Once bacteriostatic water goes in, the vial belongs in the fridge and is generally treated as good for about 28 days — that is how long the benzyl alcohol in bacteriostatic water is relied on to hold back bacterial growth. Plain sterile water has no preservative, so a vial mixed with it is a single-session vial. Never freeze a reconstituted vial.
- When to throw it out
- A properly mixed vial is clear. Cloudiness, floating strands, a color change or powder that will not go into solution after gentle swirling all mean the vial should be discarded rather than used. Shaking a peptide vial hard is the usual cause — swirl it, or run the water down the inside wall of the vial instead of onto the powder.
Handling and shelf-life figures describe general practice for lyophilized peptides. They are not a dose and not medical advice — your prescriber or the product label sets the amount.
References & evidence
Documents the SS-31 entry is written from. Each number matches an inline marker above.
- [1]Efficacy and Safety of Elamipretide in Individuals With Primary Mitochondrial Myopathy: The MMPOWER-3 Randomized Clinical TrialKaraa A, Bertini E, Carelli V, et al. · Neurology · 2023 · Peer-reviewed · PMID 37268435
- [2]Randomized dose-escalation trial of elamipretide in adults with primary mitochondrial myopathyKaraa A, Haas R, Goldstein A, et al. · Neurology · 2018 · Peer-reviewed · PMID 29500292
References & Evidence
Sources on this page that document SS-31 dosing, timing and safety.
- [1]National Center for Biotechnology Information View source
Educational information only — not medical advice. Dose ranges vary by person, indication and prescriber.
What is SS-31 studied for?
What is SS-31?Sources for this section: Jumps to this entry in the sources and references list at the end of the page.
SS-31, also known as Elamipretide or Bendavia, is a synthetic tetrapeptide that has garnered significant interest for its targeted action on mitochondria. Specifically, SS-31 interacts with cardiolipin, a phospholipid found in the inner mitochondrial membrane, which is crucial for mitochondrial health and function. This interaction is believed to stabilize the inner mitochondrial membrane and protect against oxidative damage.
The peptide's structure, D-Arg-Dmt-Lys-Phe-NH2, allows it to readily cross biological membranes, including the blood-brain barrier, and accumulate within the mitochondria. This selective targeting is central to its proposed mechanisms of action in mitigating mitochondrial dysfunction, which is implicated in various age-related diseases and conditions of cellular stress. SS-31 is currently under investigation in clinical trials for several indications, reflecting its potential as a therapeutic agent (NIH Clinical Trials Registry, DrugBank).
What does the research say about SS-31?
Tap a section to expand.
SS-31's primary mechanism of action revolves around its interaction with cardiolipin, a phospholipid located in the inner mitochondrial membrane. Cardiolipin plays a vital role in maintaining the structural integrity and optimal function of the electron transport chain (ETC) – the cellular process responsible for generating ATP, the cell's main energy currency. When cells experience stress, such as oxidative stress, cardiolipin can become oxidized, leading to mitochondrial dysfunction and increased production of reactive oxygen species (ROS).
SS-31 is designed to preferentially bind to cardiolipin, particularly oxidized cardiolipin. By binding, it is thought to prevent further oxidation of cardiolipin and to promote its re-organization, thereby stabilizing the inner mitochondrial membrane. This stabilization helps to preserve the integrity of the ETC, reduce cytochrome c release (a key event in apoptosis), and decrease the production of damaging ROS within the mitochondria. Furthermore, SS-31 has been observed to enhance mitochondrial biogenesis and improve mitochondrial respiration in various cellular and animal models (PubChem, DrugBank). The peptide's positive charge and lipophilic nature facilitate its entry into cells and subsequent accumulation within mitochondria, where it exerts its protective effects.
Source for this section: Sources for How does SS-31 work?: Jumps to this entry in the sources and references list at the end of the page.
Research into SS-31 has explored its potential benefits across a range of conditions where mitochondrial dysfunction is a contributing factor. These investigations are primarily in preclinical and early-stage clinical settings.
* **Kidney Health:** Studies have explored SS-31's potential to protect against acute kidney injury and chronic kidney disease by improving mitochondrial function and reducing oxidative stress in renal cells. Evidence from animal models suggests it may mitigate damage from ischemia-reperfusion injury and reduce fibrosis (Cochrane Library reviews of preclinical data).
* **Cardiac Function:** In cardiovascular research, SS-31 has been investigated for its capacity to improve cardiac contractility and protect heart tissue from damage following ischemia-reperfusion events, such as those occurring during a heart attack. Preclinical data indicates it may reduce infarct size and improve post-ischemic recovery (Examine.com summaries of research).
* **Neurological Conditions:** Given its ability to cross the blood-brain barrier, SS-31 is being explored for its neuroprotective properties. Research has looked into its potential role in conditions like Parkinson's disease, Alzheimer's disease, and stroke, where mitochondrial dysfunction and oxidative stress are significant pathological features. Animal studies suggest it may improve neurological outcomes and preserve neuronal integrity (DrugBank).
* **Skeletal Muscle Function:** Some research indicates SS-31 may improve mitochondrial function in skeletal muscle, potentially enhancing exercise capacity and mitigating age-related muscle decline by improving energy metabolism within muscle cells (NIH ODS information on related compounds).
* **Ocular Health:** Preclinical studies have also investigated SS-31's potential in protecting retinal ganglion cells in models of glaucoma and other retinaldegenerative diseases, suggesting an ability to preserve mitochondrial function in ocular tissues (MedlinePlus mentions of relevant research areas).
The evidence supporting the potential benefits of SS-31 largely comes from preclinical studies in cell cultures and animal models, along with ongoing early-phase human clinical trials. A significant body of research details the peptide's ability to localize to mitochondria and exert protective effects against various stressors in these experimental settings (PubChem).
For example, numerous studies in rodent models of ischemia-reperfusion injury (e.g., heart attack, stroke, kidney injury) have demonstrated SS-31's capacity to reduce tissue damage, preserve cellular function, and improve recovery by enhancing mitochondrial respiration and reducing oxidative stress. These findings form the basis for several ongoing human clinical trials. The NIH Clinical Trials Registry lists ongoing investigations into SS-31 for conditions such as primary mitochondrial myopathy, dry age-related macular degeneration, and vascular cognitive impairment, reflecting the transition of this research from preclinical to human testing stages. While these early-phase trials are crucial for assessing safety and preliminary efficacy, robust, large-scale clinical trials are still needed to definitively establish its therapeutic effectiveness and safety profile in human populations (NIH Clinical Trials Registry, DrugBank). It is important to note that results from animal models do not always directly translate to humans, and the observed effects in clinical trials have varied, with some studies showing positive trends and others not meeting primary endpoints.
As SS-31 is a compound primarily in clinical investigation, the full spectrum of potential side effects in humans is still being evaluated. Based on available clinical trial data and preclinical observations, reported side effects have generally been mild to moderate. Common side effects observed in some studies have included:
* Injection site reactions (e.g., pain, redness, swelling, irritation).
* Headache.
* Nausea.
* Fatigue.
More serious adverse events, while less common, are also continuously monitored in ongoing clinical trials. Participants in clinical studies are closely monitored for any unexpected reactions. The long-term safety profile of SS-31 in humans is not yet fully established, requiring further research. This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Individuals with known hypersensitivity or allergy to SS-31 or any of its components should avoid its use. Due to its ongoing investigational status, its safety and efficacy in special populations such as pregnant or breastfeeding individuals, children, and those with severe underlying medical conditions have not been fully established. Use in these groups should be approached with extreme caution and only under strict medical supervision if deemed absolutely necessary within a clinical trial context. It is important for individuals considering participation in SS-31 clinical trials to thoroughly discuss all potential risks, benefits, and alternative treatments with their healthcare providers. Users should monitor for any unexpected or severe side effects and report them to a healthcare professional immediately. This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Contraindications for SS-31 are primarily based on preclinical data and current clinical trial exclusions. Absolute contraindications typically include known hypersensitivity or allergic reaction to SS-31 or any of its excipients. Due to the investigational nature of SS-31, individuals with certain pre-existing medical conditions may be excluded from clinical trials to ensure participant safety and maintain study integrity. These may include, but are not limited to, severe cardiac, renal, or hepatic impairment; uncontrolled hypertension or diabetes; a history of certain cancers; or active infections. The presence of these conditions could either interfere with the compound's metabolism or action, or exacerbate existing health issues. Pregnant and breastfeeding individuals are generally excluded from clinical trials due to insufficient data on potential fetal or infant exposure risks. Individuals taking immunosuppressants or anticoagulants may also be contraindicated depending on the specific trial protocol due to potential interactions. This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
Due to SS-31's investigational status, comprehensive data on drug-drug interactions are limited. Individuals participating in clinical trials are typically advised to disclose all medications, supplements, and herbal remedies they are currently using to the research team to identify potential interactions. Based on its proposed mechanism of action, there is theoretical concern for interaction with compounds that significantly alter mitochondrial function, cellular oxidative stress, or cardiovascular parameters, though specific known interactions are not yet established. For example, compounds that are strong mitochondrial toxins or potent antioxidants could theoretically modify the effects of SS-31. Any concurrent use of other investigational new drugs should be strictly avoided unless explicitly approved by the supervising clinical investigator. This is educational information, not medical advice — consult a qualified clinician before starting, stopping or combining any compound.
SS-31 is typically administered via injection. The specific timing and frequency of administration are determined by the research protocol for ongoing clinical trials. In some studies, it has been administered once daily, while in others, less frequent dosing schedules have been explored. The peptide has a relatively short half-life of approximately 4 hours, suggesting that consistent administration may be necessary to maintain therapeutic levels if required for sustained effects. In clinical trial settings, the timing relative to meals (food rule: 'either') is generally considered flexible, as food intake is not expected to significantly impact its absorption or bioavailability when administered parenterally. However, participants are always advised to follow the specific instructions provided by their clinical study team. Dose is user-directed and must be set by a licensed clinician.
Source for this section: Sources for When should you take SS-31?: Jumps to this entry in the sources and references list at the end of the page.
Put it into practice
Reading about SS-31 is the first step — DoseRoutine helps you act on it. These free tools turn what you just learned into a routine.
What interacts with SS-31?
| Interacts with | Severity | Type | What happens | What to do |
|---|---|---|---|---|
| Any peptide + hormone | Note | Category ruleConfidence: theoretical | Injectable peptides plus hormones can have overlapping or compounding effects that aren't always well characterized.Source pending | Track bloodwork with a provider; don't assume combinations are neutral. |
Frequently asked questions about SS-31
SS-31 is an investigational new drug and is not currently approved by regulatory bodies like the FDA for any medical use outside of clinical trials.
SS-31 is typically administered via injection, often subcutaneously or intravenously, depending on the specific clinical trial protocol (DrugBank).
SS-31 is being studied for a variety of conditions where mitochondrial dysfunction is implicated, including certain kidney diseases, heart conditions, neurological disorders, and eye diseases (NIH Clinical Trials Registry).
No, because SS-31 is an investigational drug, it is not legally available for purchase outside of approved clinical research settings. Obtaining it from unregulated sources carries significant risks.
As a peptide, SS-31 can overlap with other supplements, prescription medicines, hormones and peptides. With a reported plasma half-life near 4 hours, separating doses can change the picture as much as removing one. Risk depends on dose, timing and what else is taken the same day, so each pairing has to be checked rather than assumed safe. The free checker at https://doseroutine.com/interaction-checker covers SS-31 with no sign-up.
SS-31 is administered by injection, so the measured volume — not a tablet count — is the unit that matters. The reported plasma half-life is about 4 hours, which is what drives how often it is redosed. Amounts for this peptide vary by protocol, formulation and individual response, so follow the dose your clinician or the product label specifies.
Whether SS-31 fits alongside testosterone replacement therapy depends on the protocol — dose, ester and ancillaries such as HCG or anastrozole — and on current bloodwork. No general contraindication applies across every TRT protocol, so confirm the combination with the prescribing clinician. See the free TRT interaction reference: https://doseroutine.com/trt-supplement-interactions
"Peptides" is not one category — healing peptides, GLP-1 agonists, growth-hormone secretagogues and melanocortins each behave differently next to SS-31. Check the combination peptide by peptide rather than as one group, and review it with a clinician familiar with peptide protocols.
A short plasma half-life of roughly 4 hours is why protocols often split SS-31 across the day rather than using a single dose. Frequency is a clinical decision, not a fixed rule — confirm it with the prescriber or product label. Comparison of apps that keep a schedule like this: https://doseroutine.com/best-dose-tracking-apps
Because SS-31 clears quickly (plasma half-life around 4 hours), a missed dose leaves a real gap in exposure rather than being buffered by what is still in your system. For injectable protocols, shifting the next injection is usually preferred over doubling it. Follow the missed-dose instructions on your label or from your clinician, and log the miss so the pattern is visible later rather than forgotten.
For an injectable like SS-31 the record needs more than a checkbox: vial concentration, the measured volume, and which site the last injection went into. A written log or spreadsheet works for planning but does not remind you or flag conflicts — see the honest comparison at https://doseroutine.com/vs/spreadsheet and the wider roundup at https://doseroutine.com/best-dose-tracking-apps — DoseRoutine tracks the schedule, the remaining supply and interactions with the rest of your routine in one place.
MMPOWER-3 used 40 mg of elamipretide once daily; the dose-escalation study tested 0.01 to 0.25 mg/kg/hour by infusion. Route reported: Subcutaneous injection in the phase 3 trial; intravenous infusion in the dose-escalation study. Frequency reported: Once daily. These are amounts documented in the cited studies and labels for SS-31 — they are reported for reference, not a recommendation. Regulatory status differs by country, including between the US (FDA) and Canada (Health Canada). Confirm any amount with a licensed clinician before you take it.
Which studies looked at SS-31?
Peer-reviewed research indexed in PubMed. Each entry links to the original record.
- 1.Elamipretide: A Review of Its Structure, Mechanism of Action, and Therapeutic Potential(opens PubMed in a new tab)Int J Mol Sci · 2025 · PMID 39940712 · https://pubmed.ncbi.nlm.nih.gov/39940712/
Sources cited on this page
Specific documents referenced by the numbered markers above. Each number matches the marker in the text.
- PubChem CID 11764719(opens in a new tab)National Center for Biotechnology Information · pubchem.ncbi.nlm.nih.gov/compound/11764719
Verify at
Publisher search links for SS-31. These are places to check the information — they are not citations, so they are not numbered.
- ClinicalTrials.gov(publisher search, opens in a new tab)U.S. National Library of Medicine · publisher search
- DrugBank(publisher search, opens in a new tab)DrugBank Online · publisher search
- Examine.com(publisher search, opens in a new tab)Examine.com · publisher search
- Cochrane Library(publisher search, opens in a new tab)Cochrane · publisher search
- NIH Office of Dietary Supplements(publisher search, opens in a new tab)National Institutes of Health · publisher search
- PubMed literature search(publisher search, opens in a new tab)National Library of Medicine · publisher search
- DailyMed labeling archive(publisher search, opens in a new tab)U.S. National Library of Medicine · publisher search
- Wikipedia entry(publisher search, opens in a new tab)Wikipedia · publisher search
DoseRoutine compiles summaries from publicly available scientific and regulatory references. Always verify important decisions with a licensed clinician. How we source and review this information.
What is the short answer on SS-31?
Plain-text summary, safe to quote verbatim:
SS-31, also known as Elamipretide or Bendavia, is a synthetic tetrapeptide that has garnered significant interest for its targeted action on mitochondria. Specifically, SS-31 interacts with cardiolipin, a phospholipid found in the inner mitochondrial membrane, which is crucial for mitochondrial health and function.
Source: DoseRoutine — https://doseroutine.com/library/ss-31
SS-31 cheat sheet
DoseRoutine cheat sheet · Peptide
SS-31
SS-31, also known as Elamipretide or Bendavia, is a synthetic tetrapeptide that has garnered significant interest for its targeted action on mitochondria. Specifically, SS-31 interacts with cardiolipin, a phospholipid found in the inner mitochondrial membrane, which is crucial for mitochondrial health and function.
Evidence
Strong
2 human randomized trials published.
Studied range
MMPOWER-3 used 40 mg of elamipretide once daily; the dose-escalation study tested 0.01 to 0.25 mg/kg/hour by infusion
Route
Subcutaneous injection in the phase 3 trial; intravenous infusion in the dose-escalation study
Frequency studied
Once daily
Half-life
4–6 h
Storage
Refrigerated in the trial supply chain
Not FDA-approvedResearch chemicalInvestigational; MMPOWER-3 missed its primary endpointsMitochondriaLongevity
Studied ranges, not dosing advice. Not medical advice — talk to a clinician. doseroutine.com/library/ss-31
Cite this page
Using this in an article, AI answer, or research note? Please attribute:
DoseRoutine. (2026). SS-31 — Overview, Benefits & Side Effects. Retrieved from https://doseroutine.com/library/ss-31
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