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SS-31 (Elamipretide) dosage and protocol
Last reviewed Oct 20, 2026. Editorial policy
Mitochondrial-targeting peptide that binds to cardiolipin to protect and restore mitochondrial function
- Vial size: 50 mg
- Reconstitution: 3 mL bacteriostatic water
- Concentration: 16.67 mg/mL
- Administration: subcutaneous
Research areas
- Mitochondrial Health
- Cardiovascular Health
- Kidney Protection
- Anti-Aging
Quick start
- Reconstitute: Add 3 mL bacteriostatic water to the 50 mg vial for about 16.67 mg/mL
- Typical dose: 5 mg daily for two weeks, then 10 mg daily
- Easy measuring: At 16.67 mg/mL, 1 unit is about 167 mcg on a U-100 syringe, so 5 mg is 30 units and 10 mg is 60 units
- Storage: Freeze unreconstituted; refrigerate after mixing
Dosing protocol
| Phase | Dose | Frequency | Volume |
|---|---|---|---|
| Weeks 1–2 | 5 mg (5000 mcg) | Once daily (SC) | 0.30 mL (30 units) |
| Weeks 3–8 | 10 mg (10,000 mcg) | Once daily (SC) | 0.60 mL (60 units) |
How it works
SS-31 (elamipretide) is a small, cell-permeable tetrapeptide (D-Arg-dimethylTyr-Lys-Phe-NH2) that concentrates in the inner mitochondrial membrane. There it binds cardiolipin, a phospholipid that anchors and organises the electron transport chain complexes and maintains cristae structure. By stabilising cardiolipin and limiting its peroxidation, SS-31 is proposed to improve electron flow, reduce leakage of reactive oxygen species, and support ATP production in stressed or aging cells. In rodent and large-animal models, SS-31 improved mitochondrial function and reduced injury in heart failure, ischemia-reperfusion, kidney injury and age-related muscle decline. Effects in aged animals included improved exercise capacity and cardiac diastolic function. Human trials have produced mixed results. Studies in primary mitochondrial myopathy and heart failure did not consistently meet their primary endpoints. In Barth syndrome, a rare genetic cardiolipin disorder, the FDA granted accelerated approval to elamipretide in 2025, based on improvements in muscle strength measures; confirmatory evidence is still being gathered. Benefits in healthy people have not been demonstrated.
Units chart for a 50 mg vial
| Water added | Strength | 1 unit = | 5 mcg | 10 mcg |
|---|---|---|---|---|
| 1 mL | 50 mg/mL | 500 mcg | 0 units | 0 units |
| 2 mL | 25 mg/mL | 250 mcg | 0 units | 0 units |
| 3 mL | 16.67 mg/mL | 166.7 mcg | 0 units | 0.1 units |
Units on a U-100 insulin syringe (100 units = 1 mL).
Pages for each vial size and water volume
Reconstitution steps
- Draw 3.0 mL bacteriostatic water with a sterile syringe
- Inject slowly down the vial wall; avoid foaming
- Gently swirl/roll until dissolved (do not shake)
- Label with reconstitution date and refrigerate at 2–8°C, protected from light; use within 30 days
Storage
Evidence: Common practice. What vendors and users usually do. No published stability testing supports a specific number.
- Powder or unopened: Sealed powder: freezer (about −20 °C) for long-term storage, refrigerator for weeks. Let the vial reach room temperature before opening.
- Mixed or in use: Refrigerator, 2–8 °C. Do not freeze and thaw repeatedly.
- Use within: no tested number
- Light: Keep it in the box or another dark container.
Most reconstituted peptides are kept in the refrigerator (2–8 °C) and used within about 28 days. That is a convention, not tested data: the 28 days comes from the USP <797> limit for opened multiple-dose containers, which is about sterility, not about whether the peptide stays intact.
Sources: Crestigen: Peptide storage and handling guide; USP General Chapter <797> Pharmaceutical Compounding: Sterile Preparations
Store unreconstituted at -20°C. Refrigerate after mixing
Important notes
- Protects mitochondria by binding to cardiolipin
- Well-tolerated over wide dose range
- Dosage varies based on condition being addressed
- Can cause abdominal pain, dizziness, headache
- Start at lower dosing and increase slowly
- Limited clinical use - consider MOTS-C first
Supplies
- Bacteriostatic water (5mL)
- Insulin syringes (1mL)
- Alcohol swabs