Survodutide, an investigational obesity medicine: trial results, nausea and approval

Survodutide is an investigational obesity medicine, given as a subcutaneous injection once a week. As of 13 November 2026, survodutide is not authorised in any country, so it is not available in Polish pharmacies and no doctor can prescribe it (1). The manufacturer, Boehringer Ingelheim, has completed the main phase III clinical trials and has announced that it will submit applications for approval, but has not given any dates (1). According to the European Medicines Agency's list of 3 November 2026, no application for the authorisation of survodutide in the European Union was yet under evaluation (2).

In the trials, survodutide reduced body weight, but many participants tolerated it poorly. In the largest trial, SYNCHRONIZE-CVOT, almost half of the people taking survodutide had nausea (48-49%), and roughly one in five (19-21%) stopped treatment because of gastrointestinal symptoms. In the placebo group, the figure was 2% (3). The same trial did not show that survodutide increases the risk of heart attack, stroke or other cardiovascular events (3).

In brief

• No regulator has authorised survodutide. The manufacturer has announced that it will submit applications for approval without giving dates, and on 3 November 2026 the European Medicines Agency was not yet evaluating an application to authorise survodutide in the European Union. Vials labelled 'survodutide' that are sold online are not authorised medicines.
• In the SYNCHRONIZE-1 trial, adults with obesity but without diabetes lost an average of 12.2% of their body weight after 76 weeks on the 3.6 mg dose and 13.0% on the 6.0 mg dose, compared with 5.4% in the placebo group. This result also includes people who stopped treatment. The more often quoted 16.6% is an estimate that assumes everyone took the medicine until the end of the trial.
• In the SYNCHRONIZE-CVOT trial, 48-49% of people taking survodutide and 12% of people in the placebo group had nausea, and 19-21% stopped treatment because of gastrointestinal symptoms, compared with 2% in the placebo group. With semaglutide and tirzepatide, which are already approved, between 2% and 7% of people stopped treatment for this reason, but these figures come from other trials and cannot be compared directly.
• The SYNCHRONIZE-CVOT trial, which included 5,530 people with heart disease, chronic kidney disease or risk factors, did not show a higher risk of cardiovascular events in people taking survodutide. Nor did it show that survodutide protects against them.

What is survodutide and how does it work?

Survodutide activates two receptors: the GLP-1 receptor and the glucagon receptor (3, 4). GLP-1 is a hormone released in the gut that reduces appetite and the amount of food eaten (5). Glucagon is a hormone made by the pancreas that acts mainly on the liver and raises blood glucose (4).

The authors of published reviews explain that activating the glucagon receptor is meant to increase the amount of energy the body uses and to reduce the amount of fat in the liver, while activating the GLP-1 receptor is meant to reduce appetite and offset the effect of glucagon on blood glucose (4, 6). It is not yet known whether this makes survodutide more effective than medicines that activate only the GLP-1 receptor. Only trials that compare these medicines head to head can answer that question (4).

The manufacturer is also studying survodutide in liver disease. In the SYNCHRONIZE-MASLD trial in 216 adults with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), liver fat fell by at least 30% after 48 weeks in 68.5% of people taking survodutide and in 28.6% of people in the placebo group (the analysis included people who stopped treatment) (7).

Obesity medicines differ in which receptors they activate (5, 8, 9):

GIP, like GLP-1, is a hormone released in the gut after a meal (8). Retatrutide and orforglipron are two other investigational obesity medicines. We describe where they stand in our article on when retatrutide and orforglipron could reach Poland.

Is survodutide approved, and when could it reach Poland?

Survodutide is not authorised in any country, and nobody has given a date for when it might reach Polish pharmacies. In November 2026, Zealand Pharma, which works with the manufacturer, announced that the phase III trial programme in obesity had been completed and that Boehringer Ingelheim was preparing applications for approval in various countries. The press release does not name any regulators or dates, and it states that survodutide is not approved for use and that its efficacy and safety have not yet been established (1).

Every month, the European Medicines Agency publishes a list of the applications for new medicines that it is evaluating. Survodutide was not on the list of 3 November 2026 (2). In 2023, the agency admitted survodutide to its PRIME scheme, under which it advises manufacturers during the development of selected medicines. This concerned steatohepatitis (inflammation of a fatty liver) with fibrosis, not obesity, and PRIME support is not a marketing authorisation (1).

Evaluating an application at the European Medicines Agency takes many months. For orforglipron, an investigational obesity medicine in tablet form, almost 9 months passed between the start of the evaluation in January 2026 and the positive opinion of the agency's expert committee in October 2026 (2, 10). The decision on authorisation is then made by the European Commission, and each EU country sets the price and any reimbursement separately (10).

Can you take survodutide in Poland as part of a clinical trial?

Before it is approved, the only legal way to take survodutide is as a participant in a clinical trial. The SYNCHRONIZE-1 and SYNCHRONIZE-2 trials each had 5 sites in Poland, and the SYNCHRONIZE-CVOT trial had 34 sites in 20 Polish cities. All three trials have now ended (11).

According to the ClinicalTrials.gov registry, on 13 November 2026 two survodutide trials were recruiting in Poland: LIVERAGE and LIVERAGE-Cirrhosis. Both concern steatohepatitis, not obesity alone (11). Each trial has its own eligibility criteria, and the trial site decides who can take part.

Can you buy survodutide online?

Synthetic peptides are sold online labelled 'for research use only'. Such products are not authorised medicines, and nobody checks what the vial contains or how much of it. Poland's Chief Pharmaceutical Inspector (GIF) and Chief Sanitary Inspector (GIS) warn that selling synthetic peptides in this way, when the products are marketed for human use, is illegal and can lead to criminal liability (12). Survodutide cannot be bought legally, because it is not authorised in any country (1). We explain the risks of injecting products from an illegal source, and what to do if someone is already taking them, in our article on peptides bought online.

How much weight can you lose on survodutide?

In the SYNCHRONIZE-1 trial, adults with obesity but without diabetes who were given survodutide lost an average of 12-13% of their body weight after 76 weeks, compared with 5.4% in the placebo group. The result also includes people who stopped treatment (13).

The trial included 725 adults with a BMI of 30 or more, or a BMI of 27 or more and at least one weight-related condition other than diabetes. At the start of the trial, their average weight was 108.8 kg. Once a week, participants received an injection of placebo or of survodutide, with the dose gradually increased to 3.6 mg or 6.0 mg. All participants also received lifestyle advice. Average weight loss after 76 weeks was 12.2% on the 3.6 mg dose, 13.0% on the 6.0 mg dose and 5.4% in the placebo group. 72.6% and 71.9% of people taking survodutide lost at least 5% of their body weight, compared with 46.3% of people in the placebo group (13).

The SYNCHRONIZE-2 trial included 752 adults with overweight or obesity and type 2 diabetes. After 76 weeks, people taking survodutide had lost an average of 8.2% of their body weight on the 3.6 mg dose and 9.8% on the 6.0 mg dose, compared with 3.9% in the placebo group (14).

Why are two different results reported for survodutide: 13% and 16.6%?

Both results come from the SYNCHRONIZE-1 trial, but from two different analyses. The 13.0% figure for the 6.0 mg dose was calculated for all participants, including those who stopped taking the medicine or started taking another obesity medicine (13). A press release in April 2026 gave the result of the second analysis: assuming that all participants took the medicine until the end of the trial, the estimated weight loss was 16.6%, compared with 3.2% in the placebo group (15). It is usually this second, higher figure that appears in the media.

This difference matters especially for survodutide, because many participants stopped treatment because of side effects. The 13.0% figure better reflects what the whole group of people starting treatment can expect, including those who will stop because of nausea or other symptoms.

How often did survodutide cause nausea and vomiting?

The most common side effects of survodutide were gastrointestinal: nausea, vomiting, diarrhoea and constipation (1, 3). In the SYNCHRONIZE-CVOT trial, nausea occurred in 48.0% of people on the 3.6 mg dose and 49.0% of people on the 6.0 mg dose, and in 12.1% of the placebo group. Vomiting occurred in 31.7% and 34.0% of people taking survodutide and in 4.8% of people in the placebo group (3).

19.3% of people on the 3.6 mg dose and 20.8% of people on the 6.0 mg dose stopped treatment because of gastrointestinal symptoms, compared with 1.9% in the placebo group (3). In the SYNCHRONIZE-1 trial, 80.9% and 89.7% of people taking survodutide and 47.9% of people in the placebo group had some kind of gastrointestinal symptom, mostly mild or moderate (13).

Do people stop survodutide more often than semaglutide and tirzepatide?

The table below brings together data from different trials. The trials differed in their participants, duration and way of increasing the dose, so the table does not show which medicine is better tolerated.

The data for semaglutide and tirzepatide come from the summaries of product characteristics (SmPCs) of these medicines (5, 8). In these data, nausea occurred about as often with survodutide as with semaglutide, while the proportion of people who stopped treatment because of gastrointestinal symptoms was several times higher.

When did trial participants stop taking survodutide?

Trial participants most often stopped taking survodutide while the dose was being increased. Zealand Pharma attributes this to the SYNCHRONIZE-CVOT trial protocol, which allowed only limited flexibility to ease side effects by increasing the dose more slowly or changing it (1). It is not yet known whether increasing the dose more slowly will reduce the number of people who stop taking survodutide.

For semaglutide, the summary of product characteristics, the document approved by the regulator that sets out how the medicine should be used, allows for this. If severe gastrointestinal symptoms occur, the doctor may consider delaying the dose increase or going back to the previous dose until the symptoms ease (5). Nausea on semaglutide usually passed after a few days (its median duration was 8 days), and body weight went down whether or not nausea occurred (5). We describe how to ease nausea, vomiting and constipation in our article on side effects of obesity medicines.

What do the nausea results mean for someone waiting for a new medicine?

The trials so far do not suggest that survodutide would be a better choice for people who tolerate semaglutide or tirzepatide poorly because of nausea. None of the trials described here compared survodutide with these medicines directly. In separate trials, nausea occurred at least as often with survodutide as with semaglutide and tirzepatide, and the proportion of people who stopped treatment because of gastrointestinal symptoms was higher (3, 5, 8).

If you have severe nausea while taking an obesity medicine, you do not have to wait for new medicines. You can talk to your doctor about increasing the dose more slowly, going back to a lower dose or switching to another medicine available in Poland. We explain what the first weeks of treatment usually look like in our article on the first months of obesity treatment with medication.

Does survodutide increase the risk of heart attack and stroke?

The SYNCHRONIZE-CVOT trial did not show that survodutide increases the risk of heart attack, stroke or other cardiovascular events compared with placebo. Nor did it show that survodutide reduces this risk (3).

The SYNCHRONIZE-CVOT trial included 5,530 adults from 34 countries with a BMI of 27 or more and diagnosed cardiovascular disease, chronic kidney disease, or at least two heart disease risk factors or complications of obesity. Once a week, participants received placebo or survodutide, with the dose increased to 3.6 mg or 6.0 mg. Median follow-up was 22 months. The researchers counted cardiovascular deaths, non-fatal heart attacks and strokes, procedures to restore blood flow in the coronary arteries because of ischaemia (coronary revascularisation), and heart failure events. These occurred in 3.7% of people taking survodutide and in 4.1% of people in the placebo group (3).

The hazard ratio, that is, the risk in the survodutide group relative to the risk in the placebo group, was 0.89, with a 95% confidence interval of 0.67 to 1.18. The interval includes values both below and above 1, so the result is consistent both with a lower risk and with a slightly higher risk than on placebo. The trial was designed to rule out an increase in risk beyond a predefined margin, and it met this goal (3). Serious adverse events occurred in 22.5% and 20.8% of people taking survodutide and in 23.9% of people in the placebo group. Fatal adverse events occurred in 0.9% of people in each survodutide group and in 0.6% of people in the placebo group, most often because of heart disease (3).

In the SELECT trial, semaglutide 2.4 mg reduced the combined risk of cardiovascular death, heart attack and stroke by 20% compared with placebo. That trial included 17,604 people with cardiovascular disease and a BMI of 27 or more, without diabetes (5). The two trials differed in their participant groups, duration and the events the researchers counted, so comparing their results does not show which medicine protects the heart better.

Which obesity medicines can a doctor prescribe in Poland?

Instead of survodutide, a doctor can prescribe medicines that are already in Polish pharmacies. Five obesity medicines are authorised: semaglutide as injections and as tablets, tirzepatide and liraglutide as injections, naltrexone with bupropion as tablets, and orlistat as capsules. We describe how these medicines differ and how much they cost on our page about obesity treatment, and who can get a prescription in our article on eligibility for obesity medicines.

In the Nasz Gabinet obesity treatment programme, the doctor chooses a medicine from those available in Polish pharmacies. We do not prescribe survodutide, because it is not authorised.

Frequently asked questions

How is survodutide different from retatrutide?

Survodutide activates the GLP-1 and glucagon receptors, and retatrutide also activates the GIP receptor (3, 9). Both medicines are given as a once-weekly injection, and neither is authorised yet. Retatrutide is being developed by Eli Lilly, and survodutide by Boehringer Ingelheim together with Zealand Pharma (1, 9).

Is survodutide more effective than tirzepatide (Mounjaro)?

It is not known whether survodutide is more effective than tirzepatide. The phase III trials described here compared survodutide with placebo, not with another obesity medicine (3, 13, 14). Results from different trials, run in different groups and for different lengths of time, do not show which medicine is more effective.

Has an obesity medicine that activates the glucagon receptor been approved yet?

Mazdutide, which also activates the glucagon and GLP-1 receptors, is approved in China for treating obesity and type 2 diabetes (4). In the European Union, no obesity medicine that acts on the glucagon receptor is authorised.

How much does survodutide cost?

Survodutide has no price, because it is not authorised for sale in any country (1). Prices found online refer to illegally traded products of unknown composition (12).

Sources

1. Zealand Pharma. Zealand Pharma announces Boehringer Ingelheim's survodutide is the first glucagon/GLP-1 dual agonist to demonstrate a favorable cardiovascular safety profile in global Phase 3 SYNCHRONIZE-CVOT trial with significant cardiometabolic benefits. Press release no. 55/2026, 9.11.2026. nasdaq.com
2. European Medicines Agency. Applications for new human medicines under evaluation by the CHMP, November 2026 (data as of 3.11.2026). ema.europa.eu
3. Bozkurt B, le Roux CW, Wharton S et al. Cardiovascular outcomes with survodutide in adults with obesity at increased cardiovascular risk (SYNCHRONIZE-CVOT): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2026. PMID 43003106, DOI
4. Ard JD, Almandoz JP. The Power of Two: Harnessing Dual Glucagon and Incretin Signaling for Treatment of Obesity and Metabolic Dysfunction-Associated Steatohepatitis - A Narrative Review with a Translational Focus. Obes Rev. 2026:e70228. PMID 42860310, DOI
5. European Medicines Agency. Wegovy (semaglutyd) - charakterystyka produktu leczniczego i ulotka dla pacjenta (summary of product characteristics and patient leaflet). ema.europa.eu
6. Sergi CM. Survodutide for the treatment of obesity: Mechanistic rationale, clinical evidence, and remaining uncertainties. Contemp Clin Trials. 2026;170:108493. PMID 42822760, DOI
7. Kaplan LM et al. Survodutide in adults with obesity and metabolic dysfunction-associated steatotic liver disease: SYNCHRONIZE-MASLD, a randomized, double-blind, placebo-controlled phase 3 trial. Nat Med. 2026;32(8):2948-2958. PMID 42252333, DOI
8. European Medicines Agency. Mounjaro (tirzepatyd) - charakterystyka produktu leczniczego (summary of product characteristics). ema.europa.eu
9. Jastreboff AM, Kaplan LM, Davies MJ et al. Retatrutide, a Triple Hormone Receptor Agonist, for Treatment of Obesity. N Engl J Med. 2026;395(18):1781-1793. PMID 42814954, DOI
10. European Medicines Agency. New oral GLP-1 medicine for weight management and type 2 diabetes. Press release, 16.10.2026. ema.europa.eu
11. ClinicalTrials.gov. Survodutide trials with sites in Poland, as of 13.11.2026: SYNCHRONIZE-1 (NCT06066515), SYNCHRONIZE-2 (NCT06066528), SYNCHRONIZE-CVOT (NCT06077864), LIVERAGE (NCT06632444), LIVERAGE-Cirrhosis (NCT06632457). clinicaltrials.gov
12. Główny Inspektor Sanitarny i Główny Inspektor Farmaceutyczny. Ostrzeżenie publiczne. Nielegalny obrót syntetycznymi peptydami oferowanymi jako odczynniki chemiczne lub do badań (Public warning: illegal trade in synthetic peptides offered as chemical reagents or for research). 7.08.2025. gov.pl
13. le Roux CW, Wharton S, Startseva E et al. Survodutide Once Weekly for the Treatment of Adults with Obesity. N Engl J Med. 2026;395(8):776-787. PMID 42253238, DOI
14. Wharton S et al. Survodutide Once Weekly in Adults with Obesity and Type 2 Diabetes. N Engl J Med. 2026. PMID 42820639, DOI
15. Zealand Pharma. Zealand Pharma announces Boehringer Ingelheim's novel glucagon/GLP-1 dual agonist survodutide achieved significant weight loss of 16.6% delivering meaningful metabolic improvement in people with obesity or overweight in Phase 3 trial. Press release, 28.04.2026. inderes.fi