Mitochondrial Synthetic cell-permeable tetrapeptideFDA-approved medicine

SS-31

Elamipretide · MTP-131 · Bendavia

Evidence: Approved label. Example dose: finalize with a provider. Not a fact-check stamp.

2.5 to 10 mg daily – 4 mg SubQ Daily or specific days per week

Cardiolipin-targeting mitochondrial peptideInner mitochondrial membrane stabilizerFDA-approved (ELPINEO for Barth syndrome)Aromatic-cationic peptide

SS-31 (also known as Elamipretide, Bendavia, MTP-131) is a synthetic cell-permeable tetrapeptide (D-Arg-Dmt-Lys-Phe-NH2) that selectively targets and stabilizes cardiolipin in the inner mitochondrial membrane. Cardiolipin is a phospholipid essential for electron transport chain efficiency, cristae structure maintenance, and ATP production. SS-31 is the only FDA-approved compound specifically targeting mitochondrial inner membrane function (approved as ELPINEO for Barth syndrome). It has been studied in clinical trials for heart failure, renal ischemia, age-related macular degeneration, primary mitochondrial myopathy, and Barth syndrome. SS-31 represents a direct approach to mitochondrial optimization that complements upstream metabolic activators like MOTS-c.

Quick Start

Route

SubQ injection

Start low

2.5 to 10 mg SubQ

Frequency

Daily or specific days per week

Timing

No evidence-based fed or fasted requirement

Any time of day. No fasting required. Targets inner mitochondrial membrane cardiolipin.

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Start here. Every protocol below is ordered lowest-first. Begin at the smallest effective dose, hold about a week to assess tolerance, and step up only if needed.

Tiered Protocols · lowest first

Conservative start

2.5 to 10 mg daily · SubQ injection · Daily or specific days per week

conservative starter

2.5 to 10 mg daily

Daily or specific days per week

Expert

Inner Mitochondrial Repair

4 mg · SubQ · Daily

in vitro · Birk et al. 2013 (J Am Soc Nephrol 24:1250-1261)

Extremely fragile peptide. Prevents mitochondrial depolarization. Also known as Elamipretide. The study cited here is laboratory cell research. A concentration in a dish is not a dose, so this amount is community practice rather than a trial result.

4 mg

Daily

Reconstitution CalculatorU-100

Vial strength

BAC water

Vials in this mix

Syringe size

Target dose

050100u

Draw to

— units

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I will split this dose across more than one syringe

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How it works

SS-31 concentrates approximately 1000-fold in the inner mitochondrial membrane due to its aromatic-cationic structure, which electrostatically interacts with cardiolipin's negatively charged phosphate groups. By stabilizing cardiolipin, SS-31 preserves the cristae architecture necessary for proper electron transport chain (ETC) complex organization, prevents cytochrome c detachment (reducing apoptotic signaling), maintains efficient electron transfer between complexes III and IV, and reduces electron leak that generates reactive oxygen species (ROS). The net effect is improved ATP production efficiency and reduced oxidative stress at the source. SS-31 does not act as a traditional antioxidant (scavenging ROS after formation) but rather prevents excessive ROS generation by maintaining ETC integrity. This upstream mechanism distinguishes it from all other mitochondrial supplements.

What to expect

Early

Days 1–7

Days 1-14: Minimal perceptible changes in most users. SS-31 works at the mitochondrial membrane level, and functional improvements take time. Some users report subtle energy improvements.

Mid

Weeks 2–4

Weeks 2-6: Exercise tolerance improvements become noticeable. Recovery between sessions improves. HRV may show improvement (mitochondrial function affects autonomic regulation). Fatigue levels decrease.

Later

Weeks 4–12

Weeks 6-12: Cumulative mitochondrial protection and optimization. Clinical trials showed functional improvements at 4-12 weeks. Cardiac function markers may improve. Best assessed through repeat testing (6-minute walk test, HRV, exercise capacity).

Evidence

HumanStrong

AnimalStrong

In-vitroPresent

Each reference below was re-fetched from its PubMed record, and the quoted sentence was confirmed to appear in that abstract and to support the claim it sits under. Follow any of them to read the source.

This mitochondria-targeting tetrapeptide selectively binds cardiolipin (CL), a lipid found in the inner mitochondrial membrane, thus stabilizing mitochondrial cristae structure, reducing oxidative stress, and enhancing adenosine triphosphate (ATP) production.

This mitochondria-targeting tetrapeptide selectively binds cardiolipin (CL), a lipid found in the inner mitochondrial membrane, thus stabilizing mitochondrial cristae structure, reducing oxidative stress, and enhancing adenosine triphosphate (ATP) production.

Elamipretide: A Review of Its Structure, Mechanism of Action, and Therapeutic Potential. International journal of molecular sciences · 2025 · PMID 39940712

Evidence scope. Narrative review of elamipretide; mechanistic support does not validate the card's subcutaneous 2.5-10 mg use.

Claims we could not support

No abstract we checked supports these for this molecule at this route. That is not the same as saying they are false — it marks where the evidence is missing.

Dose/route: 2.5 to 10 mg daily via SubQ injection, Daily or specific days per week. No checked live PubMed abstract supported this complete molecule/formulation/route/dose/frequency combination.

Primary safety claim: Mild injection site reactions. No checked live abstract directly established this as the primary concern for the card's exact formulation and regimen.

The honest take

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Mitochondrial optimization

Strongest claim. FDA-approved for Barth syndrome (mitochondrial disease). Mechanism (cardiolipin stabilization) is definitively established. One of the only compounds with direct, proven mitochondrial membrane activity.

Cardiac protection

Phase 2 data in HFpEF showed improvements in cardiac function markers. Animal data in cardiac ischemia-reperfusion is robust. Promising but not FDA-approved for cardiac indications.

Anti-aging

Mitochondrial decline is a hallmark of aging. SS-31 directly addresses this mechanism. Animal studies show reversal of age-related mitochondrial dysfunction. Conceptually one of the best-supported anti-aging mechanisms but not proven in human longevity trials.

Interactions & stacking

Two different questions: what is documented about running these together, and what is documented about drawing them into the same syringe. A good pharmacological partner can still have to be pinned separately.

Documented together

BPC-157SS-31 mitochondrial + BPC tissue repair

TB-500SS-31 mitochondrial + TB systemic repair

GHK-CuSS-31 cellular energy + GHK-Cu tissue remodeling

GHKNon-overlapping mechanisms

Keep separate

Nephrotoxic drugsSS-31 is renally excreted. Concurrent use with aminoglycosides, chronic high-dose NSAIDs, or other nephrotoxic agents may increase renal burden. Monitor kidney function.

CJC-1295 with DACDAC maleimide reactivity concern in syringe.

Check any specific pair in the Stack & Interaction Checker, which answers both questions separately. Absence of a documented conflict is not evidence of safety.

Side effects & safety

Commonly reported

Mild injection site reactions
Generally very well tolerated in clinical trials
Rare headache
Rare nausea

Less common & notes

Clinical trial safety data shows favorable tolerability across multiple studies.
No significant organ toxicity identified.
Renal excretion means monitoring kidney function is prudent, especially with concurrent nephrotoxic medications.
No significant drug interactions identified in clinical programs beyond renal considerations.

Pharmacokinetics

Illustrative plasma concentration · 18 h

Half-life

Peak · Tmax

Elimination

20h

Bioavailability

~100%

SubQ

Duration of action

24-48 hours

Cardiolipin stabilization and mitochondrial protection persist beyond plasma clearance

Clearance

Renal excretion (primarily unchanged)

Storage. Store unreconstituted vials frozen (-20C) or refrigerated (2-8C). After reconstitution with BAC water, refrigerate at 2-8C. Stable for 28 days. FDA-approved formulation is well-characterized for stability. Protect from light.

Regulatory status

FDA-approved as ELPINEO for Barth syndrome. Phase 2 studies completed for HFpEF, renal ischemia, AMD, and primary mitochondrial myopathy. Off-label use at physician discretion. WADA status: Not specifically listed. Available through compounding pharmacies and research channels.

Put it to work

Calculate, log & track

Open SS-31 straight into OnePin with your vial and dose pre-filled, then let it handle the syringe math and remind you before the vial runs out.

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Go deeper

The guide & community

The complete SS-31 walkthrough, real protocol discussion and coaching live inside the BlessUp community on Skool.

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