A mitochondria-targeting aromatic-cationic tetrapeptide developed clinically as elamipretide.
The calculator records 1 mg daily and 5 mg twice-weekly rows. Clinical elamipretide programs used materially different exposure and formulations. This is educational source context, not a protocol or recommendation.
There is no regulator-approved starting dose for this research use. A low-looking number is not automatically safe.
This is the range represented in the in-app protocol library. It describes the source record; it does not validate the regimen.
Higher exposure is not established as more effective. Human pharmacokinetic and long-term safety data may be absent.
“SS-31” research material and clinical elamipretide formulation should not be assumed bioequivalent.
The cadence represented by the recorded calculator presets.
Published experiments may use a different route, formulation, timing, or population and should not be treated as interchangeable.
No single schedule has been validated across products or research contexts.
The phase 3 trial directly tested 40 mg/day for 24 weeks and did not meet either primary endpoint in the overall population.
Keep cold, dry, and protected from light according to the manufacturer certificate or validated lab SOP.
Use sterile technique, refrigerate as validated, and avoid repeated freeze-thaw cycles.
Record lot, concentration, preparation date, and the identity/purity documentation used by the lab.
What published studies and recent community write-ups report about amounts, timing and course length. 7 clinical, 2 preclinical and 3 community-reported rows, each linked to its source. These are descriptions of what others report, not instructions, and nothing here is medical advice.
| Context | Dose | Frequency | Route | Course | Source |
|---|---|---|---|---|---|
| Clinical7 rows | |||||
| FDA label, Forzinity (Barth syndrome)Adults and children with genetically confirmed Barth syndrome weighing at least 30 kg | 40 mg (0.5 mL of an 80 mg/mL solution); 20 mg in adults with eGFR below 30 mL/min who are not on dialysis | Once daily, at the same time each day | Subcutaneous, abdomen at least 2 inches from the navel or outer thigh, rotating sites daily | Continuous; the approval covers ongoing treatmentNone; a missed dose is skipped rather than doubled | DailyMed, National Library of Medicine2025 |
| The 2025 label gives a single fixed dose with no titration and a half-dose only for severe renal impairment, because exposure rose 125% when creatinine clearance fell below 30 mL/min. Approval was granted under the accelerated pathway on an intermediate endpoint (knee extensor strength) from 12 patients, and injection site erythema occurred in all 12 treated patients versus 3 on placebo. | |||||
| TAZPOWER randomized crossover trial and open-label extension12 males aged 12-35 with genetically confirmed Barth syndrome | 40 mg | Once daily | Subcutaneous | 12 weeks on drug and 12 weeks on placebo separated by a 4-week washout, then open-label dosing to 36 weeks and beyond4-week washout between the two blinded periods only | Genetics in Medicine (PubMed Central)2021 |
| Neither primary endpoint (6-minute walk distance or a Barth fatigue score) was met in the 12-week blinded periods. In the open-label extension, 10 of the 12 continued and 8 reached 36 weeks, by which point walking distance had improved 95.9 m and knee extensor strength had risen, but these are uncontrolled before-and-after comparisons in a handful of patients. | |||||
| TAZPOWER 168-week open-label extension10 Barth syndrome patients who entered the extension; 8 reached week 168 | 40 mg | Once daily | Subcutaneous | 168 weeks of continuous dosing (3 patients reached 192 weeks per the label)None | Genetics in Medicine (PubMed)2024 |
| Walking distance was above the extension baseline at every visit, with a cumulative 96.1 m gain at week 168, and 3D echocardiographic volumes and the monolysocardiolipin to cardiolipin ratio moved in the expected direction. Injection site reactions were the most common adverse event; with no placebo arm after week 28, the long-term efficacy figures cannot separate drug effect from time and expectation. | |||||
| MMPOWER phase 1/2 intravenous dose escalation36 adults with genetically confirmed primary mitochondrial myopathy | 0.01, 0.10 or 0.25 mg/kg per hour infused over 2 hours | Once daily for 5 consecutive days | Intravenous infusion | 5 days, with follow-up testing 2 days after the last doseNot applicable | Neurology (PubMed)2018 |
| The highest dose cohort walked a mean 64.5 m farther at day 5 against 20.4 m on placebo, a difference that did not reach significance (p = 0.053), although the dose-response trend did (p = 0.014). Each cohort had only 9 treated and 3 placebo participants, and the 0.25 mg/kg per hour infusion became the reference point for the 40 mg subcutaneous dose used afterwards. | |||||
| MMPOWER-2 phase 2 crossover trial30 adults with primary mitochondrial myopathy who had completed MMPOWER | 40 mg | Once daily | Subcutaneous | 4 weeks on drug and 4 weeks on placebo4-week washout between the two periods | Journal of Cachexia, Sarcopenia and Muscle (PubMed)2020 |
| Six-minute walk distance was 398.3 m on elamipretide versus 378.5 m on placebo, a 19.8 m difference that missed significance (p = 0.083), while patient-reported fatigue scores favored the drug. Injection site reactions occurred in 80% of participants, mostly mild, and the authors note that subcutaneous bioavailability was about 90% of the intravenous formulation. | |||||
| MMPOWER-3 phase 3 trial218 adults (mean age 45.6, 64% women) with genetically confirmed primary mitochondrial myopathy | 40 mg | Once daily | Subcutaneous, self-injected at rotating abdominal or thigh sites | 24 weeksNone | Neurology (PubMed)2023 |
| The trial missed both primary endpoints: the walking distance difference versus placebo was minus 3.2 m (p = 0.69) and the fatigue score difference was negligible (p = 0.37). Tolerability was good, with 94% completing the double-blind period, but injection site erythema affected 86% of treated participants against 28% on placebo, and a post hoc nuclear-DNA subgroup signal remains a hypothesis. | |||||
| ReCLAIM-2 phase 2 trial in dry macular degeneration176 adults aged 55 and over with dry AMD and noncentral geographic atrophy (117 on drug, 59 on placebo) | 40 mg | Once daily | Subcutaneous, via the sponsor's delivery system | 48 weeks, then a 4-week follow-upNone | Ophthalmology Science (PubMed Central)2025 |
| Neither primary endpoint (low-luminance visual acuity or geographic atrophy area) reached significance, while prespecified photoreceptor ellipsoid zone measures showed 43% and 47% less progression than placebo at nominal p values. Adverse events were reported by 86% of treated patients versus 71% on placebo, led by injection site reactions. | |||||
| Preclinical2 rows | |||||
| Preclinical aged-mouse muscle energetics, single dose and 8-day course5-month-old and 27-month-old female C57BL/6 mice | 3 mg/kg | Single injection (measurements 1 hour later) or once daily for 8 days | Intraperitoneal | 1 hour to 8 daysNot applicable | Aging Cell (PubMed Central)2013 |
| One injection restored resting and maximal mitochondrial ATP production and the cell energy state of aged muscle to young levels within an hour, with no effect on young muscle, and 8 days of dosing increased treadmill endurance in the old mice. These are acute rodent measurements and say nothing about human dosing. | |||||
| Preclinical 8-week infusion in aged mice5-month-old and 26-month-old female C57BL/6Nia mice | 3 mg/kg per day | Continuous | Subcutaneous osmotic minipump | 8 weeksNot applicable | Free Radical Biology and Medicine (ScienceDirect)2019 |
| Eight weeks of infusion reversed the age-related fall in maximal ATP production and oxidative phosphorylation coupling, shifted the glutathione pool toward its reduced state, and increased gastrocnemius mass, fatigue resistance and treadmill endurance, all without raising mitochondrial protein content. Delivery by implanted pump has no equivalent in human use. | |||||
| Community-reported3 rows | |||||
| Off-label research-vial dosing table | 5-10 mg (longevity use); 20-40 mg (mitochondrial myopathy); 4-40 mg (cardiovascular) | Once daily, usually in the morning | Subcutaneous from reconstituted 5, 10, 30 or 50 mg vials | Continuous daily dosing in most protocolsSome practitioners described as using 8 weeks on and 4 weeks off | Community resource2026 |
| This 2026 guide separates the 40 mg Forzinity dose from the 5-10 mg per day that it says most off-label longevity protocols use, and states that the lower range has no consensus behind it. It describes cycling as unsupported by any publication and points to the TAZPOWER extension as evidence that continuous daily dosing was maintained for years. | |||||
| Community tiered dosing with on-off blocks | 2-5 mg (low), 5-10 mg (standard), 10 mg and above (upper) | Once daily, sometimes split into two injections | Subcutaneous (worked example: a 10 mg vial in 2 mL gives 5 mg per 1 mL) | 4-8 weeks on2-4 weeks off, then reassess | Community resource2026 |
| A peptide-tracking app's 2026 article lays out three dose tiers drawn from user logs, suggests morning or pre-workout timing, and pairs SS-31 with MOTS-c as a mitochondrial stack. It states plainly that these are community patterns rather than approved labeling and that trial regimens differ. | |||||
| Label dose set against grey-market practice | 40 mg (label); 5-10 mg most commonly reported by users | Once daily | Subcutaneous, abdomen or thigh | Ongoing per the label; user runs of a few weeks to a few monthsNo consistent off period reported among users | Community resource2026 |
| A European reference site contrasts the registered 40 mg daily dose, including the 20 mg renal reduction, with the 5-10 mg pattern repeated across forums and vendor labels, which it says has no clinical basis. It also notes that elamipretide is not on the 2026 WADA Prohibited List and that the EU has granted only an orphan designation, not an authorization. | |||||
The label and every trial began at the full 40 mg subcutaneous dose with no titration, injected at the same time each day in the abdomen or outer thigh. Injection site redness, itching and induration appear early and were the dominant adverse events in all of the trials.
Four weeks at 40 mg in MMPOWER-2 produced a 19.8 m walking-distance difference that fell short of significance alongside improved fatigue scores. The label describes peak levels 0.5 to 1 hour after injection and essentially the whole dose recovered in urine within 48 hours, so there is no build-up over the first weeks.
Twelve blinded weeks in Barth syndrome and 24 blinded weeks in mitochondrial myopathy showed no advantage over placebo on walking or fatigue. The label's knee-strength data come from the open-label extension, where median gains of 34 newtons at extension week 12 and 68 newtons at week 24 were recorded without a control group.
In the TAZPOWER extension, walking distance stayed above baseline at every visit through week 168 and cardiac volumes improved, with 8 of 10 patients still dosing. The approval rests on this uncontrolled long-term experience plus the crossover data, and a placebo-controlled confirmatory trial is a condition of continued approval.
Community guides describe 5-10 mg once daily in 4-8 week blocks followed by 2-4 weeks off, or continuous dosing with an optional 8-weeks-on, 4-weeks-off pattern. None of these schedules or doses has been tested in a human trial, and the guides themselves say so.
Plus 3 community resources (dosing guides, forum threads and vendor write-ups), reported above but not linked.
SS-31, known generically as elamipretide and by the development codes MTP-131 and Bendavia, is a synthetic four-residue peptide designed by Hazel Szeto and Peter Schiller that concentrates in the inner mitochondrial membrane and binds the phospholipid cardiolipin. Stealth BioTherapeutics took it through trials in primary mitochondrial myopathy, heart failure, reperfusion injury, dry age-related macular degeneration and Barth syndrome, and the large trials in mitochondrial myopathy and macular degeneration both missed their primary endpoints. On September 19, 2025 the FDA granted accelerated approval to Forzinity (elamipretide) injection, 40 mg subcutaneously once daily, to improve muscle strength in people with Barth syndrome weighing at least 30 kg, based on knee extensor strength in a 12-patient trial, with a confirmatory trial required. Powder sold online as SS-31 is a research chemical rather than the approved product, and community guides describe it at a fraction of the labeled dose.
These themes describe recurring questions in published research. They are not claims of effectiveness or recommendations for use.
MMPOWER trials measure walking capacity, fatigue, symptoms, and safety.
Preclinical work explores inner-membrane structure and electron-transport function.
Post-hoc analyses examine whether nuclear-DNA subgroups differ from mtDNA groups.
Programs have studied ophthalmic, cardiac, and rare-disease populations.
Study models remain visible so laboratory and animal findings are not mistaken for established human outcomes.
In 218 participants, 40 mg/day did not significantly improve six-minute walk distance or fatigue overall.
A short phase 1/2 study evaluated IV doses and exercise outcomes.
Signals in genotype subgroups require prospective confirmation and do not overturn the overall result.
These amount records are independent from vial strength, reconstitution volume and measuring device. A recorded source is not the same as study backing, and these values are not recommendations.
Sequence, synonyms and registry identifiers as recorded in PubChem, the National Library of Medicine's open chemistry database. Formula, mass and CAS number are summarized at the top of the page.
D-Arg-Dmt-Lys-Phe-NH2 (Dmt = 2',6'-dimethyl-L-tyrosine)
Elamipretide, Forzinity, Bendavia, MTP-131, SS-31, Ocuvia, RX-31, UNII 87GWG91S09
SFVLTCAESLKEHH-WKAQUBQDSA-N
Designed to associate with the inner mitochondrial membrane/cardiolipin
(2S)-6-amino-2-[[(2S)-2-[[(2R)-2-amino-5-(diaminomethylideneamino)pentanoyl]amino]-3-(4-hydroxy-2,6-dimethylphenyl)propanoyl]amino]-N-[(2S)-1-amino-1-oxo-3-phenylpropan-2-yl]hexanamide
2 curated references, each with its journal, year and study model, plus 3 community resources reported but not linked.