Description
SS‑31 (elamipretide) is a mitochondria‑targeted tetrapeptide that selectively binds cardiolipin in the inner mitochondrial membrane, stabilizing electron transport chain complexes and reducing reactive oxygen species production while enhancing ATP synthesis. This peptide has demonstrated protective effects in preclinical models of heart failure, neurodegenerative disease, and age‑related muscle atrophy, and received FDA accelerated approval in 2025 as the first treatment for Barth syndrome. This educational protocol presents a once‑daily subcutaneous approach using concentrated reconstitution for practical insulin‑syringe measurements.
- Reconstitute: Add 1.0 mL bacteriostatic water → 10 mg/mL concentration for single‑syringe convenience.
- Typical daily range: 5–10 mg once daily (gradual titration); advanced protocols may reach 15–20 mg/day under supervision.
- Easy measuring: At 10 mg/mL, 1 unit = 0.01 mL = 100 mcg on a U‑100 insulin syringe.
- Storage: Lyophilized: freeze at −20 °C (−4 °F); after reconstitution, refrigerate at 2–8 °C (35.6–46.4 °F); use within 4 weeks.
Dosing & Reconstitution Guide
Educational guide for reconstitution and weekly dosing
Standard / Gradual Approach (1 mL = 10 mg/mL)
| Week | Daily Dose (mg) | Units (per injection) (mL) |
|---|---|---|
| Weeks 1–2 | 5 mg (5000 mcg) | 50 units (0.50 mL) |
| Weeks 3–8 | 10 mg (10,000 mcg) | 100 units (1.0 mL) |
Frequency: Inject once daily subcutaneously at a consistent time. This concentrated dilution (1.0 mL per 10 mg vial) keeps standard doses within a single insulin syringe for convenience and accuracy.
Reconstitution Steps
- Draw 1.0 mL bacteriostatic water with a sterile syringe.
- Inject slowly down the vial wall; avoid vigorous shaking to prevent foaming.
- Gently swirl/roll until fully dissolved (clear solution).
- Label with reconstitution date and refrigerate at 2–8 °C (35.6–46.4 °F), protected from light; use within 4 weeks.
Advanced / Aggressive Approach (1 mL = 10 mg/mL)
| Week | Daily Dose (mg) | Units (per injection) (mL) |
|---|---|---|
| Weeks 1–2 | 5 mg (5000 mcg) | 50 units (0.50 mL) |
| Weeks 3–4 | 10 mg (10,000 mcg) | 100 units (1.0 mL) |
| Weeks 5–8 | 15 mg (15,000 mcg) | Split: 2 × 75 units (0.75 mL each) |
| Optional Weeks 9–12 | 20 mg (20,000 mcg) | Split: 2 × 100 units (1.0 mL each) |
