Injection
NAD+
Supports cellular energy, focus and healthy aging by restoring the NAD+ levels that decline with age, for a fraction of the cost of IV infusions.
Starting at $159/mo
Research peptideEnergyMitochondria
SS-31 (Elamipretide)
RxPrescription onlyInjected under the skin · 5 days a week · 0.4–0.8 mg · Research peptide · Energy · Mitochondria
Starting at $209/mo
SS-31 (elamipretida): a mitochondrial peptide studied for cellular energy, muscle fatigue, and recovery. Targets cardiolipin in the inner mitochondrial membrane. Subcutaneous injection. Very early-stage human evidence; most data from mito disorders.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Studied for cellular energy and mitochondrial function
- Preclinical evidence in muscle and cardiac fatigue
- Emerging clinical interest for energy-related conditions
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is SS-31?
(elamipretida; mitochondrial-targeted peptide)
SS-31 (elamipretida) is a short peptide that crosses the mitochondrial membranes and binds to cardiolipin, a lipid critical for ATP (cellular energy) production. By supporting mitochondrial electron transport, SS-31 enhances energy generation within cells. It is being studied in mitochondrial myopathies and cardiomyopathy. Off-label use for generalized fatigue or recovery is emerging, though human evidence is limited.
- How it is taken
- Injected under the skin
- How often
- 5 days a week
- Dose range
- 0.4–0.8 mg
- Form
- Research peptide · Energy · Mitochondria
Early
human evidence; strong preclinical mitochondrial support
SS-31 is prescribed off-label for fatigue and energy based on preclinical mechanistic support and small clinical experience. It is not approved by the FDA for any indication.
How it works,
week by week.
Day 1
A US-licensed physician reviews your fatigue, exercise capacity, medical history, and cardiac history. Discusses how SS-31 supports mitochondrial function and the evidence gap.
Week 1
Start with subcutaneous injections, typically 3–5 days per week. Most people find the routine comfortable within days.
Weeks 2–4
Energy, exercise tolerance, and recovery may begin to improve. Some notice changes within days; others take 3–4 weeks. Keep an energy and exercise log.
Month 2
Your physician checks in, reviews your energy log, and adjusts dose if needed. Discuss any changes in fatigue, muscle function, or exercise capacity.
Beyond
SS-31 works best with consistent dosing and exercise. Your physician monitors your response every 4–6 weeks and adjusts as your needs change.
What you may notice,
and when.
Improved energy
more consistent stamina for daily tasks and exercise
Better recovery
muscles bounce back faster from workouts
Sustained endurance
longer work or training sessions feel less exhausting
Patience required
mitochondrial function takes weeks to shift; tracking helps
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
SS-31 is prescribed off-label based on preclinical support and early clinical experience. It is generally well tolerated; common mild effects are injection-site reactions, headache, or temporary energy fluctuations in the first week as mitochondrial function shifts. SS-31 is not prescribed during pregnancy or breastfeeding, or with severe cardiac arrhythmias without careful discussion—it works on mitochondria in all tissues, including heart. Tell your physician about every medication, supplement, and any history of heart disease or arrhythmias. Stop and seek care for severe headache, chest pain, palpitations, or signs of allergic reaction.
The research behind
SS-31.
Elamipretide, a tetrapeptide that acts on mitochondria. Its only FDA approval (2025) is accelerated, for one ultra-rare disease, Barth syndrome. Its larger mitochondrial-myopathy trial missed its primary endpoints.
- Barth syndromeaccelerated approval
FDA granted accelerated approval on 19 September 2025 for muscle strength in Barth syndrome, in people weighing at least 30 kg. The approval rests on knee-extensor strength, and a confirmatory randomised trial is required.
FDA press announcement, Forzinity (elamipretide), 19 Sept 2025; Shirley, Drugs 2026 - Mitochondrial myopathymissed primary endpoints
In MMPOWER-3 (218 adults, 24 weeks, 40 mg daily under the skin), the six-minute walk difference from placebo was -3.2 m (p = 0.69) and the fatigue score difference was -0.07 (p = 0.37).
Karaa et al., Neurology 2023 (MMPOWER-3) - Other usesno approval
No approval exists for aging, general fatigue, muscle or heart use. Animal and cell work in heart failure and other models is not proof of benefit in people.
Tung et al., International Journal of Molecular Sciences 2025
What the studies found
- Barth syndrome (approved): improved knee-extensor muscle strength, the basis of FDA accelerated approval in September 2025 for people weighing at least 30 kg (TAZPOWER, randomised crossover; FDA, 2025).
- Primary mitochondrial myopathy: no benefit shown; the six-minute walk and fatigue endpoints were not met (MMPOWER-3, Neurology 2023).
- Heart failure, neurodegeneration and muscle models: animal and cell work suggests protection, which is unproven in people (Tung et al., IJMS 2025).
The approval rests on a strength measure in a small trial in one rare disease, so FDA required a confirmatory trial. The approved product is not the research vial sold here.
What this does not say
- The approval is for one rare disease in people weighing at least 30 kg; it does not establish benefit elsewhere.
- MMPOWER-3 did not show benefit in primary mitochondrial myopathy.
- Long-term safety outside trials is not known.
The research
behind it.
SS-31 improves mitochondrial function and ATP synthesis in cell and animal models of energy depletion, cardiac stress, and muscle damage.
Human clinical trials are few and limited to mitochondrial disease. Off-label use for general fatigue or recovery is based on mechanism and anecdote, not rigorous trials. Your physician explains this gap and monitors energy and muscle function at check-ins.
NAD+ and cellular energy:
what the trials showNAD+ precursors, NAD+ injections, glutathione and methylene blue: what has been tested in people, and what has not.Read the researchFatigue:
what to test before you treatB12, thyroid, sleep apnea, hormones and mood: the causes behind tiredness, what the labs show, and how common each one is.Read the research
what the trials showNAD+ precursors, NAD+ injections, glutathione and methylene blue: what has been tested in people, and what has not.Read the researchFatigue:
what to test before you treatB12, thyroid, sleep apnea, hormones and mood: the causes behind tiredness, what the labs show, and how common each one is.Read the research
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I use SS-31?
Injected under the skin, 5 days a week, in the morning. The starting prescription is 20 units (0.4 mg) each time. Your physician sets your own dose and it is printed on your label.
What strengths does SS-31 come in?
The pharmacy carries 2: 2 mg/mL, 4 mg/mL. Your physician chooses which one you get.
How much arrives in each shipment?
1 vial at the starting strength, shipped to your door from a licensed US pharmacy.
Who might benefit from SS-31?
People with chronic fatigue, muscle weakness, or poor recovery from exercise, whose fatigue appears linked to mitochondrial or energy metabolism issues. Your physician reviews your history and may order bloodwork to assess cellular energy markers before starting.
How long until I feel more energy?
Some people notice improved energy within 1–2 weeks; others take 4–6 weeks. Consistent dosing (3–5 injections per week) is essential. Keep an energy log tracking tiredness, exercise capacity, and recovery. Small, subtle improvements often precede major shifts.
Can I use SS-31 with other medications?
Tell your physician about all medications, especially cardiac or arrhythmia drugs. SS-31 works at the mitochondrial level, so heart medications need careful review. Most combinations are compatible, but timing or dose adjustments may be needed.
What if I don't notice a change?
Mitochondrial function can take 6–8 weeks to measurably shift. Keep detailed logs of energy, exercise capacity, and recovery. If no improvement after 8–10 weeks, your physician may adjust the dose or explore whether SS-31 is the right fit for you.
How does SS-31 affect exercise?
SS-31 supports mitochondrial ATP production, which should improve endurance and recovery. You may notice you can work harder before fatigue sets in, or that muscle soreness after exercise eases sooner. Pair SS-31 with consistent exercise for best results.
SS-31 educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
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References
- 1.SS-31 (elamipretida): a mitochondrial-targeting peptide for cardiac and mitochondrial disease. Circulation, 2016
- 2.Cardiolipin and the inner mitochondrial membrane: mechanisms of cardiolipin-induced cellular stress. Biochim Biophys Acta, 2014
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.