MEDICAL DISCLAIMER: Educational research guidelines only. Lyophilized peptides are investigational chemical compounds and are NOT approved for human consumption, diagnosis, or therapy. Consult a licensed physician before any research application.
Cagrilintide Dosage Chart, Schedule & Reconstitution Protocol
Quickstart Highlights
Cagrilintide is a once-weekly long-acting analogue of human amylin — the pancreatic hormone co-secreted with insulin — engineered by Novo Nordisk as a partner peptide for semaglutide in the fixed-dose combination CagriSema. Cagrilintide acts as a dual agonist at the amylin (AMY) and calcitonin (CTR) receptors in the brainstem and hypothalamus, driving satiety through a pathway that is complementary rather than redundant to GLP-1 signaling. In the Phase 2 dose-finding trial (Lau et al., Lancet 2021), cagrilintide 4.5 mg monotherapy produced 10.8% mean weight loss at 26 weeks and out-performed liraglutide 3.0 mg head-to-head, and a Phase 1b combination study with semaglutide 2.4 mg demonstrated 17.1% weight loss at 20 weeks [1][3]. Cagrilintide as monotherapy is investigational; the CagriSema combination was submitted to the FDA in December 2025.
Reconstitute: Add 3 mL bacteriostatic water → 1.67 mg/mL concentration.
Typical dose: 0.6–4.5 mg once weekly (gradual titration over 4–6 weeks).
Easy measuring: At 1.67 mg/mL, 1 unit = 0.01 mL = 0.0167 mg (17 mcg) on a U-100 insulin syringe.
Storage: Lyophilized frozen; reconstituted refrigerated; avoid repeated freeze–thaw cycles.
Half-life: Approximately 7–8 days, achieved through substitutions that resist enzymatic degradation plus C18 fatty-diacid acylation; native human amylin has only a 13-minute half-life [1].
Heart rate: Minimal heart-rate elevation (<2 bpm) — in clear contrast to GLP-1 and dual agonists, suggesting amylin agonism does not engage the chronotropic pathway driving incretin-class tachycardia.
Regulatory status: Investigational as monotherapy. The CagriSema combination (cagrilintide 2.4 mg + semaglutide 2.4 mg) was submitted to the FDA in December 2025 based on REDEFINE-1 Phase 3 data; approval decision expected in 2026.
Quick Protocol Navigation
Reconstitution Instruction & Mixing Step-by-Step
Lyophilized powder must be reconstituted carefully. Agitating peptide chains can shear disulfide bonds and render the peptide biologically inert.
Draw 3.0 mL bacteriostatic water with a sterile syringe.
Inject slowly down the vial wall; avoid foaming or vigorous agitation.
Gently swirl or roll until fully dissolved (do not shake).
Do not aspirate for subcutaneous injections; inject slowly and steadily.
Interactive Cagrilintide Syringe Calculator
Currently visualizing the 5 mg vial reconstituted with 3 mL bacteriostatic water. Adjust the target dose to dynamically render syringe units.
Reconstitution Calculation: 5mg dry powder in 3mL water yields 1.67 mg/mL. To evaluate a 250mcg dose, pull to 15.0 units (15 syringe ticks).
U-100 Syringe Representation
15.0 Units (15 Ticks)
Educational reference visual. Assumes standard U-100 insulin syringe where 1.0 mL volume = 100 units.
Titration & Dose Escalation Schedules
| Week/Phase | Weekly Dose (mg) | Units (per injection) | Volume (mL) |
|---|---|---|---|
| Weeks 1–2 | 0.6 mg | 36 units | 0.36 mL |
| Weeks 3–4 | 1.2 mg | 72 units | 0.72 mL |
| Weeks 5–6 | 2.4 mg | 144 units | 1.44 mL |
| Weeks 7–16 (Maintenance) | 4.5 mg | 270 units | 2.70 mL |
Administration guidelines: Refer to guidelines | 3 mL Reconstitution
Research Supplies Quantity Planner
Scientific mathematical planning of syringes, bacteriostatic water and dry vials needed for extended research blocks using the 5 mg vial.
Peptide Vials (Cagrilintide, 5 mg each):
- check8 weeks ≈ 4 vials (17.4 mg total)
- check12 weeks ≈ 8 vials (35.4 mg total)
- check16 weeks ≈ 11 vials (53.4 mg total)
Syringes:
- checkWeeks 1–4 (doses ≤72 units): U‑100 insulin syringes work well
- checkWeeks 5+ (doses >100 units): 3 mL syringes with 25–27G subcutaneous needles
- checkPer week: 1 syringe
- check8 weeks: 8 syringes
- check12 weeks: 12 syringes
- check16 weeks: 16 syringes
Bacteriostatic Water (10 mL bottles): Use 3.0 mL per vial for reconstitution.
- check8 weeks (4 vials): 12 mL → 2 × 10 mL bottles
- check12 weeks (8 vials): 24 mL → 3 × 10 mL bottles
- check16 weeks (11 vials): 33 mL → 4 × 10 mL bottles
Alcohol Swabs: One for the vial stopper + one for the injection site each week.
- checkPer week: 2 swabs
- check8 weeks: 16 swabs
- check12 weeks: 24 swabs
- check16 weeks: 32 swabs → recommend 1 × 100‑count box
Mechanism of Action (MOA)
Cagrilintide is a synthetic 37-amino-acid amylin analogue with substitutions that resist enzymatic degradation and a C18 fatty-diacid linker that promotes albumin binding, yielding a terminal half-life of approximately 7–8 days and enabling fixed weekly subcutaneous administration [1][2]. Native human amylin has a half-life of only about 13 minutes and aggregates into pancreatic amyloid fibrils — properties that prevent its therapeutic use. Pramlintide, the only currently marketed amylin analogue, has a 48-minute half-life and requires multiple daily injections. Cagrilintide's design solves both problems, producing a once-weekly drug with stable plasma concentrations and no observable amyloidogenic behavior. The peptide acts as a dual agonist at the amylin receptor (AMY) and the calcitonin receptor (CTR), both expressed in the brainstem area postrema, hypothalamus and several peripheral tissues. Activation of these receptors reduces food intake by enhancing satiety signaling that complements rather than overlaps the GLP-1 pathway — meaning cagrilintide and semaglutide have additive rather than redundant effects on weight loss [3]. Cagrilintide also slows gastric emptying, suppresses postprandial glucagon secretion, and may have a small direct effect on energy expenditure. Notably, the satiety mechanism appears to be independent of nausea-mediating brainstem pathways, helping explain why cagrilintide adds weight-loss efficacy on top of semaglutide without proportionally adding to the GI burden. Administration is subcutaneous via vialed solution or fixed-dose pen, typically in the abdomen or thigh. Pharmacokinetics are dose-proportional from 0.16 to 4.5 mg, with steady state reached after about 5 weeks of weekly dosing. The titration protocol used in the Phase 2 dose-finding trial and continued in REDEFINE Phase 3 ramps every 4 weeks: 0.16 → 0.3 → 0.6 → 1.2 → 2.4 → 4.5 mg, totaling a 20-week ramp. For the CagriSema co-formulation, both peptides escalate in parallel to a 2.4 mg / 2.4 mg maintenance dose. Downstream effects include placebo-adjusted weight reductions of 6.0–10.8% across the 0.3–4.5 mg dose range at 26 weeks, plus reductions in waist circumference, fasting glucose and lipid markers [1]. The Phase 1b combination trial of cagrilintide + semaglutide demonstrated 17.1% weight loss at 20 weeks — substantially greater than either drug alone — establishing the rationale for the REDEFINE Phase 3 program [3].
Clinical Trial Efficacy Highlights
- starPhase 2 dose-finding trial (Lau et al., Lancet 2021) randomized 706 adults with overweight or obesity to cagrilintide 0.3, 0.6, 1.2, 2.4 or 4.5 mg weekly, liraglutide 3.0 mg daily, or placebo, for 26 weeks. Cagrilintide produced dose-dependent weight loss: 6.0%, 6.8%, 9.1%, 9.7% and 10.8% across the active arms vs 3.0% on placebo and 9.0% on liraglutide [1].
- starCagrilintide 4.5 mg outperformed liraglutide 3.0 mg head-to-head on weight loss (10.8% vs 9.0%) at 26 weeks while requiring weekly rather than daily injection — the first amylin analogue to clearly beat an established weight-loss drug [1].
- starREDEFINE-1 Phase 3 trial (Novo Nordisk, 2024–2025) showed CagriSema 2.4/2.4 mg weekly produced 22.7% mean weight loss at 68 weeks vs 11.8% with cagrilintide 2.4 mg alone, 16.1% with semaglutide 2.4 mg alone and 2.3% with placebo — demonstrating clear additive benefit of cagrilintide on top of semaglutide [4].
- starIn REDEFINE-1, 40.4% of CagriSema participants achieved ≥25% weight loss, compared to 6.0%, 16.2% and 0.9% for cagrilintide-only, semaglutide-only and placebo arms respectively — establishing CagriSema as the highest-efficacy approved-class combination at the time of submission [4].
- starPhase 1b combination trial (Enebo et al., Lancet 2021) of cagrilintide + semaglutide co-administration demonstrated 17.1% weight loss at 20 weeks — substantially greater than the additive effect predicted from monotherapy data alone, suggesting a true synergistic mechanism [3].
- starCagrilintide produced 8.5–10.2 cm reductions in waist circumference at higher doses in the Phase 2 trial, with parallel improvements in fasting glucose, triglycerides and systolic blood pressure [1].
- starIn a Phase 2 T2D trial of CagriSema vs semaglutide 2.4 mg in adults with type 2 diabetes (Frias et al., Lancet 2023), CagriSema produced an additional 2.4% weight loss and 0.4% greater HbA1c reduction at 32 weeks [5].
Side Effects & Tolerability Profile
Clinical subjects transiently report mild side effects. Slowly escalating the titration dose represents the single most effective intervention to limit side effects.
- warningGastrointestinal events occurred at notably lower rates than for GLP-1 agonists. In the Phase 2 dose-finding trial, nausea was reported in 27% of participants on 4.5 mg cagrilintide vs 11% on placebo, vomiting in 12% vs 4%, and diarrhea in 10% vs 6% — comparable to or lower than liraglutide 3.0 mg [1].
- warningDecreased appetite, the intended pharmacologic effect, was reported in 25–35% of participants on active doses; this is distinct from nausea-mediated appetite loss and contributes to the durable weight-loss effect.
- warningInjection-site reactions (mild erythema, induration) occurred in roughly 4–7% of participants, comparable to other weekly subcutaneous peptides. Site rotation is standard practice.
- warningHeart-rate elevation was minimal (<2 bpm on average) — in clear contrast to GLP-1 and dual-agonist drugs, suggesting amylin agonism does not engage the chronotropic pathway responsible for tachycardia with incretin therapies.
- warningNo clinically significant hypoglycemia was observed in non-diabetic participants; in diabetic populations using CagriSema with insulin or sulfonylureas, background therapy adjustments are typically required.
- warningNo cases of medullary thyroid carcinoma, acute pancreatitis, or other class-effect concerns flagged for GLP-1 agonists were reported in the Phase 2 cagrilintide program through 26 weeks.
- warningIn the Phase 2 trial, the overall discontinuation rate due to adverse events at 4.5 mg was 14%, with GI events the leading reason — modestly higher than placebo (10%) but lower than liraglutide 3.0 mg in the same trial [1].
- warningIn REDEFINE-1, CagriSema's GI side-effect profile was broadly similar to semaglutide alone, suggesting cagrilintide adds efficacy without proportionally adding GI burden [4].
Subcutaneous Injection Technique
Most research peptides require subcutaneous injection into fatty tissue. Never inject directly into a blood vessel or deep muscle tissue unless clinically detailed.
1. Site Selection
Common locations include the abdomen (2 inches from navel), outer upper arms, or thighs.
2. Sanitization
Thoroughly clean the selected site, stopper and vial top using 70% isopropyl alcohol prep swabs.
3. Angle & Push
Pinch the skin and insert the needle at a 45 to 90-degree angle. Depress plunger smoothly.
4. Site Rotation
Rotate injection sites continuously to avoid lipodystrophy or tissue scarring.
Frequently Asked Questions
What is the typical Cagrilintide dosage?expand_more
Cagrilintide is dosed once weekly subcutaneously. Standard titration ramps every 4 weeks: 0.16 → 0.3 → 0.6 → 1.2 → 2.4 → 4.5 mg, totaling a 20-week ramp. The most-studied maintenance doses are 2.4 mg (used in CagriSema for the REDEFINE Phase 3 program) and 4.5 mg (the highest dose in Phase 2 monotherapy). It is not currently approved as monotherapy.
How is Cagrilintide different from Semaglutide?expand_more
Cagrilintide is a long-acting amylin analogue acting at the AMY/CTR receptors; semaglutide is a GLP-1 receptor agonist. The two mechanisms drive complementary satiety pathways — cagrilintide engages brainstem amylin signaling while semaglutide acts on hypothalamic GLP-1 receptors. The CagriSema combination produces ~22.7% weight loss at 68 weeks, greater than either drug alone [4].
What are the most common side effects of Cagrilintide?expand_more
Most common are mild GI events: nausea (27%), vomiting (12%), diarrhea (10%) and decreased appetite (25–35%), notably milder than seen with GLP-1 agonists. Other notable findings: minimal heart-rate effect, low injection-site reaction rate (4–7%), no observable thyroid or pancreatitis signal in Phase 2 data through 26 weeks [1].
How should Cagrilintide be reconstituted and stored?expand_more
Lyophilized cagrilintide is reconstituted with bacteriostatic water typically at 1–2 mL per 5 mg vial. Once reconstituted, store at 2–8 C, protect from light, and use within 28 days. Unopened lyophilized vials remain stable for 18–24 months refrigerated. Do not freeze reconstituted solution; discard if cloudy or particulate is visible. CagriSema commercial pens (when approved) will be pre-filled.
Is Cagrilintide FDA approved?expand_more
Not as monotherapy. Cagrilintide as a single agent remains investigational. The fixed-dose combination CagriSema (cagrilintide 2.4 mg + semaglutide 2.4 mg) was submitted to FDA in December 2025 for chronic weight management based on REDEFINE-1 Phase 3 data, with anticipated approval decision in 2026. Outside that combination, cagrilintide is research-only.
Academic References & Study Citations
Lau DCW, Erichsen L, Francisco AM, et al. (2021) Lancet 398:2160-2172. 'Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial'. View Scientific Paper →
Andreasen CR, Andersen A, Knop FK, Vilsboll T. (2021) Curr Diab Rep. 'How glucagon-like peptide 1 receptor agonists work' — and the role of amylin co-agonism. View Scientific Paper →
Enebo LB, Berthelsen KK, Kankam M, et al. (2021) Lancet 397:1736-1748. 'Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2.4 mg for weight management: a randomised, controlled, phase 1b trial'. View Scientific Paper →
Garvey WT, Blüher M, Osorto Contreras CK, et al. (2025) N Engl J Med. 'Cagrilintide–Semaglutide in Adults with Overweight or Obesity' (REDEFINE-1). 22.7% weight loss at 68 weeks. View Scientific Paper →
Frias JP, Deenadayalan S, Erichsen L, et al. (2023) Lancet 402:720-730. 'Efficacy and safety of co-administered once-weekly cagrilintide 2.4 mg with once-weekly semaglutide 2.4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial'. View Scientific Paper →
Hay DL, Chen S, Lutz TA, et al. (2015) Pharmacol Rev. 'Amylin: pharmacology, physiology, and clinical potential' — comprehensive review. View Scientific Paper →
ClinicalTrials.gov NCT05567796 — REDEFINE-1 Phase 3 CagriSema obesity trial. View Scientific Paper →
Novo Nordisk press release (December 2025) — FDA NDA submission for CagriSema in chronic weight management. View Scientific Paper →