Cagrilintide is Novo Nordisk's long-acting amylin analog currently under investigation for chronic weight management. As one half of the CagriSema combination (paired with semaglutide 2.4 mg), it represents a new approach to obesity pharmacotherapy. Cagrilintide is not FDA-approved and remains investigational as of 2026. This is not medical advice.
Quick Reference: Standard Protocol
| Parameter |
Standard Protocol |
| Dose |
250 mcg |
| Route |
Subcutaneous injection |
| Timing |
Morning |
| Frequency |
3 days per week (e.g., Mon/Wed/Fri) |
| Cycle |
8 weeks on, 8 weeks off |
| Vial size |
5 mg |
| Reconstitution |
2 mL bacteriostatic water → 2.5 mg/mL |
| Draw amount |
10 units on insulin syringe |
| Storage |
Refrigerate 2-8°C, use within 28 days |
Standard protocol: 250 mcg subcutaneous in the morning, 3 days per week, for 8-week cycles. This is far below the clinical trial dose of 2.4 mg weekly but aligns with conservative community protocols for research peptides.
Clinical trials used 2.4 mg once weekly (REDEFINE program). Community protocols use roughly 1/3 of the lowest clinical dose per injection, spread across 3 days for more stable levels. For the full peptide profile, see our cagrilintide peptide page.
Cycling: 8 Weeks On, 8 Weeks Off
Run 250 mcg three times per week for 8 weeks, then take 8 weeks off. Cagrilintide's ~160-hour half-life means it accumulates with repeated dosing, so the 3x/week schedule provides sustained receptor activation.
The community cycle length is much shorter than clinical trial durations (26-68 weeks continuous), reflecting the conservative approach typical of research peptide protocols.
Enhanced Protocol: REDEFINE Clinical Titration
The clinical trial program uses a structured 16-week titration to the full therapeutic dose:
| Week |
Cagrilintide Dose |
Semaglutide Dose (CagriSema) |
| 1-4 |
0.25 mg |
0.25 mg |
| 5-8 |
0.5 mg |
0.5 mg |
| 9-12 |
1.0 mg |
1.0 mg |
| 13-16 |
1.7 mg |
1.7 mg |
| 17+ |
2.4 mg |
2.4 mg |
This clinical protocol is the evidence-based approach used in REDEFINE trials. The 250 mcg community protocol above is the conservative cheat sheet standard.
Routes of Administration
Subcutaneous injection (standard): Inject in abdomen, thigh, or upper arm. Rotate sites between injections. Standard SC technique with 29-31 gauge insulin syringe.
Clinical pen device: In trials, cagrilintide was delivered via Novo Nordisk's prefilled pen. Research-grade lyophilized powder requires manual reconstitution.
Reconstitution Quick Reference
| Vial Size |
BAC Water |
Concentration |
250 mcg Dose |
| 5 mg |
2 mL |
2.5 mg/mL |
10 units |
Math: 5,000 mcg / 2 mL = 2,500 mcg/mL. For 250 mcg: 250 / 2,500 = 0.1 mL = 10 units. One vial lasts 20 doses.
Swirl gently -- do not shake. Refrigerate at 2-8°C and use within 28 days. For step-by-step instructions, see the Reconstitution Calculator.
Where These Numbers Come From
Cagrilintide has a robust clinical trial program with published phase 2 and phase 3 data.
Phase 2 monotherapy (Lau et al., 2021): 706 adults with overweight/obesity across 57 sites. Cagrilintide 4.5 mg produced 10.8% mean weight loss at 26 weeks, comparable to liraglutide 3.0 mg. Clear dose-response relationship observed from 0.3 mg to 4.5 mg.
REDEFINE 1 -- CagriSema phase 3 (Aronne et al., 2025): CagriSema 2.4/2.4 mg produced 22.7% mean weight loss at 68 weeks vs 2.1% placebo. 60% of participants achieved 20% or more weight loss -- a threshold historically associated with bariatric surgery outcomes.
REDEFINE 2 -- CagriSema in T2D (Lingvay et al., 2025): Significant weight loss and glycemic improvement in adults with overweight/obesity and type 2 diabetes.
Phase 2 CagriSema in T2D (Frias et al., 2023): CagriSema produced superior weight loss and glycemic improvement vs either monotherapy over 32 weeks.
Stacking Protocols
| Stack |
Components |
Purpose |
| CagriSema |
Cagrilintide + semaglutide |
Amylin + GLP-1 dual pathway (clinically validated) |
| Weight Management |
Cagrilintide + tirzepatide |
Not clinically studied -- theoretical only |
CagriSema is the primary stack: The combination targets complementary pathways -- amylin receptors (satiety, gastric emptying, glucagon suppression) and GLP-1 receptors (insulin secretion, appetite, hedonic eating). Clinical data shows the combination produces significantly greater weight loss than either agent alone.
Side Effects & Safety
- Nausea -- most common (25-40%); peaks during dose escalation, typically mild-moderate
- Diarrhea -- 10-20%, usually transient
- Constipation -- 8-15%
- Vomiting -- 5-15%, more frequent at higher doses
- Injection site reactions -- 5-10%, mild erythema and pruritus
- Decreased appetite -- 5-12%, related to mechanism of action
- Pancreatitis -- rare but monitored (as with all GLP-1/amylin agents)
- Gallbladder events -- cholelithiasis reported, consistent with rapid weight loss
Dose titration is essential -- the 16-week escalation protocol significantly reduces GI adverse events. Not studied in pregnancy.
Frequently Asked Questions
What is the standard cagrilintide dose?
Community protocols use 250 mcg subcutaneous, 3 days per week in the morning, for 8-week cycles. Draw 10 units from a 5 mg vial reconstituted with 2 mL BAC water. Clinical trials target 2.4 mg once weekly.
How much weight loss does cagrilintide produce?
As monotherapy, cagrilintide 4.5 mg produced 10.8% mean weight loss at 26 weeks. Combined with semaglutide 2.4 mg (CagriSema), the REDEFINE 1 trial showed 22.7% mean weight loss at 68 weeks.
What is CagriSema?
CagriSema is Novo Nordisk's investigational once-weekly combination of cagrilintide 2.4 mg and semaglutide 2.4 mg, targeting both amylin and GLP-1 pathways for enhanced weight loss.
Is cagrilintide FDA-approved?
No. As of 2026, cagrilintide remains investigational. Phase 3 REDEFINE trials are ongoing.
What are the most common side effects?
GI effects: nausea, diarrhea, constipation, and vomiting. Typically mild to moderate and diminish with proper dose titration.
How is cagrilintide different from pramlintide?
Pramlintide requires twice- or thrice-daily injections. Cagrilintide's fatty acid acylation gives it a ~160-hour half-life, enabling once-weekly dosing with substantially greater weight loss.
Can cagrilintide be used with tirzepatide?
Not clinically studied. Both slow gastric emptying, and combining without clinical data could increase GI risk. CagriSema (cagrilintide + semaglutide) is the only clinically validated combination.
How long does it take to see results?
In clinical trials, meaningful weight loss becomes apparent by weeks 8-12 as doses escalate. Maximum effects at 40-68 weeks of continuous treatment.
References
| Citation |
Topic |
PMID |
| Lau et al., Lancet (2021) |
Phase 2 dose-finding, cagrilintide monotherapy |
34798060 |
| Frias et al., Lancet (2023) |
Phase 2 CagriSema in T2D |
37364590 |
| Trevisan et al., Cardiol Rev (2024) |
Cagrilintide review for obesity |
36883831 |
| Aronne et al., N Engl J Med (2025) |
REDEFINE 1 phase 3 CagriSema |
40544433 |
| Lingvay et al., N Engl J Med (2025) |
REDEFINE 2 CagriSema in T2D |
40544432 |
For educational and research purposes only. This is not medical advice. Cagrilintide is investigational and not FDA-approved.