Cagrilintide vs Semaglutide
A long-acting amylin analogue given once weekly. Alone it produced up to 10.8% weight loss over 26 weeks against 3.0% on placebo [1]; the 20.4% figure people quote is the CagriSema combination with semaglutide, not cagrilintide on its own [3]. Not approved anywhere — the combination is under FDA review.
The revolutionary once-weekly GLP-1 medication that helps your body feel full faster and longer, leading to significant weight loss while also protecting your heart—FDA approved and backed by some of the largest clinical trials in obesity medicine history.
Written by Michael Carroll — Owner, Director of Research · Reviewed by the Peptide Initiative Research Team · Editorial standards
Quick comparison
Dose range
Cagrilintide
0.3–4.5 mg
Semaglutide
0.5–1 mg
Frequency
Cagrilintide
Once weekly
Semaglutide
Once weekly
Administration
Cagrilintide
Subcutaneous injection
Semaglutide
Subcutaneous injection
Cycle length
Cagrilintide
Continuous — trials ran 26 to 68 weeks with no planned stop
Semaglutide
Ongoing/indefinite
Onset speed
Cagrilintide
Gradual (3-4 weeks)
Semaglutide
Moderate (1-2 weeks)
Evidence level
Cagrilintide
Strong human trials (Phase 3 or FDA approved)
Semaglutide
Strong human trials (Phase 3 or FDA approved)
Benefit ratings
Appetite Control
Weight Loss
GLP-1 Synergy
Heart Protection
Compound specifications
Cagrilintide
Molecular formula
C194H312N54O59S2
Molecular weight
4409 g/mol
Half-life
159-195 hours (~7-8 days)
Bioavailability
~100% (subcutaneous)
CAS number
1415456-99-3
Semaglutide
Molecular formula
C187H291N45O59
Molecular weight
4113.58 g/mol
Half-life
Approximately 7 days (168 hours)
Bioavailability
89% (subcutaneous); 0.4-1% (oral, with absorption enhancer)
CAS number
910463-68-2
Dosing compared
Cagrilintide
Subcutaneous
0.3 mg
Once weekly · 26 weeks in the dose-finding trial
The lowest dose studied as monotherapy. Roughly 100 participants took it for 26 weeks; the cagrilintide groups as a whole lost 6.0% to 10.8% of body weight against 3.0% on placebo, with 0.3 mg at the bottom of that range [1]. Participants reached their assigned dose through an escalation period of up to 6 weeks; in the combination trials cagrilintide and semaglutide were co-escalated in 4-week steps over 16 weeks [2]. So there is a titration to your own target dose — there is not a ladder from one dose level to the next, because the dose groups ran in parallel and nobody crossed between them [1].
0.6 mg
Once weekly · 26 weeks in the dose-finding trial
A studied dose level, about 100 participants, 26 weeks [1]. Also one of the six cagrilintide doses tested alongside semaglutide 2.4 mg in the phase 1b trial [2].
1.2 mg
Once weekly · 26 weeks alone; 20 weeks in combination
In combination with semaglutide 2.4 mg this dose produced 15.7% weight loss at 20 weeks against 9.8% for semaglutide plus placebo — about 6 points of additional loss attributable to cagrilintide [2].
2.4 mg
Once weekly · 26 to 68 weeks depending on the trial
The dose that went forward. Every phase 3 trial uses 2.4 mg, both alone and as half of the fixed-dose CagriSema combination: REDEFINE 1 in 3,417 adults with obesity [3], REDEFINE 2 in 1,206 adults with type 2 diabetes [6], and REIMAGINE 2 in 2,713 people with type 2 diabetes, which carried a cagrilintide 2.4 mg monotherapy arm of 152 [7]. In the phase 1b trial 2.4 mg with semaglutide gave 17.1% weight loss at 20 weeks against 9.8% on semaglutide plus placebo [2]. Participants reached their assigned dose through an escalation period of up to 6 weeks; in the combination trials cagrilintide and semaglutide were co-escalated in 4-week steps over 16 weeks [2]. So there is a titration to your own target dose — there is not a ladder from one dose level to the next, because the dose groups ran in parallel and nobody crossed between them [1].
4.5 mg
Once weekly · 26 weeks in the dose-finding trial
The highest dose ever given to humans, and the top of the monotherapy dose-response: 10.8% weight loss (11.5 kg) at 26 weeks against 3.0% (3.3 kg) on placebo, and against 9.0% (9.6 kg) for liraglutide 3.0 mg — a 1.8 percentage point edge over liraglutide, p=0.03 [1]. It was not the dose taken into phase 3. A dedicated cardiac study escalated 53 healthy participants to 4.5 mg and found no clinically relevant QTc prolongation against placebo [8].
Semaglutide
Subcutaneous
4 weeks
0.25 mg
Once weekly · 4 weeks
This is the starter dose to help your body adjust. It does not lower blood sugar much on its own, so it is only used for the first 4 weeks before stepping up [5].
At least 4 weeks at each step
0.5-1 mg
Once weekly · At least 4 weeks at each step
After the starter month, the dose goes up to 0.5 mg, and can rise to 1 mg if more blood sugar control is needed. Wait at least 4 weeks before each increase [5].
Ongoing/maintenance
2-2.4 mg
Once weekly · Ongoing/maintenance
The highest weekly doses. 2 mg is the maximum for diabetes (Ozempic) [5]; up to 2.4 mg is used for weight management (Wegovy) after a slower titration.
Oral
30 days
3 mg
Once daily · 30 days
The pill form (Rybelsus) starts at 3 mg each morning for 30 days. Like the starter shot, this dose is for getting started and does not control blood sugar by itself. Take on an empty stomach with a small sip of water, 30 minutes before food or other pills [6].
30+ days
7 mg
Once daily · 30+ days
After the first 30 days, the dose increases to 7 mg once daily. This is the first dose that actively lowers blood sugar [6].
Ongoing/maintenance
14 mg
Once daily · Ongoing/maintenance
The highest pill dose, used if more blood sugar control is needed after at least 30 days at 7 mg [6].
Best suited for
Cagrilintide
Weight loss and appetite control
Cagrilintide excels at reducing hunger by mimicking amylin, a hormone your pancreas naturally releases after meals. Phase 2 trials showed people losing up to 10.8% of body weight with cagrilintide alone - and that's without combining it with other medications.
Boosting GLP-1 medication results
When you hit a plateau with semaglutide or want even better results, cagrilintide adds a second satiety pathway. The CagriSema combination achieved over 20% weight loss in clinical trials - significantly more than either drug alone.
People who want once-weekly convenience
Unlike older amylin medications that required three daily injections, cagrilintide's extended half-life of about a week means you only inject once weekly. Set a reminder on your phone and you're done.
Those seeking natural-feeling appetite reduction
Cagrilintide works by enhancing your body's own fullness signals rather than forcing you to eat less. Many users report feeling genuinely satisfied with smaller meals rather than fighting willpower battles.
Metabolic health improvement
Beyond weight loss, cagrilintide helps with blood sugar control and metabolic markers. It slows stomach emptying and reduces post-meal glucose spikes, making it valuable for people with or at risk for type 2 diabetes.
Semaglutide
People with Obesity Seeking Significant Weight Loss
If your BMI is 30 or higher (or 27+ with weight-related health conditions), semaglutide is currently one of the most effective non-surgical weight loss options available. [7] Clinical trials show average weight loss of 15% of body weight—that's 30+ pounds for someone starting at 200 pounds [1].
Those Who've Struggled with Diet and Exercise Alone
Semaglutide works by changing the biological signals that drive hunger and cravings. If you've tried to lose weight through willpower alone and found yourself constantly battling hunger, this medication addresses that underlying biology rather than just telling you to eat less [3][7][13].
People with Type 2 Diabetes Needing Better Control
Originally developed for diabetes, semaglutide excellently controls blood sugar while also promoting weight loss—addressing two major health concerns simultaneously. [3][5] It can often allow people to reduce or eliminate other diabetes medications [21].
Individuals at High Cardiovascular Risk
The SELECT trial proved that semaglutide reduces heart attacks, strokes, and cardiovascular death by 20% in people with obesity and existing heart disease—even without diabetes. It's one of the few weight loss medications proven to improve hard cardiovascular outcomes [2].
Side effects
Cagrilintide
Common
- Nausea
- Constipation
- Diarrhea
- Injection site reactions
Uncommon
- Vomiting
- Headache
Serious
- Severe allergic reactions
Semaglutide
Common
- Nausea
- Constipation or Diarrhea
- Decreased Appetite
- Vomiting
Uncommon
- Gallbladder Problems
- Hair Loss (Telogen Effluvium)
Serious
- Pancreatitis
- Thyroid Tumors (Theoretical Risk)
Safety & evidence
Cagrilintide
Evidence level
Strong human trials (Phase 3 or FDA approved)
FDA status
Not approved anywhere. Cagrilintide alone is not in any regulatory filing; the fixed-dose CagriSema combination with semaglutide was submitted to the FDA on 18 December 2025 and is under review.
Safety overview
Gastrointestinal effects are the dominant finding and they are common, not rare. In the 26-week dose-finding trial, gastrointestinal adverse events occurred in 41% to 63% of cagrilintide participants across the dose groups against 32% on placebo, with nausea in 20% to 47% against 18%; 73 of 906 participants (10%) stopped treatment permanently and 30 (4%) did so because of adverse events [1]. In the 68-week phase 3 obesity trial the combination with semaglutide produced gastrointestinal adverse events in 79.6% against 39.9% on placebo, mainly transient and mild to moderate [3]; in the type 2 diabetes phase 3 the figures were 72.5% against 34.4% [6]. In the 2,713-person REIMAGINE 2 trial, adverse events were reported by 82.2% (125 of 152) of those on cagrilintide 2.4 mg alone against 70.5% (105 of 149) on placebo [7]. A dedicated cardiac study in 105 healthy participants found no clinically relevant QTc prolongation at the highest studied dose of 4.5 mg against placebo [8].
Contraindications
- Pregnancy or breastfeeding — no human data
- Known hypersensitivity to cagrilintide or any excipient
- There is no approved label, so there is no authoritative contraindication list — everything here is inferred from trial exclusion criteria and the amylin class
Semaglutide
Evidence level
Strong human trials (Phase 3 or FDA approved)
FDA status
FDA approved for this use
Safety overview
Semaglutide has been studied in over 20,000 participants across multiple large clinical trials, making it one of the most thoroughly researched weight loss medications available. [1][2][8][9][10] The FDA approved it after rigorous review of safety data. While GI side effects are common (especially early on), serious side effects are rare. [1][7] The SELECT trial showed it actually reduces cardiovascular events, adding a safety benefit beyond just weight loss [2].
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
- History of serious allergic reaction to semaglutide
- Current or recent pancreatitis
- Pregnancy or planning to become pregnant
Which is right for you?
Choose Cagrilintide if...
- Weight loss
- Appetite control
- Metabolic health
- GLP-1 augmentation
Choose Semaglutide if...
- Significant weight loss
- Long-term weight management
- Cardiovascular risk reduction
- Blood sugar control