Cagrilintide vs Tirzepatide
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 dual-action powerhouse that targets both GIP and GLP-1 receptors, delivering the most dramatic weight loss results ever seen in a medication—averaging over 20% body weight reduction while also crushing blood sugar levels in people with diabetes.
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
Tirzepatide
5–10 mg
Frequency
Cagrilintide
Once weekly
Tirzepatide
Once weekly
Administration
Cagrilintide
Subcutaneous injection
Tirzepatide
Subcutaneous injection
Cycle length
Cagrilintide
Continuous — trials ran 26 to 68 weeks with no planned stop
Tirzepatide
Ongoing/indefinite
Onset speed
Cagrilintide
Gradual (3-4 weeks)
Tirzepatide
Moderate (1-2 weeks)
Evidence level
Cagrilintide
Strong human trials (Phase 3 or FDA approved)
Tirzepatide
Strong human trials (Phase 3 or FDA approved)
Benefit ratings
Appetite Control
Weight Loss
GLP-1 Synergy
Blood Sugar Control
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
Tirzepatide
Molecular formula
C225H348N48O68
Molecular weight
4813.45 g/mol
Half-life
Approximately 5 days (120 hours)
Bioavailability
~80% (subcutaneous)
CAS number
2023788-19-2
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].
Tirzepatide
Subcutaneous injection
First 4 weeks
2.5 mg
Once weekly · First 4 weeks
FDA label starting dose; non-therapeutic, used only to improve GI tolerability before escalating [5]. Inject in abdomen, thigh, or upper arm and rotate sites.
Increase by 2.5 mg after at least 4 weeks at each dose
5-10 mg
Once weekly · Increase by 2.5 mg after at least 4 weeks at each dose
Per FDA label, increase to 5 mg after 4 weeks; further increases in 2.5 mg steps no sooner than every 4 weeks as needed [5].
Ongoing maintenance
12.5-15 mg
Once weekly · Ongoing maintenance
15 mg is the maximum FDA-labeled dose [5]. SURMOUNT-1 used up to 15 mg weekly for obesity [1].
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.
Tirzepatide
People Who Want Maximum Weight Loss Results
If you're serious about losing significant weight, tirzepatide delivers results that were previously only achievable through bariatric surgery. Clinical trials showed average weight loss exceeding 20% of body weight—that's 50+ pounds for someone starting at 250 pounds. No other medication comes close [1].
Those Who Haven't Succeeded with Semaglutide
Thanks to its dual GIP/GLP-1 mechanism, tirzepatide often works better for people who had limited results with GLP-1-only drugs like semaglutide. The added GIP activation provides extra metabolic benefits that can break through plateaus and deliver superior weight loss [2][9].
People with Type 2 Diabetes Needing Aggressive Control
Head-to-head trials proved tirzepatide beats semaglutide for blood sugar control. The average HbA1c reduction of over 2 percentage points means many people can dramatically reduce or eliminate other diabetes medications. It's a genuine game-changer for metabolic health [2].
Individuals Looking to Transform Their Relationship with Food
Tirzepatide doesn't just reduce hunger—it fundamentally changes how food appeals to you. Users describe feeling free from constant food thoughts, finding it easy to stop eating when satisfied, and losing interest in formerly irresistible treats. It's not willpower—it's biochemistry working for you [11].
Side effects
Cagrilintide
Common
- Nausea
- Constipation
- Diarrhea
- Injection site reactions
Uncommon
- Vomiting
- Headache
Serious
- Severe allergic reactions
Tirzepatide
Common
- Nausea
- Diarrhea
- Decreased Appetite
- Vomiting
Uncommon
- Gallbladder Problems
- Hair Thinning (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
Tirzepatide
Evidence level
Strong human trials (Phase 3 or FDA approved)
FDA status
FDA approved for this use
Safety overview
Tirzepatide has been extensively studied in the SURPASS (diabetes) and SURMOUNT (obesity) trial programs, involving thousands of participants over multiple years. [1][2][3] The FDA approved it after thorough safety review. [5][6] While GI side effects are common (especially during dose increases), they're typically mild to moderate and improve over time. [5][6] Serious adverse events are rare. The SURPASS-CVOT trial is ongoing to evaluate long-term cardiovascular outcomes. [16]
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC) [6]
- Multiple Endocrine Neoplasia syndrome type 2 (MEN2) [6]
- History of serious allergic reaction to tirzepatide [6] or any GLP-1/GIP medication
Which is right for you?
Choose Cagrilintide if...
- Weight loss
- Appetite control
- Metabolic health
- GLP-1 augmentation
Choose Tirzepatide if...
- Maximum weight loss results
- Long-term obesity management
- Type 2 diabetes control
- Metabolic health improvement