Cagrilintide
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.
Written by Michael Carroll — Owner, Director of Research · Reviewed by the Peptide Initiative Research Team · Editorial standards
Suggested dose
0.3 – 4.5 mg
Compound profile
Cagrilintide scientific & efficacy data
Weight Management
Peptide profile
Strong human trials
Cagrilintide
0.3 mg · Once weekly
Molecular formula
C194H312N54O59S2
- Mol. weight
- 4409 g/mol
- CAS number
- 1415456-99-3
- PubChem
- 171397054
- Developed · 2021
- Thomas Kruse
Novo Nordisk
Amino acid sequence
Lys-Cys-Asn-Thr-Ala-Thr-Cys-Ala-Thr-Gln-Arg-Leu-Ala-Asn-Phe-Leu-Val-Arg-Ser-Ser-Asn-Asn-Leu-Gly-Pro-Val-Leu-Pro-Pro-Thr-Asn-Val-Gly-Ser-Asn-Thr-Tyr-NH2 (acylated with C18 diacid via gamma-Glu linker)Appetite Control
Amylin is a pancreatic hormone released with insulin that signals satiety; cagrilintide is a long-acting version of it, engineered with a half-life of 159-195 hours so a single weekly injection holds the signal [2]. The mechanism is independent of GLP-1, which is why the two add together rather than overlap [4].
Weight Loss
On its own: up to 10.8% of body weight (11.5 kg) at 26 weeks at the 4.5 mg dose, against 3.0% (3.3 kg) on placebo [1]. Combined with semaglutide 2.4 mg: 20.4% at 68 weeks against 3.0% on placebo in 3,417 adults [3]. The second number is the pair, not the peptide — quoting 20% for cagrilintide alone is wrong by roughly a factor of two.
GLP-1 Synergy
The clearest demonstration is the phase 1b trial, where everyone received semaglutide 2.4 mg and only cagrilintide differed: 17.1% weight loss at 20 weeks with cagrilintide 2.4 mg against 9.8% with placebo added to the same semaglutide — about 7 percentage points attributable to cagrilintide [2]. In type 2 diabetes the combination also beat semaglutide alone on weight (-15.6% vs -5.1% at 32 weeks) though the HbA1c difference was small [5][7].
Dosing
How much Cagrilintide do I take?
0.3 – 4.5 mg · once weekly
0.3 – 4.5 mg
Once weekly
Covers all 5 documented dose levels · timing · dose-adjustment guidance.
Every documented dose level
| Phase | Dose | Frequency |
|---|---|---|
| 26 weeks in the dose-finding trial | 0.3 mg | Once weekly |
| 26 weeks in the dose-finding trial | 0.6 mg | Once weekly |
| 26 weeks alone; 20 weeks in combination | 1.2 mg | Once weekly |
| 26 to 68 weeks depending on the trial | 2.4 mg | Once weekly |
| 26 weeks in the dose-finding trial | 4.5 mg | Once weekly |
Suitability
Is Cagrilintide right for me?
Best for weight loss & appetite control
Best for
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.
Consider alternatives if
Do not use if
Use with caution if
Not sure?
Compare Cagrilintide with similar peptides to find the best fit for your goals.
Administration
How do I use Cagrilintide?
Subcutaneous injection
Route
Subcutaneous injection once weekly
Best sites
Covers reconstitution · step-by-step technique · storage · a sample daily schedule.
Safety
Is Cagrilintide safe?
4 common side effects · 3 serious
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].
Cagrilintide is not approved anywhere, so none of this comes from a regulator-reviewed label — it comes from the trials, all of them funded and run by Novo Nordisk.
Monotherapy evidence is thinner than the phase 3 headline numbers suggest: about 100 participants per dose group for 26 weeks in the dose-finding trial [1], 302 in the REDEFINE 1 cagrilintide arm [3], and 152 in REIMAGINE 2 [7].
Most of the large-scale safety data describes the COMBINATION with semaglutide, where the two drugs cannot be separated. There is no data beyond 68 weeks, none in pregnancy, and none in people using cagrilintide without medical supervision.
Less common
These typically resolve with continued use or dose adjustment.
Common side effects · experienced by some users
Nausea
The most frequently reported side effect, affecting 20-47% of users depending on dose. Usually mild and improves over the first few weeks.
Management: Start with lower doses and titrate slowly. Eat smaller, more frequent meals. Avoid greasy or heavy foods.
Constipation
Occurs due to slowed gastric emptying and reduced food intake. Reported in 15-25% of users.
Management: Increase fiber and water intake. Stay physically active. Consider a stool softener if needed.
Diarrhea
May occur especially during dose adjustments. Usually temporary and mild to moderate.
Management: Stay well hydrated. Avoid foods that trigger symptoms. Usually resolves within 1-2 weeks.
Injection site reactions
Mild redness, swelling, or itching at injection sites. Generally resolves quickly.
Management: Rotate injection sites regularly. Ensure proper injection technique. Apply ice if needed.
Stop and seek help if
- Severe allergic reaction (rash, swelling, difficulty breathing)
- Persistent severe nausea or vomiting not improving with dose reduction
- Signs of pancreatitis (severe abdominal pain radiating to back)
- Planned pregnancy or positive pregnancy test
- Inability to maintain adequate nutrition despite dose adjustments
- Any concerning symptoms your healthcare provider advises stopping for
Always consult your healthcare provider before stopping or modifying your dose. Do not stop abruptly without medical guidance, especially if you are also on diabetes medications.
With other peptides
- Safe:Semaglutide — Designed to be combined - the CagriSema combination shows enhanced weight loss through complementary mechanisms
- Safe:Tirzepatide — May be combined, but both affect appetite strongly - monitor for excessive appetite suppression
- Safe:BPC-157 — Generally safe to combine for gut support during weight loss
- Caution:Pramlintide — Do NOT combine - both are amylin analogs with overlapping mechanisms
With medications
- Caution:Insulin — Increases hypoglycemia risk - insulin dose may need reduction, especially post-meal doses
- Caution:Sulfonylureas — Increased hypoglycemia risk - may need dose adjustment with provider guidance
- Safe:Metformin — Generally safe to combine - may provide complementary metabolic benefits
- Safe:Oral medications — Slowed gastric emptying may affect absorption timing - take critical meds separately
With supplements
- Safe:Protein supplements — Highly recommended to maintain muscle mass during weight loss
- Safe:Fiber supplements — Can help with constipation - take with plenty of water
- Safe:Multivitamins — Recommended as reduced food intake may limit nutrient intake
- Safe:Electrolytes — Helpful if experiencing GI side effects to prevent dehydration
Effectiveness
How do I know Cagrilintide is working?
Strong human trials · first signs weeks 1-6
Evidence level
Strong human trials
(Phase 3 or FDA approved)
Regulatory 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.
Onset of effects
Gradual
(3-4 weeks)
How it works
Cagrilintide is a lab-made version of amylin, a hormone your pancreas releases right after you eat.
Think of amylin as your body's natural 'I'm full' signal - it tells your brain to stop eating and slows down how fast food leaves your stomach so you feel satisfied longer. The problem with natural amylin is it only lasts about 15-20 minutes.
Cagrilintide is specially designed to last about a week, so you only need one injection and the fullness signals keep working day after day.
The deeper mechanism
Cagrilintide is a lipidated 37-amino acid amylin analog with dual agonist activity at both amylin receptors (AMY1-3) and calcitonin receptors (CTR).
The C18 diacid fatty acid chain attached via a gamma-glutamate linker enables non-covalent albumin binding, extending the half-life to 159-195 hours and permitting once-weekly dosing.
The peptide activates receptors in the area postrema and nucleus of the solitary tract, promoting meal-ending satiation through descending neural pathways to hypothalamic feeding centers.
Secondary mechanisms include delayed gastric emptying, suppression of postprandial glucagon secretion, and potential effects on energy expenditure through preventing compensatory metabolic adaptation.
When combined with GLP-1 receptor agonists like semaglutide, the complementary receptor activation produces synergistic effects on weight loss through independent but convergent satiety pathways.
What to expect
Weeks 1-6
What you might notice
- This is the escalation window — trials took up to 6 weeks to reach the assigned dose [1], or 16 weeks when co-escalated with semaglutide [2]
- Gastrointestinal effects are most likely here and are common, not rare: 41-63% across the cagrilintide groups against 32% on placebo [1]
What's normal
What's next
- 4% of the 906 phase 2 participants stopped because of adverse events — if effects are severe, that is a conversation with a prescriber, not something to push through [1]
Week 26
What you might notice
- The endpoint of the monotherapy trial. Weight loss ranged 6.0% to 10.8% (6.4-11.5 kg) across the 0.3-4.5 mg dose groups against 3.0% (3.3 kg) on placebo [1]
- At the top dose that was 10.8% against 9.0% for liraglutide 3.0 mg — better, by 1.8 percentage points (p=0.03) [1]
What's normal
- Loss below the headline figure: the range starts at 6.0%, and the 10.8% is the highest dose in the best case [1]
What's next
- No monotherapy trial has run past 26 weeks, so nothing beyond this point is established for cagrilintide alone [1]
Week 68 (combination only)
What you might notice
- The phase 3 endpoint, and it belongs to the COMBINATION with semaglutide, not to cagrilintide alone: 20.4% against 3.0% on placebo in 3,417 adults [3], and 13.7% against 3.4% in 1,206 adults with type 2 diabetes [6]
- Gastrointestinal effects persisted at that scale — 79.6% against 39.9% on placebo [3]
What's next
- The combination is under FDA review; cagrilintide alone is in no regulatory filing [3]
Signs it's working
Weight loss indicators
- Clothes fitting more loosely
- Scale showing consistent weekly weight reduction
- Reduced waist circumference
- Visible changes in body composition
- Need to tighten belt or buy smaller sizes
Appetite and eating changes
- Feeling satisfied with smaller portions
- Reduced interest in snacking between meals
- Less food noise and obsessive food thoughts
- Natural preference for lighter, smaller meals
- Ability to stop eating when full
Metabolic improvements
- Better blood sugar readings (if monitored)
- Improved fasting glucose on lab work
- More stable energy throughout the day
- Reduced post-meal sluggishness
- Better cholesterol and triglyceride levels
Not seeing results? Common reasons
- Dose too low - may need to increase to therapeutic levels (2.4mg or higher)
- Not enough time - meaningful results typically take 8-12 weeks at adequate doses
- Calorie-dense liquid calories bypassing satiety signals - watch smoothies, alcohol, sugary drinks
- Eating through fullness signals - pay attention to your body's cues
- Inconsistent dosing schedule - must be same day each week for optimal levels
- Unrealistic expectations - 1-2 lbs per week is healthy, sustainable weight loss
Key research
Clinical trials
Cagrilintide tested in people
68 registered studies, 11 still enrolling.
By phase
A trial spanning two phases is counted in both, so these can sum above the total. Observational studies carry no phase.
What kind of research
About 35,373 people took part in the studies that actually administered Cagrilintide. Observational studies analyse the records of people already taking it — nobody was given anything for the study, so they are counted separately and cannot show cause and effect.
Most recent
A Research Study to Compare Two Different Versions of Injectable CagriSema in People With Type 2 Diabetes
Novo Nordisk A/S
NN9838-4968
Novo Nordisk A/S
A Research Study to See How Much CagriSema Lowers Blood Sugar and Body Weight Compared to Placebo in Children and Adolescents With Type 2 Diabetes
Novo Nordisk A/S
Sources: ClinicalTrials.gov, the EU Clinical Trials Information System and ISRCTN, deduplicated so a study registered twice is counted once. A study is counted when Cagrilintide is named as an intervention; studies that only mention it in passing are not.
Questions
Frequently asked about Cagrilintide
How is cagrilintide different from semaglutide?
They work through completely different mechanisms. Semaglutide mimics GLP-1, while cagrilintide mimics amylin - both are natural satiety hormones but they activate different receptors in your brain. Think of them as two different volume knobs for your hunger signals. That's why combining them (CagriSema) works so well - you're turning down appetite through two separate pathways.
When will cagrilintide be FDA approved?
Novo Nordisk submitted CagriSema (the combination of cagrilintide and semaglutide) to the FDA in 2025 based on successful Phase 3 trials. Approval is anticipated, but exact timing depends on the FDA review process. Cagrilintide alone is currently being studied for its own dedicated approval pathway.
Can I use cagrilintide by itself or does it need to be combined with semaglutide?
Cagrilintide works effectively on its own - the Phase 2 trial showed 10.8% weight loss with cagrilintide alone at the highest dose. However, the combination with semaglutide (CagriSema) produces even better results - around 20% weight loss. Your provider can help determine which approach is right for your goals.
What if I'm already on semaglutide - can I add cagrilintide?
Yes, that's actually the strategy behind CagriSema. If you've plateaued on semaglutide or want enhanced results, adding cagrilintide targets a complementary satiety pathway. Clinical trials show the combination significantly outperforms either drug alone for weight loss.
How long until I notice results with cagrilintide?
Most people notice reduced appetite within the first 1-2 weeks. Meaningful weight loss typically becomes apparent by weeks 4-8 as doses are titrated up. Maximum results are seen over 6-12 months of consistent use. Remember, healthy weight loss of 1-2 pounds per week is both safe and sustainable.
Are the side effects better or worse than GLP-1 medications?
The side effect profiles are similar - both primarily cause GI symptoms like nausea and constipation. Some data suggests cagrilintide may be slightly better tolerated, with lower rates of nausea in head-to-head comparisons. Most side effects improve within the first few weeks and can be minimized with gradual dose increases.
Will I regain weight if I stop taking cagrilintide?
Like other weight loss medications, stopping cagrilintide typically leads to weight regain because the underlying biology driving weight gain remains. These medications are designed for long-term use. Maintaining weight loss usually requires ongoing treatment combined with sustained lifestyle changes.
Is cagrilintide safe for people with diabetes?
Yes, cagrilintide has been studied specifically in people with type 2 diabetes. It can improve blood sugar control in addition to promoting weight loss. However, if you're on insulin or sulfonylureas, doses may need adjustment to prevent low blood sugar. Always work with your healthcare provider.
Ready for the protocol?
Every dosing tier, administration route, timing note, and dose-adjustment rule for Cagrilintide, on one page.