Cagrilintide
AM833 · Cagri · NNC0174-0833
Long-acting amylin analogue run weekly for satiety, usually alongside a GLP-1.
Typical dose
2.4 mg
once weekly
Range
0.3–4.5
mg
Half-life
6.6 days
see Dosing
Evidence
Human trials
Subcutaneous
What it is
Cagrilintide is a lipidated, long-acting analogue of amylin, the hormone co-secreted with insulin from pancreatic beta cells. Native amylin has a half-life of minutes and aggregates readily; cagrilintide was engineered around both problems, giving a molecule that can be injected once a week.
It is the non-GLP-1 half of the appetite equation. In its phase 2 monotherapy trial, 4.5 mg weekly produced roughly 10-11% weight loss over 26 weeks. Combined with semaglutide 2.4 mg as CagriSema, phase 3 (REDEFINE 1) reported about 20% at 68 weeks, versus roughly 15% for semaglutide alone.
The honest caveat: in a head-to-head phase 3 (REDEFINE 4), CagriSema failed to show non-inferiority against tirzepatide. Cagrilintide adds meaningfully to a GLP-1, but it is not a shortcut past the best single agents.
Nothing containing cagrilintide is approved anywhere. Everything on the grey market is unlicensed material of unverified identity and purity.
How it works
Amylin signals through calcitonin receptors paired with RAMP accessory proteins, concentrated in the area postrema and hindbrain. Activating them slows gastric emptying, suppresses glucagon after meals, and produces a satiety signal that is separate from and additive to the GLP-1 pathway.
Cagrilintide keeps that pharmacology but adds a C20 fatty acid that binds albumin, plus substitutions that stop the peptide fibrillating. The result is a weekly drug that hits an appetite circuit GLP-1 agonists do not touch, which is why the two are combined rather than swapped.
Dosing
2.4 mg is the dose taken through phase 3 in CagriSema; 4.5 mg was the top monotherapy dose in phase 2 and brought more nausea with it.
Standard titration
| Step | Dose | Note |
|---|---|---|
| Weeks 1-4 | 0.3 mg | Starting dose — assess GI tolerance |
| Weeks 5-8 | 0.6 mg | Hold longer if nausea has not settled |
| Weeks 9-12 | 1.2 mg | — |
| Weeks 13-16 | 2.4 mg | Trial maintenance dose for most people |
| Week 17+ | 4.5 mg | Optional; only worth it if 2.4 mg is well tolerated and has stalled |
Reconstitution calculator
Pre-loaded with Cagrilintide’s vial size, water volume and typical dose. Change anything.
Typical: 2.4 mg · range 0.3–4.5
Draw to
48 u
0.48 mL · 2.4 mg
Concentration
5 mg/mL
50 mcg per unit
Doses per vial
2.1
Vial lasts
2 weeks 1 day
CheckThe draw fills more than 90% of the barrel. Workable, but there is no room for an air bubble or a correction.
Once mixed
2-8 C, used within about 4 weeks when reconstituted with bacteriostatic water; discard sooner if the solution clouds or shows particles.
1 mL of bacteriostatic water into a 5 mg vial gives 5 mg/mL, so 2.4 mg is 48 units on a U-100 insulin syringe and a 0.3 mg starting dose is 6 units. Aim the stream down the glass wall, then swirl until clear — never shake.
Storage
Before mixing
Fridge at 2-8 C, protected from light; stable for years lyophilised and tolerates a few weeks at room temperature in transit.
After mixing
2-8 C, used within about 4 weeks when reconstituted with bacteriostatic water; discard sooner if the solution clouds or shows particles.
Reported benefits
- ▪Meaningful appetite suppression through a pathway independent of GLP-1
- ▪Adds roughly 5 percentage points of weight loss on top of semaglutide in phase 3
- ▪Around 10-11% weight loss as a standalone at 4.5 mg over 26 weeks
- ▪Slows gastric emptying and blunts post-meal glucagon
- ▪Once-weekly injection with no dosing-time constraints
- ▪Some users tolerate it better than pushing a GLP-1 to its ceiling dose
Side effects
- ▪Nausea, most pronounced in the first days after each dose escalation
- ▪Vomiting and constipation, worse when stacked with a GLP-1
- ▪Reduced appetite that can push intake far below target if not managed
- ▪Injection site redness or nodules
- ▪Fatigue and dehydration secondary to reduced food and fluid intake
- ▪Gallstone risk that tracks with the rate of weight loss, not the drug itself
- ▪Lean mass loss without adequate protein and resistance training
- ▪Markedly delayed gastric emptying — the stomach can still hold solid food many hours after a meal, so any surgery, endoscopy or procedural sedation needs the drug held beforehand and the anaesthetist told, because of retained gastric contents and aspiration risk
- ▪Acute pancreatitis — not established for cagrilintide on its own, but a recognised risk of the GLP-1 it is almost always run alongside; severe persistent upper abdominal pain radiating to the back means stop and get assessed.
Do not use if
- ▪Pregnancy or breastfeeding
- ▪Gastroparesis or another significant GI motility disorder
- ▪Prior pancreatitis
- ▪Active eating disorder or a history of restrictive eating
- ▪Insulin or sulfonylurea users without downward dose adjustment — hypoglycaemia risk
Evidence level — Human trials
Controlled human clinical data exists.
Not approved in any market; cagrilintide is an investigational drug filed with the FDA as part of the CagriSema combination and is sold to individuals only as a research chemical.
Commonly run with
Semaglutide
Long-acting GLP-1 agonist dosed weekly; the reference compound for appetite-driven fat loss.
1 mg · Once weekly
Tirzepatide
Weekly dual GIP/GLP-1 agonist; beats semaglutide on total weight loss in head-to-head data.
5 mg · Once weekly
Survodutide
Weekly glucagon/GLP-1 dual agonist that raises energy expenditure as well as cutting appetite.
3.6 mg · once weekly
Cagrilintide FAQ
Is cagrilintide worth running without a GLP-1?+
It works alone — phase 2 monotherapy produced about 10-11% loss at 4.5 mg over 26 weeks. But the whole design case for it is additive satiety, and the combination data are substantially stronger than either agent by itself.
Can I inject it in the same syringe as semaglutide?+
The commercial product is a co-formulation, but two separately reconstituted grey-market vials are not the same thing and mixing them yourself risks pH incompatibility and aggregation. Draw and inject them separately, on the same day.
Why does it make me feel full so fast rather than just less hungry?+
Amylin's main peripheral effect is slowed gastric emptying, so meals sit in the stomach longer. That is also why large or fatty meals are the ones that trigger nausea — smaller, lower-fat meals usually fix it.
Does it cause the same muscle loss complaints as GLP-1s?+
Any drug producing this rate of weight loss will take lean mass with it if protein and training are neglected. There is preclinical interest in amylin analogues preserving a better fat-to-lean ratio, but no human body-composition data strong enough to rely on.
References
- 1.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 — The Lancet (2021) PMID 34798060
- 2.Development of Cagrilintide, a Long-Acting Amylin Analogue — Journal of Medicinal Chemistry (2021) PMID 34288673
- 3.Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity — The New England Journal of Medicine (2025) PMID 40544433
- 4.Cagrilintide-Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes — The New England Journal of Medicine (2025) PMID 40544432
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