Cagrilintide + Tirzepatide
Weekly appetite pair
Experimental material. Read before using anything from here.
Nothing on this page is a medical recommendation, prescription or treatment plan. It is an organized translation of protocols circulating in research communities and, where it exists, of what published trials tested. The two are marked differently — and they are not equivalent.
Most of the compounds here have no FDA approval for human use. Several are sold labeled "research use only", which means they have not gone through purity, sterility or dosage controls for human consumption. A community-reported dose is not a validated dose: it is what someone reported having done.
Talk to a licensed health professional before considering any of these compounds. If you already use one and feel anything unexpected, seek care — do not wait for the next routine test.
Absolute contraindication, in Brazil and in the United States
Tirzepatide carries an FDA black box warning for thyroid C-cell tumors in rats, dependent on dose and treatment duration, at clinically relevant exposures. Whether it causes them in humans is unknown.
It is contraindicated in anyone with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2). Unlike semaglutide, the Brazilian package insert for MOUNJARO carries this contraindication in section 4, with the same scope as the American one. It is also contraindicated in anyone who has had severe hypersensitivity: there are reports of anaphylaxis and angioedema.
This warning was not on this page until September 4, 2026, and the failure was this site's, not the source's. The audit of the dose tables against the FDA package inserts is in The GLP-1s against the package insert.
Summary
Brings together two weekly weight-loss peptides. Tirzepatide is a dual GLP-1/GIP agonist, approved as Mounjaro and Zepbound. Cagrilintide comes in as an add-on for satiety, at the lowest dose, with tirzepatide already stable.
Quick reference
- Format
- Two separate vials is the standard. Some suppliers sell pre-mixed (e.g., 5 mg / 5 mg).
- Schedule
- Both 1×/week. Same day, different injection sites.
- Titration
- Start with tirzepatide alone for 8 weeks, then add cagrilintide at 0.25 mg/week.
- Origin
- Tirzepatide can be prescription (Mounjaro/Zepbound) or research grade. Cagrilintide is research only.
Full Staggered Titration Schedule
| Phase | Weeks | Tirzepatide | Cagrilintide | Notes |
|---|---|---|---|---|
| Tirz initiation | 1-4 | 2.5 mg/week | Not started | Confirm tirzepatide GI tolerance first. |
| Tirz escalation 1 | 5-8 | 5.0 mg/week | Not started | Continue tirzepatide alone. |
| Cag introduction | 9-12 | 5.0 mg/week (hold) | 0.25 mg/week | Add cagrilintide at the lowest dose. Hold tirz steady. |
| Dual escalation 1 | 13-16 | 7.5 mg/week | 0.5 mg/week | GI effects often peak here. |
| Dual escalation 2 | 17-20 | 10.0 mg/week | 1.0 mg/week | Both compounds step up. |
| Dual escalation 3 | 21-24 | 12.5 mg/week | 1.7 mg/week | Approach maintenance. |
| Maintenance | 25+ | 15.0 mg/week | 2.4 mg/week | Full 3-receptor coverage if tolerated. |
Cycle Guidelines
| Approach | Duration | Off period | Best for |
|---|---|---|---|
| Full staggered titration | 24-week ramp + open-ended maintenance | No standardized off period | Primary weight-loss strategy with full pathway coverage |
| Tirz-first, cag add-on | Stabilize tirzepatide at 10-15 mg, then add cag for 12+ weeks | Cag can be cycled on its own | Users already on tirzepatide who want more satiety |
| Sub-maximal combination | Lower doses of each (e.g. tirz 10 mg + cag 1.2 mg) | As needed | Tolerability-focused; based on Valdecantos 2024 sub-max data |
Tirzepatide Reconstitution Math
| Vial size | BAC water added | Concentration | 2.5 mg | 5 mg | 10 mg | 15 mg |
|---|---|---|---|---|---|---|
| 5 mg | 1.0 mL | 5 mg/mL | 0.50 mL (50 units) | 1.00 mL (100 units) | N/A | N/A |
| 10 mg | 2.0 mL | 5 mg/mL | 0.50 mL (50 units) | 1.00 mL (100 units) | 2.00 mL (200 units*) | 3.00 mL (300 units*) |
| 10 mg | 1.0 mL | 10 mg/mL | 0.25 mL (25 units) | 0.50 mL (50 units) | 1.00 mL (100 units) | 1.50 mL (150 units*) |
| 30 mg | 3.0 mL | 10 mg/mL | 0.25 mL (25 units) | 0.50 mL (50 units) | 1.00 mL (100 units) | 1.50 mL (150 units*) |
Cagrilintide Reconstitution Math
| Vial size | BAC water added | Concentration | 0.25 mg | 0.5 mg | 1.0 mg | 2.4 mg |
|---|---|---|---|---|---|---|
| 5 mg | 2.0 mL | 2.5 mg/mL | 0.10 mL (10 units) | 0.20 mL (20 units) | 0.40 mL (40 units) | 0.96 mL (96 units) |
| 10 mg | 2.0 mL | 5.0 mg/mL | 0.05 mL (5 units) | 0.10 mL (10 units) | 0.20 mL (20 units) | 0.48 mL (48 units) |
| 10 mg | 1.0 mL | 10.0 mg/mL | 0.025 mL (2.5 units) | 0.05 mL (5 units) | 0.10 mL (10 units) | 0.24 mL (24 units) |
Cagrilintide + Tirzepatide vs CagriSema vs Cagrilintide + Retatrutide
| Feature | Cagrilintide + Tirzepatide | CagriSema (cagrilintide + semaglutide) | Cagrilintide + Retatrutide |
|---|---|---|---|
| Components | Cagrilintide + Tirzepatide | Cagrilintide + Semaglutide | Cagrilintide + Retatrutide |
| Receptor coverage | AMY + GLP-1R + GIPR (3 families) | AMY + GLP-1R (2 families) | AMY + GLP-1R + GIPR + GCGR (4 families) |
| Combination clinical data | Preclinical only (Valdecantos 2024) | Phase 3 REDEFINE-1: ~22.7% at 68 weeks | None (fully speculative) |
| Best monotherapy result | Tirzepatide: 25.5% at 84 weeks | Semaglutide: ~14.9% at 68 weeks | Retatrutide: 28.7% at 68 weeks |
| GIP receptor | Yes (tirzepatide) | No | Yes (retatrutide) |
| Glucagon receptor | No | No | Yes (retatrutide) |
| Dysesthesia risk | No | No | Yes (retatrutide) |
| FDA-approved component | Yes (tirzepatide as Mounjaro / Zepbound) | Semaglutide approved; cag not | Neither approved |
| Injections per week | 2 (separate vials) | 1 or 2 | 2 (separate) or 1 (pre-blend) |
| Estimated grey-market cost | $500-$1,000/month | $500-$900/month | $600-$1,200/month |
Storage and handling
The rules below apply to practically every lyophilized peptide in this reference. Where a compound has its own requirement, it appears in the table in the previous section.
- Lyophilized powder, sealed: refrigerator, between 2 and 8 °C, protected from light. Many tolerate room temperature for short transport periods, but that is tolerance, not a recommendation.
- After reconstitution: always refrigerated, between 2 and 8 °C. The stability window drops to days or a few weeks, depending on the compound.
- Never freeze after reconstituting. The freeze–thaw cycle degrades the peptide.
- Do not shake. Swirl the vial slowly. Shaking breaks the peptide chain.
- Bacteriostatic water down the wall of the vial, in a slow stream, not squirted directly onto the powder.
- Cloudy solution, with particles or a color change: discard. There is no recovery.
Lab tests and monitoring
This list is the one that appears recurrently in the source, with small variations by compound. It serves as a starting point for a conversation with a professional — not as a substitute for that conversation.
- Before starting: complete blood count, comprehensive metabolic panel, lipid panel, fasting glucose and HbA1c, TSH and free T4, blood pressure and resting heart rate.
- Depending on the compound: IGF-1 (GH axis), lipase and amylase (VIP and the incretin agonists), serum copper and ceruloplasmin (GHK-Cu and blends containing it), CRP.
- Reassessment: most protocols review between week 4 and week 8, and then every 8–12 weeks.
- Do not wait for the routine lab test in the face of abdominal pain, visual changes, a change in a mole, shortness of breath, asymmetric swelling or any new and persistent symptom. That is a reason to seek care, not a spreadsheet item.
Evidence limits
Data source: peptidedosingprotocols.com, accessed on September 3, 2026. Translation and organization in Portuguese are original work. No primary source (PubMed, trial registry, package insert) was checked in building this page — the check was against the secondary source, and that alone.