CagriSema
Cagrilintide 2.4 mg + semaglutide 2.4 mg, fixed dose
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.
Black box warning in the US, caution in Brazil — and the two package inserts disagree
Semaglutide carries the strongest warning the FDA applies to a medicine. In rodents it causes thyroid C-cell tumors in a dose- and treatment-duration-dependent manner, at clinically relevant exposures. Whether it causes them in humans is unknown.
In the United States this is an absolute contraindication in anyone with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2). In Brazil, it is not. The package inserts of Ozempic, Wegovy and Rybelsus contraindicate only hypersensitivity; on MTC, they say to use with caution and classify human relevance as considered low. Here, the prescriber decides — not the package insert.
There are reports of anaphylaxis and angioedema with semaglutide, and that is a contraindication in both countries.
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
Weekly fixed-dose combination of cagrilintide 2.4 mg (long-acting amylin analog) and semaglutide 2.4 mg (GLP-1 receptor agonist), developed by Novo Nordisk for chronic weight management. Unlike the other combinations in this section, it is a single product in formal development, not a user-made pairing.
Quick reference
- Reconstitution
- Pre-mixed vial: bacteriostatic water per the specification. Separate vials: reconstitute each one.
- Dose
- Final weekly target: cagrilintide 2.4 mg + semaglutide 2.4 mg.
- Titration
- About 16 weeks of escalation before maintenance, mirroring the REDEFINE protocol.
- Status
- Investigational; NDA filed with the FDA in December 2025; not approved.
Typical 16-Week Titration
| Week | Cagrilintide | Semaglutide | Notes |
|---|---|---|---|
| 1–4 | 0.25 mg | 0.25 mg | Initiation: gastrointestinal tolerability is highest priority. |
| 5–8 | 0.5 mg | 0.5 mg | Early escalation; nausea typically peaks in this window. |
| 9–12 | 1.0 mg | 1.0 mg | Mid escalation. |
| 13–16 | 1.7 mg | 1.7 mg | Late escalation. |
| 17+ | 2.4 mg | 2.4 mg | Maintenance research-target dose. |
Cycle Guidelines
| Approach | Duration | Off period | Best for |
|---|---|---|---|
| Trial-mirroring cycle | 68 weeks | Per clinician guidance | Matching REDEFINE 1 / REDEFINE 2 clinical trials. |
| Standard research cycle | 12–24 weeks | 4–8 weeks | Most planning windows; aligns with phase 2 obesity trial readouts. |
| Short investigative cycle | 8–12 weeks | 4 weeks | Tolerability and titration assessment only. |
Reconstitution by Vial Format
| Total mg per vial | BAC water added | Concentration (combined) | Approx weekly draw at 4.8 mg total |
|---|---|---|---|
| 20 mg (4 full doses) | 2.0 mL | 10 mg/mL | 0.48 mL = 48 units U-100 |
| 20 mg (4 full doses) | 3.0 mL | 6.67 mg/mL | 0.72 mL = 72 units U-100 |
| 20 mg (4 full doses) | 2.5 mL | 8 mg/mL | 0.60 mL = 60 units U-100 |
Reconstitution by Vial Format
| Compound | Vial size | BAC water added | Concentration | Weekly draw at 2.4 mg |
|---|---|---|---|---|
| Cagrilintide | 5 mg | 2.0 mL | 2.5 mg/mL | 0.96 mL = 96 units U-100 |
| Cagrilintide | 10 mg | 3.0 mL | 3.33 mg/mL | 0.72 mL = 72 units U-100 |
| Semaglutide | 5 mg | 2.0 mL | 2.5 mg/mL | 0.96 mL = 96 units U-100 |
| Semaglutide | 10 mg | 3.0 mL | 3.33 mg/mL | 0.72 mL = 72 units U-100 |
Stability window after reconstitution
| Cagrilintide | Semaglutide | Pre-blended CagriSema | |
|---|---|---|---|
| Lyophilized (powder form) | −20 °C, long term | −20 °C, long term | −20 °C, long term |
| Reconstituted (liquid form) | 2–8 °C | 2–8 °C | 2–8 °C |
| Appearance | Clear after reconstitution | Clear after reconstitution | Clear after reconstitution |
| Stability window after reconstitution | Up to ~28 days refrigerated | Up to ~28 days refrigerated | Per supplier COA |
CagriSema vs Tirzepatide vs Semaglutide Alone
| Feature | CagriSema | Tirzepatide (Zepbound) | Semaglutide alone (Wegovy) | Cagrilintide alone |
|---|---|---|---|---|
| Receptor targets | Amylin/calcitonin + GLP-1 | GIP + GLP-1 | GLP-1 | Amylin/calcitonin (DACRA) |
| Dosing frequency | 1×/week | 1×/week | 1×/week | 1×/week |
| Maintenance dose | 2.4 mg + 2.4 mg | Up to 15 mg | 2.4 mg | 2.4 mg (in REDEFINE arms) |
| Headline weight loss | −20.4% at 68 wks (REDEFINE 1, treatment-policy) | Up to −22.5% at 72 wks (SURMOUNT-1, 15 mg arm) | −14.9% at 68 wks (REDEFINE 1 reference arm) | −11.5% at 68 wks (REDEFINE 1 reference arm) |
| FDA status (June 2026) | NDA filed Dec 2025; not approved | Approved (Zepbound, Mounjaro) | Approved (Wegovy, Ozempic) | Investigational |
| Head-to-head data | Did not meet non-inferiority vs tirzepatide at 84 wks (Reuters Feb 2026) | — | — | — |
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.