Cagrilintide + Semaglutide (CagriSema)
Also called CagriSema
An investigational combination of an amylin analogue and a GLP-1 receptor agonist. Unlike most peptide pairings, it has large randomized clinical trials, but those results belong to the pharmaceutical product, not research vials with similar names.
Overview
What it is
Cagrilintide is a long-acting amylin analogue. Semaglutide is a GLP-1 receptor agonist. Both pathways help regulate appetite and fullness.
How it works
Amylin and GLP-1 are hormones that slow stomach emptying and signal fullness through different receptors. The development program is testing whether combining them improves weight and blood-sugar outcomes beyond either alone.
What the research shows
In REDEFINE 1 (3,417 adults with overweight or obesity, no diabetes), average weight change at 68 weeks was about 20.4% with the combination versus 3.0% with placebo, with lifestyle support in all groups. In REIMAGINE 1 (adults with type 2 diabetes), the higher-dose group lowered HbA1c by about 1.8 points at 40 weeks. A September 2026 sponsor update reported 12.4% weight loss versus 9.1% with tirzepatide 5 mg in adults with type 2 diabetes; that comparison is not yet peer reviewed.
Studied for
- Chronic weight managementphase 3 trials
- Blood sugar in type 2 diabetesphase 3
Safety and regulatory status
Safety and side effects
In REDEFINE 1, digestive side effects occurred in about 80% of people on the combination versus 40% on placebo, mostly mild to moderate and temporary: nausea, vomiting, diarrhea, constipation and abdominal pain. A research product should never be added to prescribed semaglutide without medical oversight.
Regulatory status
Investigational as of the sponsor's September 2026 update. A US application was submitted in December 2025; submission is not approval. Status can change.
Mixing and dosing reference
Reference information only. Read before using this section.
Cagrilintide + Semaglutide (10 mg Blend) Dosage Protocol
- Vial
- 10 mg total blend 5 mg Cagrilintide + 5 mg Semaglutide
- Add diluent
- 3 mL
- Concentration
- 3.33 mg/mL
- 1 unit (U-100)
- 33.33 mcg total in 0.01 mL
- Route
- Subcutaneous
- How often
- Once per week (subcutaneous), same day each week.
- Typical range
- 0.25–2.4 mg each peptide weekly with gradual titration.
Standard / Gradual Titration
| Week/Phase | Dose per Peptide (mcg / mg) | Units (mL) |
|---|---|---|
| Weeks 1–4 | 250 mcg (0.25 mg) each | 15 units (0.15 mL) |
| Weeks 5–8 | 500 mcg (0.50 mg) each | 30 units (0.30 mL) |
| Weeks 9–12 | 1000 mcg (1.0 mg) each | 60 units (0.60 mL) |
| Weeks 13–16 | 1700 mcg (1.7 mg) each | 102 units (1.02 mL) |
| Week 17+ | 2400 mcg (2.4 mg) each | 144 units (1.44 mL) |
How to mix
- Draw 3.0 mL bacteriostatic water with a sterile syringe.
- Inject slowly down the vial wall; avoid foaming.
- Gently swirl/roll until fully dissolved (do not shake).
- Label with date and refrigerate at 2–8 °C (35.6–46.4 °F), protected from light; follow product-specific use-by instructions.
Dosing details
- Start: 0.25 mg each weekly for 4 weeks.
- Escalate: Increase stepwise every 4 weeks (0.5 → 1.0 → 1.7 → 2.4 mg each).
- Target: 2.4 mg each weekly by Week 17+.
- Frequency: Once per week (subcutaneous), same day each week.
- Timing: Any consistent time; rotate injection sites.
Storage
- Lyophilized: Store at −20 °C (−4 °F) in dry, dark conditions; minimize moisture exposure.
- Reconstituted: Refrigerate at 2–8 °C (35.6–46.4 °F); follow product-specific use-by instructions and avoid freeze–thaw.
- Allow vials to reach room temperature before opening to reduce condensation uptake.
Administration technique
- Clean the vial stopper and skin with alcohol; allow to dry.
- Pinch a skinfold; insert the needle at 45–90° into subcutaneous tissue.
- Do not aspirate for subcutaneous injections; inject slowly and steadily.
- Rotate sites systematically (abdomen, thighs, upper arms) to avoid lipohypertrophy.
- For volumes exceeding 1 mL (e.g., 1.44 mL at maintenance dose), inject slowly over several seconds.
Important notes
- Use new sterile insulin syringes; dispose in a sharps container.
- Rotate injection sites (abdomen, thighs, upper arms) weekly to reduce local irritation.
- Inject slowly; wait a few seconds before withdrawing the needle.
- Document weekly dose and site rotation to maintain consistency.
- Higher doses may increase GI side effects (nausea, reduced appetite); titrate gradually.
Protocol source: PeptideDosages.com
Common questions
Is cagrilintide another GLP-1?
No. It acts on the amylin pathway. Semaglutide supplies the GLP-1 activity.
Why do headlines show different percentages?
Trials report more than one type of analysis. Check the population, length and method before comparing numbers.
Is a research blend the same as CagriSema?
No. Matching ingredient names does not mean equivalent manufacturing, stability or clinical performance.
Related in Metabolic Health
Sources and further reading (5)
- Novo Nordisk. REIMAGINE 5 and REDEFINE 9 topline update, Sept 2026 (sponsor report).
- Garvey WT, et al. Coadministered cagrilintide and semaglutide in adults with overweight or obesity. NEJM, 2025.
- American Diabetes Association. REDEFINE results, 2025 Scientific Sessions.
- REIMAGINE 1 phase 3a study in adults with type 2 diabetes, 2026.
- Source summary: PeptideDosages.com research overview (rewritten for NVO).
Laboratory research material: GLP-1S + Cagrilintide (NVO research code) Research Use Only