GLP-1 & metabolic · Treatment of obesity and metabolic disorders
Cagrilintide
0.25 → 2.4 mg weekly, titrated
Long-acting amylin analog in Phase 3 development for weight management, mimicking amylin’s satiety and gastric-slowing effects. Being developed alone and combined with semaglutide (CagriSema) for greater weight loss than either drug alone.
Reconstitution
| Vial | 1 mL water | 2 mL water |
|---|---|---|
| 5 mg | 5 mg/mL | 2.5 mg/mL |
- Use bacteriostatic water as the diluent.
- Add the water slowly, letting it run down the inside wall of the vial rather than onto the powder.
- Swirl gently to mix, then leave it to dissolve. Do not shake.
- Give it a few minutes. The finished solution should be clear and colourless.
Protocol
Route: Subcutaneous
Standard titration (once weekly, subcutaneous)
- Mirrors semaglutide: weeks 1 to 4 0.25 mg, weeks 5 to 8 0.5 mg, weeks 9 to 12 1.0 mg, weeks 13 to 16 1.7 mg, then 2.4 mg as maintenance
- Hold each step 4 weeks
Commonly stacked
- Cagrilintide is an amylin analogue and is often paired with semaglutide, since the two work by different mechanisms and the combination outperforms either alone
- When stacking, titrate each on its own schedule, same day, different injection sites
Dosing detail
- Start at 0.25 mg weekly and step up every 4 weeks to 2.4 mg, the same shape as semaglutide.
- Trials have gone as high as 4.5 mg weekly, but 2.4 mg is the common maintenance target.
- Often run alongside semaglutide for greater effect than either alone.
- One day per week. Long-acting, so timing is forgiving.
Duration
- Titrate over ~16 weeks, then maintain. Some reduce to 1.8 to 2.0 mg weekly once at goal to hold results.
Notes
- An amylin analogue, so it works on satiety differently than the GLP-1 drugs and stacks well with them.
- Inject subcutaneously and rotate sites.
- Nausea is the usual early effect.
Storage and handling
- Keep the powdered (lyophilized) vial in a cool, dark place. Refrigerate it for longer-term storage before mixing.
- Once reconstituted and refrigerated at 2–8 °C away from light, use the vial within 90 days.
- Do not freeze a reconstituted vial, and keep it away from heat and sunlight.
- If the solution turns cloudy, develops floating particles, or shows any other sign of degradation, stop using that vial.