CagriSema (cagrilintide + semaglutide) dosing — the trial design

There is no approved CagriSema dose; there is a trial design. In the phase 3 REDEFINE program, participants injected the combination subcutaneously once weekly, escalating both components in parallel to a maintenance dose of cagrilintide 2.4 mg plus semaglutide 2.4 mg (NEJM 2025). The 2.4/2.4 pairing is the only maintenance dose carried into phase 3, which is why it is the number attached to the product's name in coverage of the trials — earlier-phase studies explored a range of cagrilintide doses and settled here.

CagriSema is one product containing two active molecules at a matched ratio. Practically, in the trials:

• The two components moved together at every step — participants could not raise semaglutide while holding cagrilintide steady, or vice versa, at any point in the schedule.
• Doses were delivered as pre-measured pharmaceutical units, not drawn from separate vials.
• The ratio itself (1:1 at 2.4 mg each) was selected during phase 1b/2 development, where cagrilintide cohorts from 0.16 to 4.5 mg were tested alongside semaglutide 2.4 mg (Lancet 2021).

• Phase 1b: 16 weeks of stepwise escalation, then 4 weeks at target — 20 weeks to deliver 4 weeks of full dosing (Lancet 2021).
• Phase 2 (type 2 diabetes): both agents escalated to 2.4 mg weekly over a 32-week trial (Lancet 2023).
• REDEFINE 1 (phase 3): 68 weeks total on the escalate-then-maintain pattern at 2.4/2.4 mg weekly (NEJM 2025).

Injections were subcutaneous (abdomen, thigh, or upper arm), once weekly on a consistent day — the long half-lives of both molecules are what make weekly dosing viable. REDEFINE 1's arm structure is itself informative about dosing questions: 2,108 participants took the combination while 302 took each component alone at the same 2.4 mg, letting the trial separate what the pairing adds from what either molecule does by itself at an identical dose.

Both components slow gastric emptying, and REDEFINE 1 recorded GI adverse events in 79.6% of combination participants even with slow titration. Escalation over roughly four months is what kept those events mostly mild and transient. Starting high compresses that adaptation into misery — which is exactly the scenario informal use invites when it borrows the 2.4/2.4 headline number without the sixteen weeks of steps beneath it. The escalation is also where clinical judgment lived in the trials: protocols allowed pauses and slower steps for participants who tolerated a level poorly, a flexibility that only exists when someone is monitoring.

A gray-market imitation means reconstituting two separate powders, trusting two unverified concentrations, and manually holding a 1:1 ratio weekly — three error surfaces the trial product does not have, before any question of purity. Add that the combination is unapproved and its long-term profile still settling, and the dosing story reduces to: the REDEFINE design is public knowledge worth understanding, and a clinician is the only appropriate route to anything resembling it. Background on both molecules: cagrilintide and semaglutide.