Cagrilintide dosing — how the trials dosed it

Cagrilintide has no approved dose — what exists is a trial record. In its phase 2 program it was given as a once-weekly subcutaneous injection at maintenance doses of 0.3, 0.6, 1.2, 2.4, or 4.5 mg, reached by gradual escalation (Lancet 2021). In the CagriSema combination now in phase 3, the cagrilintide component is fixed at 2.4 mg weekly. These are study designs, reported here because they are the only evidence-anchored numbers that exist for this molecule — nothing else in circulation traces back to measured human data.

• Phase 2, alone (706 adults, 26 weeks): once-weekly maintenance doses of 0.3–4.5 mg; weight loss rose with dose, from 6.0% to 10.8% (Lancet 2021).
• Phase 1b, with semaglutide 2.4 mg: cagrilintide cohorts of 0.16, 0.3, 0.6, 1.2, 2.4, and 4.5 mg weekly, escalated over 16 weeks then held 4 weeks at target (Lancet 2021).
• Phase 3, in CagriSema (REDEFINE 1): fixed 2.4 mg weekly alongside semaglutide 2.4 mg for 68 weeks (NEJM 2025).

No trial started anyone at a maintenance dose. Participants began low (0.16–0.3 mg) and stepped up roughly every four weeks, taking about four months to reach target. The reason is tolerability: amylin agonism slows gastric emptying, and the nausea data in the phase 2 trial (20–47% even with escalation) show what the gut thinks of this mechanism. Slow titration is not bureaucratic caution — it is the difference between a tolerable drug and an intolerable one, and it is precisely the part of trial dosing that informal use most often skips. Note also what the trials did not do: no loading doses, no twice-weekly schedules, no "boost" injections — patterns that circulate in community logs without any trial ever having tested them.

Trials used once-weekly subcutaneous injection (abdomen, thigh, or upper arm) on a consistent day, with pre-measured pharmaceutical doses; the molecule's long half-life is what makes weekly dosing work. A property of long-half-life weekly drugs worth understanding: levels build gradually across the first several weeks at any dose, so the full effect — and the full side-effect load — of a step arrives on delay, which is another reason trials wait about a month before each increase rather than judging a dose by its first injection. Gray-market powder adds a step trials never had: reconstitution, where the diluent volume sets the concentration and misreading syringe units as volume is the classic dosing error — the peptide calculator exists for that arithmetic.

The gap between trial dosing and self-directed use is not just the schedule. Trials delivered verified doses of verified product with monitoring, exclusion criteria, and someone to call when nausea would not stop. An unregulated vial reproduces none of that, and cagrilintide's standalone safety record is only phase 2 deep. The numbers on this page document research; a clinician is where individual decisions belong. See the main cagrilintide page and the side-effects page for context.