Cagrilintide
A weekly fullness shot that stacks on a GLP-1 when the weight stalls. Strong in trials, strong on nausea; start tiny.
What it is
Cagrilintide makes you feel done with a meal sooner, through a different signal from the GLP-1 drugs, which is why people add it when semaglutide or tirzepatide has stopped moving the scale. It is in late-stage human trials, works, and is easy to overdo.
The person who uses cagrilintide is almost always already on a GLP-1. They lost 25 pounds on semaglutide, the loss stalled at month six, and the next step up in dose made them miserable. Cagrilintide adds a second lever: it copies amylin, the hormone your pancreas releases with insulin to tell your brain you have eaten enough, and amylin works through a different receptor from GLP-1. Novo Nordisk is developing it in a fixed combination with semaglutide (CagriSema), and the trials say the two together beat either alone by a wide margin. A smaller group runs it solo because the GLP-1 stomach slowing was intolerable and they want fullness without it.
What it feels like: the fullness is more in your head than your gut. Food loses its pull, you stop a few bites early without deciding to, and snacking between meals mostly disappears. It starts within the first week, builds over four to five weeks as the drug accumulates, and holds. The nausea is the thing to respect: it is a food-aversion nausea, different from the GLP-1 kind, worst in the days after a dose increase, and it hits hard if you eat past the fullness signal. Weight loss on its own is in the range of several percent over months; stacked on a GLP-1 it is what breaks a plateau. It will not do anything you cannot undo by eating anyway, and it does nothing for muscle, so lift and eat protein.
How people run it: 0.25 mg subQ once a week, held for at least four weeks, then 0.5 mg, which is where most people stay. The half-life is about a week, so each step takes a month to fully land, and stepping up faster than that is how you end up vomiting in week three. Going toward 2.4 mg is only for people with established tolerance and a reason. Pick the same day as your GLP-1 shot, different site. Cost reality: at 0.5 mg a week you use 2 mg of a vial a month, and the mixed solution is only good for three to four weeks, so buy the 5 mg vial, not the 10. The mistakes: starting at 0.5 because it sounds small, adding it the same week you raised your GLP-1 dose, and letting yourself get dehydrated during a nauseous week.
Evidence: this is one of the better-tested compounds here. On its own, a 26-week trial produced roughly 10 percent weight loss at the top dose against about 3 percent on placebo; combined with semaglutide in the CagriSema program, the pair outperformed either drug alone. Phase 3 is well underway. What is missing is approval and long-term safety, so it is still a trial drug, and anything sold as cagrilintide today is grey-market material, not the Novo product.
Skip it if you have never used a GLP-1; semaglutide and tirzepatide are approved, better understood and should come first. Skip it if you have had pancreatitis or a slow-stomach condition. If the nausea on cagrilintide beats you, eloralintide is the more selective amylin drug; at its lower doses its trial nausea was close to placebo, though no study has compared the two head to head and its top doses were still rough. If you want the combination done properly, the CagriSema record covers the fixed pairing.
What people use it for
Weight loss
Some evidenceA 26-week placebo-controlled trial on its own produced roughly 10 percent weight loss at the top dose against about 3 percent on placebo. In the CagriSema program the combination with semaglutide outperformed either drug alone, and phase 3 trials are underway. This is proper human trial data, not inference from animals.
Appetite and fullness
Some evidenceAmylin signals fullness to the brainstem through a receptor the GLP-1 drugs do not touch, and in trials food intake dropped accordingly. That separate pathway is the entire reason it stacks on semaglutide or tirzepatide instead of overlapping with them.
Nausea and tolerability
Some evidenceNausea was the main side effect in every trial and the main reason people dropped out, worst after each dose increase. Cagrilintide also hits the calcitonin receptor, which is thought to drive much of that; eloralintide was designed to avoid it. Slow titration cuts the nausea substantially.
Blood sugar and other markers
Some evidenceIn the combination trials, blood sugar control improved more than with semaglutide alone, with the usual improvements in waist and blood pressure that come with weight loss. Not studied long enough to say anything about heart outcomes.
How it works
- Works on fullness via amylin, not the GLP-1 pathway
- Often studied combined with Semaglutide (as CagriSema)
- In late-stage human trials, not yet approved on its own
- A newer option with a growing but incomplete evidence base
How people use it
Safety, in brief
Things people sometimes notice
- Nausea, worst in the week after a dose increase and after eating past the fullness
- Eating noticeably less without trying, which is the effect
- Constipation, or the opposite, as the stomach adjusts
- Tiredness in the first few weeks, usually from eating less
The full picture — stop signs and who should talk to a doctor first — is on the dosing guide.
Sources
The labels and studies behind this page. Each link opens the original on PubMed, DailyMed or ClinicalTrials.gov.
- Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial
- Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity
- Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial