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CagriSema

Also known as: Cagrilintide/semaglutide · Cagrilintide-semaglutide · Cagri-Sema · Cagri/Sema

Updated 46 sources

CagriSema is Novo Nordisk's once-weekly pairing of cagrilintide, a long-acting amylin copy, with semaglutide, the GLP-1 drug in Wegovy. The two hit different fullness signals, so the effects add up: 20.4% average weight loss at 68 weeks in REDEFINE 1. Novo filed for FDA approval in December 2025. Until a decision lands, the only versions outside trials are research blends sold as premixed vials, which are not Novo's formulation.
Calculate with CagriSemaDosage chart

Quick facts

Half-life
  • Cagrilintide component: 159 to 195 hours, peaking 24 to 72 hours after a dose (phase 1b, given with semaglutide).
  • Semaglutide component: 145 to 165 hours, peaking 12 to 24 hours after a dose (same trial).
Routes
  • Subcutaneous injection
Forms
  • Vial (powder)
Reported dose ranges
  • 0.16 to 4.5 mg (subcutaneous injection)
Vial sizes
  • 5 mg, 10 mg, 20 mg
FDA status
  • In clinical trials
WADA
  • Not confirmed
In each vial
Cagrilintide 2.5 mg + Semaglutide 2.5 mg

What people use CagriSema for

  • Weight loss in adults with obesity or overweight, the main REDEFINE trial program
  • Weight and blood sugar in type 2 diabetes (REDEFINE 2 and REIMAGINE trials)
  • Restarting weight loss after a semaglutide plateau, as users describe on r/CagriSema
  • Stronger appetite control without pushing semaglutide alone higher

How it is thought to work. Cagrilintide acts on amylin and calcitonin receptors, the signal that tells the brain a meal is ending and slows stomach emptying. Semaglutide acts on GLP-1 receptors, which cut appetite and help insulin release after meals. Both carry a fatty-acid chain that binds albumin, so each lasts about a week. Because the receptor families differ, the pair produced more weight loss than either drug alone in REDEFINE 1.

CagriSema dosing

6 protocols from studies, guides and community reports, grouped by goal. Tap a source badge to see where a number came from.

Weight loss2

Weight loss, REDEFINE 1 and 2 trial dose (clinical trial)

Amount (amount of cagrilintide)
2.4 mg
How often
Once weekly, cagrilintide and semaglutide at the same mg (2.4 mg + 2.4 mg at maintenance)
Route
Subcutaneous injection
Cycle
68 weeks, continuous
Titration (5 steps) and details

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Weight loss, lower maintenance dose (REDEFINE 9, clinical trial)

Amount (amount of cagrilintide)
1 to 1.7 mg
How often
Once weekly at 1.0 mg + 1.0 mg or 1.7 mg + 1.7 mg
Route
Subcutaneous injection
Cycle
60 to 68 weeks in the trials
Timing and details

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Other protocols: injected4

Type 2 diabetes, phase 2 (clinical trial)

Amount (amount of cagrilintide)
2.4 mg
How often
Once weekly, escalated to 2.4 mg + 2.4 mg
Route
Subcutaneous injection
Cycle
32 weeks
Timing and details

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Phase 1b dose-ranging with semaglutide 2.4 mg (clinical trial)

Amount (amount of cagrilintide)
0.16 to 4.5 mg
How often
Once weekly, cagrilintide 0.16 to 4.5 mg plus semaglutide 2.4 mg
Route
Subcutaneous injection
Cycle
20 weeks
Timing and details

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Premixed vial ladder (dosing guides)

Amount (amount of cagrilintide)
0.25 to 2.4 mg
How often
Once weekly, same mg of each peptide, stepping up every 4 weeks
Route
SubQ, vial (powder)
Cycle
Guides list 12 to 24 week research cycles; the trials ran 68 weeks
Titration (5 steps) and details

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Community starting ladder (r/CagriSema)

Amount (amount of cagrilintide)
0.25 to 1 mg
How often
Once weekly, 0.25 mg + 0.25 mg for 4 weeks, then up in semaglutide-style steps
Route
SubQ, vial (powder)
Titration (3 steps) and details

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Doses shown are what sources report, labelled by origin. Not medical advice.

Full CagriSema dosage guideEvery titration step in syringe units, missed doses and how to mix.

Vial strengths and syringe units

Every CagriSema vial size with the water volumes sources use. Units are what to draw on a U-100 insulin syringe, worked out exactly.

Recipe

CagriSema (5 mg (2.5 + 2.5)): concentration and U-100 syringe units for each vial size and water volume
WaterStrength0.25 mgof Cagrilintide, units1 mgof Cagrilintide, units2.4 mgof Cagrilintide, units
5 mg vial
2 mLVendor guide†2.5 mg/mL200.2 mL800.8 mL1921.92 mL2 draws
2.5 mLCompetitor guide†2 mg/mL250.25 mL1001 mL2402.4 mL3 draws
3 mLCompetitor guide†1.667 mg/mL300.3 mL1201.2 mL2 draws2882.88 mL3 draws
What one dose delivers (5 mg (2.5 + 2.5))Every draw takes every component in the vial's fixed ratio, whatever the water volume.
ComponentPer vial0.25 mg of Cagrilintide1 mg of Cagrilintide2.4 mg of Cagrilintide
Cagrilintide2.5 mg250 mcg1 mg2.4 mg
Semaglutide2.5 mg250 mcg1 mg2.4 mg
Units are on a U-100 insulin syringe (100 units = 1 mL). U-50 and U-30 barrels read the same units.† Water volume sourced for a different vial size. The math is exact either way.n/a: a component dose needs the recipe of that vial size.Water volumes from

Doses shown are what sources report, labelled by origin. Not medical advice.

Calculate with this peptideYour vial, your water, your dose: CagriSema in syringe units, with the math shown.

If you miss a dose

CagriSema has no approved label yet. The semaglutide (Wegovy) label says: if the next dose is more than 2 days away, take the missed dose as soon as possible; if it is less than 2 days away, skip it and resume on your usual day.

CagriSema side effects

What trials and labels report, kept apart from what users and guides report. Frequencies are worded as each source states them.

Reported in studies and labels5

From clinical trials and regulatory documents.

  • Gastrointestinal side effects (any)

    79.6% vs 39.9% on placebo in REDEFINE 1; 72.5% vs 34.4% in REDEFINE 2. Mostly mild to moderate and short-lived.

    How people manage it

    • The trials stepped up the dose every 4 weeks and let investigators keep people on a lower dose.

  • Nausea

    55% vs 12.6% on placebo in REDEFINE 1

  • Constipation

    30.7% vs 11.6% on placebo in REDEFINE 1

  • Vomiting

    26.1% vs 4.1% on placebo in REDEFINE 1

  • Stopping because of side effects

    About 6% vs 3.5 to 3.7% on placebo in REDEFINE 1; 8.4% vs 3% in REDEFINE 2

Reported by users and guides5

From community reports and dosing guides. Not measured rates.

  • Tiredness and drowsiness

    Commonly reported on r/CagriSema, often in the first weeks

    How people manage it

    • Some users say it tapers after a few weeks.

  • Vomiting after starting too high

    Reported on r/CagriSema by users who started at 1.25 to 1.5 mg, and after a first dose from a 10 + 10 mg vial

    How people manage it

    • Users and threads point to starting at 0.25 mg + 0.25 mg and stepping up every 4 weeks.

  • Constipation and day-after nausea

    Reported on r/CagriSema, including by trial participants

    How people manage it

    • A former trial participant used bone broth and sparkling water on injection day and a stool softener after a day without a bowel movement.

  • Emotional flatness

    Reported by a few trial participants on r/CagriSema

  • Reflux and sulfur burps

    Reported on r/CagriSema in the first weeks of a trial

All 10 CagriSema side effects and how people manage themEvery management tip, who should not use it, and side-effect questions.

Who should avoid it

  • Personal or family history of medullary thyroid cancer or MEN 2Condition

    The semaglutide label contraindicates use in these people because of a boxed warning for thyroid C-cell tumors.

  • Pregnancy or planned pregnancyCondition

    The semaglutide label says it may cause fetal harm and to stop at least 2 months before a planned pregnancy because of its long half-life.

  • Insulin or sulfonylureasSubstance

    The semaglutide label warns that combining it with insulin or an insulin secretagogue raises the risk of low blood sugar; those doses may need to come down.

Storage

Powder (before mixing)

Temperature
-20 °C

Freezer at -20 °C; 2 to 8 °C is acceptable for short periods. Keep dry and dark.

Mixed vial

Temperature
2 to 8 °C
Use within
30 days

Fridge at 2 to 8 °C, use within 30 days.

Mixed vial

Temperature
2 to 8 °C
Use within
28 days

Fridge at 2 to 8 °C, about 28 days for each peptide; for premixed vials guides defer to the supplier's stability data. Do not freeze; discard if cloudy.

Mixed with: Bacteriostatic water

Mixing. Vial labels give the total. A 10 mg blend is usually 5 mg of each, so 2 mL gives 2.5 mg/mL of each peptide. On r/CagriSema, users enter the per-component amount (5 mg) in a calculator for an even 1:1 blend. Some users add dilute acetic acid to lower pH over fibril worries; no study supports it.

Stacks people report

Combinations from guides and community posts, with the reason given.
  • Tirzepatide

    Some users add a small CagriSema dose (0.25 mg) to tirzepatide after a stall. No trial has tested it, and it stacks two GLP-1-type drugs on top of each other.

  • Retatrutide

    Users on retatrutide add a 5/5 blend for extra appetite control. No trial has tested it, and it doubles up on GLP-1 activity.

Compare CagriSema

Evidence and legal status

Evidence: strong human trials

Several phase 3 trials of Novo's product: REDEFINE 1, 2, 4 and 9 and REIMAGINE 2 and 5, plus phase 1b and phase 2 work. No published data cover research premixed blends, whose identity and stability are unverified.

FDA and WADA

In clinical trials

Under FDA-regulated trials; not approved yet.

Not FDA approved. Novo Nordisk submitted a New Drug Application for CagriSema 2.4 mg/2.4 mg on December 18, 2025, and says a decision is anticipated by late 2026. As of 2026-10-24, Drugs@FDA lists no product containing cagrilintide. Research-labeled blends are not the product under review.

FDA's list of bulk substances that may pose safety risks in compounding (current 04/22/2026) names neither cagrilintide nor semaglutide. The semaglutide label carries a boxed warning for thyroid C-cell tumors. WADA's 2026 Prohibited List does not name cagrilintide, amylin analogues or semaglutide; cagrilintide is unapproved, so the non-approved substances class (S0) may apply. Unconfirmed.

WADA: Not confirmed

CagriSema questions

What is CagriSema?

A once-weekly combination of cagrilintide (a long-acting amylin copy) and semaglutide (the GLP-1 drug in Wegovy), developed by Novo Nordisk. The trial version is a fixed dose of 2.4 mg of each.

Is CagriSema FDA approved?

No. Novo Nordisk submitted a New Drug Application on December 18, 2025. As of October 24, 2026, Drugs@FDA lists no product containing cagrilintide, and the REDEFINE 1 trial is still active.

When could CagriSema be available?

Novo says an FDA decision is anticipated by late 2026. Coverage of the filing puts the expected decision in the last 3 months of 2026. That is a timeline estimate, not an approval.

What dose of CagriSema was used in the trials?

REDEFINE 1 and 2 used 2.4 mg cagrilintide plus 2.4 mg semaglutide once weekly. Both started at 0.25 mg each and stepped up every 4 weeks (0.5, 1, 1.7 mg) to reach 2.4 mg at week 17.

Does a lower CagriSema dose work?

In REDEFINE 9, 1.0 mg + 1.0 mg gave 21.0% weight loss vs 2.0% on placebo at 68 weeks (topline, efficacy estimand). In REIMAGINE 5, the same dose beat tirzepatide 5 mg on weight in type 2 diabetes, 12.4% vs 9.1% at 60 weeks.

Why do I see 20.4% in some places and 22.7% in others?

Both come from REDEFINE 1. 22.7% assumes everyone stayed on treatment. 20.4% counts everyone randomized, including people who stopped. Neither is wrong; they answer different questions.

Is CagriSema better than tirzepatide?

Not at full dose. In REDEFINE 4, tirzepatide 15 mg beat CagriSema 2.4/2.4 mg at 84 weeks (25.5% vs 23.0% if all adhered), and CagriSema missed its non-inferiority goal. At lower doses, CagriSema 1.0/1.0 mg beat tirzepatide 5 mg in REIMAGINE 5.

How much bacteriostatic water goes in a 5 + 5 mg CagriSema vial?

One seller of a 5 mg + 5 mg blend lists 2 mL, which gives 2.5 mg/mL of each peptide. A dosing guide uses 3 mL in a 10 mg blend. More water means more liquid per dose and easier small draws; the calculator does the unit math.

Do I enter 5 mg or 10 mg into a calculator for a 5/5 blend?

Users on r/CagriSema say to enter 5 mg, the amount of each peptide, because every draw gives equal amounts of both. Entering 10 mg doubles every dose you think you are taking.

What are the most common CagriSema side effects?

Stomach and gut effects. In REDEFINE 1, 79.6% had a GI side effect vs 39.9% on placebo, mostly mild to moderate and short-lived. Nausea, constipation and vomiting led the list.

Why am I so tired on CagriSema?

Tiredness is one of the most common complaints on r/CagriSema, often worst in the first weeks. Some users say it fades; others lowered the dose or went back to semaglutide alone. It is a community report, not a measured trial rate.

How should I store CagriSema vials?

Sellers list the powder at -20 °C, with 2 to 8 °C acceptable for short periods. After mixing, refrigerate at 2 to 8 °C and use within 30 days, according to one seller. Do not freeze the mixed solution.

Premixed CagriSema blend or two separate vials?

A premixed vial is one shot a week but locks the ratio at 1:1. Two vials let you titrate each peptide on its own. One guide warns there is no validated stability data for premixed blends outside Novo's own formulation.

Who should not use CagriSema?

The semaglutide half carries label limits: no use with a personal or family history of medullary thyroid cancer or MEN 2, stop if pregnant, and stop at least 2 months before a planned pregnancy. People on insulin or sulfonylureas face a higher low-blood-sugar risk.

How long does CagriSema last in the body?

Measured together in a phase 1b trial, cagrilintide had a half-life of 159 to 195 hours and semaglutide 145 to 165 hours, so both last about a week.

Ask about CagriSema

Answers come from this site's pages only, with a link to each source.

Sources

46 sources, each checked by date. Record updated Oct 24, 2026. Numbers are restated in our own words and labelled by where they came from.

Regulatory6

  1. openFDA Drugs@FDA query for cagrilintideFDA (openFDA) · checked Oct 24, 2026
  2. NCT05567796 (REDEFINE 1), phase 3, active not recruitingClinicalTrials.gov · checked Oct 24, 2026
  3. Novo Nordisk files for FDA approval of CagriSema (18 Dec 2025)Novo Nordisk, via a vendor guide · checked Oct 24, 2026

Vendor guide3

  1. Cagrilintide 2.5mg + Semaglutide 2.5mgprymalab.net · checked Oct 24, 2026
  2. Cagrilintide + Semaglutide Blend 5/5mgmyglp1store.com · checked Oct 24, 2026
  3. Cagrilintide/Semaglutide Blend 5+5mggreyresearchpeptides.com · checked Oct 24, 2026

Competitor guide3

  1. CagriSema Dosing Guide: Cagrilintide + Semaglutide (2026)peptidedosingprotocols.com · checked Oct 24, 2026
  2. Cagrilintide + Semaglutide Dosage Chart, Schedule & Reconstitution Protocolpeptidedosage.org · checked Oct 24, 2026
  3. CagriSema Dosing Guidepeptideschedule.com · checked Oct 24, 2026

Community-reported19

  1. CAGRISEMA DOSAGE-HELP!! (comment)r/CagriSema · checked Oct 24, 2026
  2. Cagri questions and reconstitution (comment)r/CagriSema · checked Oct 24, 2026
  3. Just got first 5/5, couple questions (comment)r/CagriSema · checked Oct 24, 2026