Cagrilintide

Structure: Long-acting acylated analog of human amylin. Lipid modifications enable albumin binding for once-weekly dosing. Amylin is co-secreted with insulin from pancreatic beta cells.

Dosage:

• Monotherapy titration: 0.6mg/week (weeks 1-2) → 1.2mg (weeks 3-4) → 2.4mg (weeks 5-6) → 4.5mg/week (maintenance)
• CagriSema (combination): Cagrilintide + Semaglutide co-administered, up to roughly 20% body weight loss in clinical trials
• Bodybuilding cut: 1.2-2.4mg/week (lower doses often sufficient)

Administration:

• SubQ injection once weekly on consistent day
• Abdomen/thigh/upper arm, rotate sites
• Titrate slowly to minimise GI side effects

Key Notes:

• Amylin analog, a different mechanism from GLP-1 agonists (complementary pathways)
• Promotes satiety centrally, slows gastric emptying, reduces glucagon (lowers blood sugar)
• CagriSema (Cagrilintide + Semaglutide) showed roughly 20% body weight loss in Phase 3 trials, more than either alone
• GI side effects (nausea, vomiting, diarrhoea) are common during titration and resolve with time
• Does not directly stimulate insulin secretion, so hypoglycaemia risk as monotherapy is low
• Monitor: fasting glucose, HbA1c, amylase/lipase
• Maintain high protein intake and resistance training to preserve muscle mass during weight loss

How much of the weight lost on aggressive incretin cutting is muscle, and how to keep it: How much muscle you lose cutting on retatrutide.