Amylin Analog / SubQ / 0.16-4.5mg weekly
Cagrilintide
Amylin was identified in 1987 as the building block of the amyloid deposits in type 2 diabetic pancreases and only later understood as a satiety hormone co-secreted with insulin. Cagrilintide is the long-acting analog Novo Nordisk engineered from it, stabilized against aggregation and lipidated for weekly dosing, now in late-stage trials paired with semaglutide as CagriSema.
In plain words
Cagrilintide is a lab-made, long-acting version of amylin, a natural hormone the pancreas releases alongside insulin to tell the brain a meal is over. It is given as a weekly injection and is being developed for weight loss, both on its own and paired with semaglutide in a fixed combination called CagriSema. Randomized trials are the basis for what is known about it: up to about 11 percent weight loss on cagrilintide alone against 3.0 percent on placebo, and 20.4 percent for the combination against 3.0 percent on placebo in a 68-week phase 3 trial. Stomach and bowel effects, mainly nausea, are the main tolerability problem, and about 4 percent of people in the phase 2 trial stopped treatment because of side effects. As of August 2026 it has not been approved in the United States and there is no prescribing label for it, so outside a clinical trial the only way anyone gets it is from research-peptide sellers, with no batch-level assurance that a vial matches its label.
At a glance
| Half-life | 7.5 days |
|---|---|
| Tmax | 2.5 days |
| Route(s) | SubQ |
| Published dosing range | 0.16-4.5mg weekly |
| Vial strengths | 5, 10 mg |
Reference data from the DosePlot canon -- not a protocol recommendation.
Serum curve
Single 2.33 mg dose by SubQ, rendered from the same engine that powers the interactive chart. Relative levels, not lab values.
What does the evidence show?
Two things are labeled separately here because they answer different questions. The tier is how a study was built. The distance chips are whether that study touched this molecule, by this route, in a population resembling the reader. A randomized trial of a different molecule keeps its tier and still says nothing about this compound.
| Finding | Tier | Distance from use | Study |
|---|---|---|---|
| In a 26-week phase 2 dose-finding trial in adults with overweight or obesity, once-weekly cagrilintide produced dose-dependent weight loss of 6.0-10.8% across the 0.3-4.5 mg doses versus 3.0% with placebo, and the 4.5 mg dose beat daily liraglutide 3.0 mg (10.8% vs 9.0%). | rct | not recorded | Lau DCW et al. 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.Lancet 398(10317):2160-2172, 2021 |
| Adding cagrilintide to semaglutide 2.4 mg added roughly 7 percentage points of weight loss in a small 20-week randomized phase 1b trial: 17.1% with cagrilintide 2.4 mg plus semaglutide versus 9.8% with pooled placebo plus semaglutide, an estimated treatment difference of 7.4 percentage points. | rct | not recorded | Enebo LB et al. Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2.4 mg for weight management: a randomised, controlled, phase 1b trial.Lancet 397(10286):1736-1748, 2021 |
| In the 68-week phase 3 REDEFINE 1 trial (3417 participants without diabetes), the fixed cagrilintide 2.4 mg plus semaglutide 2.4 mg combination (CagriSema) reduced body weight by an estimated 20.4% versus 3.0% with placebo. | rct | not recorded | Garvey WT et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity.New England Journal of Medicine 393(7):635-647, 2025 |
| Gastrointestinal effects dominate tolerability: in the phase 2 trial, 41-63% of cagrilintide-treated participants reported gastrointestinal adverse events (mainly nausea, 20-47%) versus 32% on placebo, and about 4% of participants permanently stopped treatment because of adverse events. | rct | not recorded | Lau DCW et al. 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.Lancet 398(10317):2160-2172, 2021 |
| Cagrilintide's measured half-life is 159-195 hours (roughly a week), with peak levels 24-72 hours after subcutaneous injection, a profile deliberately matched to semaglutide's 145-165 hours so the two drugs can share one weekly schedule. | clinical | not recorded | Enebo LB et al. Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2.4 mg for weight management: a randomised, controlled, phase 1b trial.Lancet 397(10286):1736-1748, 2021 |
| In leptin-resistant, diet-induced obese rats, amylin agonism partially restored hypothalamic leptin signaling, and combined amylin plus leptin produced synergistic, fat-specific weight loss, part of the mechanistic case for building obesity therapy around the amylin pathway. | preclinical | not recorded | Roth JD et al. Leptin responsiveness restored by amylin agonism in diet-induced obesity: evidence from nonclinical and clinical studies.Proceedings of the National Academy of Sciences 105(20):7257-7262, 2008 |
| Grey-market users report running cagrilintide alone or alongside a GLP-1 agonist, typically titrating from fractions of a milligram toward 1-2.5 mg weekly, with appetite suppression, early satiety, and nausea the most consistently reported effects. | anecdotal | not recorded | community reports aggregated from reddit, MESO-Rx, and similar forumsno study |
How did it get here?
- preclinical1987
- A 37-amino-acid peptide is purified from the amyloid-rich pancreases of people with type 2 diabetes and named diabetes-associated peptide, soon renamed amylin. It is later recognized as a satiety hormone that beta cells co-secrete with insulin.
- clinical-adoption2005
- Pramlintide, a stabilized amylin analog, is approved in the US as an adjunct to insulin in diabetes. It proves the pathway is druggable, but its short half-life demands an injection at every meal.
- preclinical2010s
- Novo Nordisk chemists rework the amylin backbone for stability and attach a 20-carbon fatty diacid that binds albumin, stretching the half-life to about a week. The program compound AM833 becomes cagrilintide; the medicinal chemistry is published in 2021.
- first-human2018-2021
- First-in-human program: a 20-week phase 1b with semaglutide 2.4 mg (17.1% weight loss in the 2.4 mg cohort versus 9.8% with pooled placebo plus semaglutide) and a 26-week phase 2 monotherapy trial (up to 10.8% versus 3.0% on placebo), both published in the Lancet in 2021.
- clinical-adoption2021-2026
- The phase 3 REDEFINE program tests CagriSema, 2.4 mg of each drug weekly. REDEFINE 1 reports 20.4% weight loss versus 3.0% for placebo at 68 weeks (22.7% in the on-treatment analysis). Novo Nordisk files with the FDA in December 2025. As of August 2026 no US approval has issued and no US prescribing label exists, so cagrilintide remains investigational; the phase 3 program is still running, including a 7101-participant cardiovascular outcomes trial due to complete in 2027.
- grey-market2022-present
- Well before any approval, research-peptide vendors begin selling lyophilized cagrilintide, alone and in blended cagrilintide-semaglutide vials. Outside a clinical trial this is the only route by which anyone actually uses the compound, with no batch-level assurance that a vial matches its label.
How is it made?
Cagrilintide is a 37-amino-acid peptide, so making it is peptide chemistry, not steroid chemistry. Production happens in three stages.
1. Building the chain. The backbone is assembled by solid-phase synthesis: amino acids are coupled one at a time to a chain anchored on resin beads. The sequence is human amylin reworked for stability. It borrows the proline substitutions that keep pramlintide, the first amylin drug, from clumping, and adds further changes that steady the central helix. That matters because native amylin is the protein that forms amyloid deposits in the type 2 diabetic pancreas; a drug version must not inherit the habit.
2. Folding and lipidation. Off the resin, two cysteines near the start of the chain are joined into a small disulfide ring and the far end carries an amide, both inherited from the natural hormone and required for activity. A 20-carbon fatty diacid is then attached through a short linker at the N-terminal lysine. That tail binds albumin in the blood and is the reason cagrilintide lasts about a week where native amylin lasts minutes; semaglutide uses the same trick.
3. Purification and fill. Preparative chromatography strips out the deletion and truncation byproducts every long synthesis produces, and the peptide is filled aseptically, typically as a freeze-dried powder. Regulated batches are tested for identity, potency, sterility, endotoxins, and aggregates. The aggregate test carries particular weight here, since fibril formation is this peptide family's defining vice, and sterile fill and batch testing vary most outside regulated manufacturing.
Worth knowing
Amylin was discovered as a problem, not a signal: it was first purified in 1987 from the amyloid clogging the pancreatic islets of people with type 2 diabetes, and its discoverers named it diabetes-associated peptide. The satiety hormone and the plaque are the same molecule, which is why every amylin drug, cagrilintide included, is first an exercise in stopping the peptide from sticking to itself.
Cooper GJ et al. Purification and characterization of a peptide from amyloid-rich pancreases of type 2 diabetic patients.Proceedings of the National Academy of Sciences 84(23):8628-8632, 1987
There is no standalone amylin receptor gene. Amylin receptors are the calcitonin receptor wearing one of three accessory proteins (RAMP1, RAMP2, or RAMP3), so amylin pharmacology is calcitonin-receptor pharmacology in different dress.
Hay DL et al. Amylin: Pharmacology, Physiology, and Clinical Potential.Pharmacological Reviews 67(3):564-600, 2015
The phase 1b combination trial quietly picked CagriSema's dose: the cagrilintide 2.4 mg cohort lost 17.1% of body weight while the maximum 4.5 mg cohort lost 15.4%, so the higher dose showed no advantage and 2.4 mg is what Novo Nordisk carried into phase 3.
Enebo LB et al. Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2.4 mg for weight management: a randomised, controlled, phase 1b trial.Lancet 397(10286):1736-1748, 2021
Reconstitution
Cagrilintide ships lyophilized and is mixed before use; the published vial strengths are 5, 10 mg. The water volume you add sets the concentration, not the dose -- the calculator turns a vial size and a water volume into mg/mL, draw volume, and units on an insulin syringe.
Open in the reconstitution calculatorWritten and reviewed by Evan Marlow, developer of DosePlot · Updated 2026-08-27
Not medical advice. DosePlot is an informational tool, not a healthcare provider, and using it creates no provider-patient relationship. Do not start, stop, or change any protocol without the approval of a licensed healthcare professional.
Your whole protocol, in one place.
Free to start. Runs in your browser today.
14-day Premium trial inside, no card required.
Launch the web app