Cagrilintide Dosage: Titration Chart & Schedule
Investigational drug. Cagrilintide is not FDA approved. The doses below come from published clinical trials run under medical supervision. They are a record of what the studies did, not a prescribable regimen or a protocol to follow on your own.
Cagrilintide is a long-acting amylin analog dosed once weekly. It is best known as the amylin half of CagriSema, Novo Nordisk's combination with semaglutide. This page documents the titration schedule the trials actually used, the difference between the phase 2 and phase 3 doses, how cagrilintide is dosed alongside semaglutide, and the reconstitution math behind the numbers.
Cagrilintide Dosage at a Glance
Two dosing stories exist for cagrilintide, and mixing them is where confusion starts. The phase 3 CagriSema combination titrates to a 2.4 mg weekly maintenance dose, matched to semaglutide. The earlier phase 2 monotherapy study tested doses up to 4.5 mg weekly. The 2.4 mg dose is the one that carried forward into the pivotal program, so it is the practical target. Everything is once weekly, subcutaneous, and escalated slowly.
The Trial Titration Schedule
In the CagriSema program, cagrilintide climbed in roughly four-week steps, the same interval used for semaglutide and tirzepatide. The reason is tolerability: amylin signaling slows gastric emptying and blunts appetite, and a fast jump in dose spikes nausea. The four-week hold lets the gut adapt before the next increase.
| Weeks | Weekly Dose | Step |
|---|---|---|
| 1–4 | 0.25 mg | Initiation |
| 5–8 | 0.5 mg | Early titration |
| 9–12 | 1.0 mg | Mid titration |
| 13–16 | 1.7 mg | Late titration |
| 17+ | 2.4 mg | Maintenance |
Someone who tolerates a step poorly holds longer before advancing. Faster ramps were not shown to improve weight loss; they mostly increased gastrointestinal side effects.
Phase 2 Monotherapy Doses (Up to 4.5 mg)
Before CagriSema, cagrilintide was tested on its own in a phase 2 obesity trial (Lau et al., The Lancet, 2021). That study compared 0.3 mg, 0.6 mg, 1.2 mg, 2.4 mg, and 4.5 mg once weekly against placebo and against liraglutide. The higher doses lost more weight, but the improvement flattened out and side effects rose, which is why 2.4 mg was chosen for the combination rather than 4.5 mg.
| Weekly Dose | Trial Role |
|---|---|
| 0.3 mg | Lowest phase 2 arm |
| 0.6 mg | Low-mid arm |
| 1.2 mg | Mid arm |
| 2.4 mg | Selected for CagriSema |
| 4.5 mg | Highest studied dose |
Cagrilintide With Semaglutide (CagriSema)
CagriSema is a fixed-ratio injection: cagrilintide 2.4 mg plus semaglutide 2.4 mg, once weekly. Both components climb the same titration ladder together, so you are not dosing two drugs on two schedules. The pairing combines an amylin analog with a GLP-1 agonist to hit two appetite pathways at once. For where the combination sits against tirzepatide, see CagriSema vs tirzepatide.
Cagrilintide With Tirzepatide: What the Evidence Says
A common search is how to dose cagrilintide alongside tirzepatide. The honest answer: no trial has studied that combination, so there is no established dose. The validated amylin pairing is with semaglutide, not tirzepatide. Stacking cagrilintide on top of tirzepatide layers a third appetite mechanism onto an already strong dual agonist, which compounds nausea, vomiting, and the risk of eating too little. If a chart online gives you a confident cagrilintide-plus-tirzepatide schedule, it is extrapolation, not data.
Reconstitution and Measuring the Dose
Trial sites used prepared, dose-controlled product. Sold as a lyophilized powder, cagrilintide has to be reconstituted with bacteriostatic water first, and the final concentration is set entirely by how much water you add. That fixes how many units on a U-100 insulin syringe equal a given dose. Because the maintenance dose is only 2.4 mg, a small measuring error is a large percentage error. Our peptide reconstitution calculator shows the math for any vial size and water volume.
Side Effects and Why Titration Is Slow
Gastrointestinal effects dominate and track the dose: nausea, vomiting, diarrhea, and constipation are most common during dose increases. That is the entire reason the ramp exists. Amylin analogs slow gastric emptying and increase satiety, so jumping the dose produces a predictable spike in GI distress. The four-week hold at each step is the tolerability buffer. This mirrors the titration logic across the GLP-1 class covered in our GLP-1 guide.
Regulatory Status in 2026
Cagrilintide is not FDA approved, alone or as CagriSema. A dosage chart is normally anchored to an approved label that specifies the starting dose, the titration intervals, and the maximum. Cagrilintide has none of that yet, which is why online charts contradict each other and why product sold outside trials has no verified concentration. For the next-generation obesity drugs at a similar stage, see our pages on retatrutide, survodutide, and mazdutide.
Related Guides
Frequently Asked Questions About Cagrilintide
In the phase 3 CagriSema program, cagrilintide was given once weekly and titrated to a 2.4 mg maintenance dose, matched step-for-step with semaglutide. The ramp ran 0.25 mg, 0.5 mg, 1.0 mg, 1.7 mg, then 2.4 mg, with about four weeks at each step, so full dose was reached around week 16 to 20. Phase 2 monotherapy tested higher doses, up to 4.5 mg weekly. None of these is an FDA-approved regimen; cagrilintide is investigational.
The trial schedule increases the dose roughly every four weeks to limit nausea. A typical CagriSema-style ramp is 0.25 mg for weeks 1 to 4, 0.5 mg for weeks 5 to 8, 1.0 mg for weeks 9 to 12, 1.7 mg for weeks 13 to 16, and 2.4 mg from week 17 onward. The four-week hold is the same tolerability logic used for semaglutide and tirzepatide, not an arbitrary calendar.
4.5 mg once weekly is the highest dose carried through a completed obesity trial, in the phase 2 monotherapy study (Lau et al., The Lancet, 2021). That trial compared 0.3, 0.6, 1.2, 2.4, and 4.5 mg weekly. The 2.4 mg dose was selected for the phase 3 CagriSema combination on benefit-risk grounds, so the practical target most protocols use is 2.4 mg, not 4.5 mg.
There is no trial that establishes a cagrilintide-plus-tirzepatide regimen. The pairing that has been studied is cagrilintide with semaglutide (CagriSema), where both are titrated to 2.4 mg weekly. Stacking cagrilintide onto tirzepatide is an off-protocol combination people discuss online, not a validated schedule, and it doubles the sources of gastrointestinal side effects. Nobody has published a safe dose for that specific combination.
Yes, by design. CagriSema pairs cagrilintide 2.4 mg with semaglutide 2.4 mg, and the two are titrated together on the same weekly ramp. That is why the combination is described as a fixed-ratio, dual-hormone injection: one amylin analog and one GLP-1 agonist, both at 2.4 mg once weekly at maintenance.
Lyophilized cagrilintide has to be mixed with bacteriostatic water before it can be measured, and the final concentration depends entirely on how much water you add. That concentration sets how many units on an insulin syringe equal a given milligram dose. Because the maintenance dose (2.4 mg) is small, measuring error is easy to make, which is where most self-directed dosing mistakes happen.
No. As of mid-2026 cagrilintide is not FDA approved, on its own or as part of CagriSema. Novo Nordisk has run the phase 3 REDEFINE program for CagriSema, but there is no approved label, no commercial pen, and no sanctioned prescribing dose. Material sold as cagrilintide outside a clinical trial is unapproved and its true concentration and purity are unverified.
Because there is no FDA label to anchor them. Some charts pull from the phase 2 monotherapy arms (up to 4.5 mg with two-week steps), others from the CagriSema phase 3 ramp (up to 2.4 mg with four-week steps). Both are real, but they are different protocols for different purposes. When a chart lists a number with no trial source, treat it with skepticism.