CagriSema on Juno

What it does

CagriSema combines Cagrilintide, a long-acting amylin analog, with Semaglutide, a GLP-1 receptor agonist, in a fixed-dose once-weekly injection. Semaglutide drives appetite suppression, slowed gastric emptying, and glucose-dependent insulin secretion. Cagrilintide adds amylin-receptor satiety signaling. The two mechanisms combine for greater weight loss than either alone — the rationale the REDEFINE Phase 3 program is testing for obesity and Type 2 diabetes.

Used for

Weight management & metabolic health

Dose

Starting: 250 mcg · once weekly (each component titrated to 2.4 mg)
Common: 1,325 mcg · once weekly (each component titrated to 2.4 mg)
Upper: 2,400 mcg · once weekly (each component titrated to 2.4 mg)
When: EveningOnce-weekly, same day each week; evening dosing is often preferred so any transient GI side effects occur during sleep. Consistency of the weekly day matters more than time of day.
How long: continuous on / none off
Site: subcutaneous, same day each week
Food: any

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⚠ Caution

Personal or family history of medullary thyroid carcinoma (boxed warning — Semaglutide)
Multiple Endocrine Neoplasia syndrome type 2 / MEN-2 (boxed warning — Semaglutide)
History of pancreatitis (caution; GLP-1 class signal)
Severe gastroparesis or significant pre-existing gastric motility disorder (both components slow gastric emptying — Cagrilintide caution)
Pregnancy and breastfeeding; discontinue ~2 months before planned conception
Type 1 diabetes (no efficacy data; not a substitute for insulin)
Gallbladder disease (caution; events possible at higher cumulative doses)
Hypersensitivity to semaglutide, cagrilintide, or excipients

Will it work for me?

Establish a baseline (2–3 readings over 1–2 weeks before starting), then track at consistent intervals.

Blood markers

Tier 1 — Human RCTHbA1c↓· repeat at 3 monthsMost relevant in a metabolic/T2D context.
Tier 1 — Human RCTFasting glucose↓· by 8–12 weeks

Functional & psychometric

Tier 3 — Animal / in vitroBody weight (% change) + waist circumference↓· early loss 1–2 lb/week; ~22.7% at 68 weeks in REDEFINE-1Weight is the primary trial endpoint; tracked functionally at home.

Your stack

Track this peptide in your protocol — dose, schedule, vials on hand, refill projection. Stays in your browser; no account needed.

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Use this peptide

Cycling

continuous on, none off.

Chronic therapy — well tolerated for 52+ weeks; discontinuation results in weight regain.

Related peptides

What's in this blend

Cagrilintide2.4 mg/vial· 50%long-acting amylin analog — satiety signaling
Semaglutide2.4 mg/vial· 50%GLP-1 receptor agonist — appetite suppression

Reconstitution & storage

Vial	BAC water	Concentration	Shelf life
10 mg	2 mL	0.25 mg per 5 units (per-component research vial; titrate in parallel)	—

Commercial CagriSema is a fixed-dose co-formulated pen, not a self-mixed vial. For research-vial use the components are titrated in parallel; do NOT co-inject GLP-class drugs in the same syringe with unrelated peptides (separate formulation buffers). Start 0.25 mg each weekly, titrate every 2–4 weeks toward 2.4 mg each.

Storage. Refrigerate 2–8 °C; protect from light. Commercial pens follow label storage; research vials follow standard reconstituted-peptide handling.

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Nasal delivery

Not suitable for nasal delivery. Long-acting injectable peptides; no nasal route.

Monitoring & questions

Reported side effects

GI-dominant during titration: nausea, vomiting, constipation, occasional diarrhea (mostly mild-to-moderate, resolve within 4–8 weeks)
Insulin/sulfonylurea hypoglycemia risk when co-prescribed (dose reductions may be needed)
Gallbladder events at higher cumulative doses
Pancreatitis (rare but important)
Weight regain on discontinuation

Reference

How it works

Incretin (GLP-1) appetite suppression layered with amylin satiety signaling. The mechanisms are complementary rather than redundant: GLP-1 acts at pancreatic β-cells, gut, and brain; amylin acts at the area postrema to slow gastric emptying and promote satiety. Co-administration produces additive appetite suppression and reduces reliance on GLP-1 dose escalation. This is the one blend on this list with dedicated combination RCT evidence (REDEFINE program).

Juno's take

CagriSema is the most clinically advanced blend in this library — it has its own dedicated Phase 3 combination trial, which is why the weight-management indication holds at Tier 1. The T2D-glycemic claim sits a tier lower pending mature combination data in diabetes specifically. Investigational status — not yet FDA-approved. Anything you can buy under this name outside a clinical trial is an unregulated research chemical.

EvidenceTier 1 — Human RCT

Tiers are per indication. The same molecule can be Tier 1 for one use and Tier 4 for another — the tier reflects published literature, not community framing.

Chronic weight management (obesity / overweight)

Tier 1high confidence

REDEFINE-1, a large Phase 3 RCT (Garvey 2025, NEJM), reported ~22.7% weight loss on CagriSema vs. ~15% for semaglutide alone — built on Tier 1 evidence for each component (STEP program for semaglutide; Lau 2021 Phase 2 plus ~11.8% at 68 wk in REDEFINE-1 for cagrilintide). Replicated mechanism, well-characterized in humans.

Garvey WT et al. 2025 Lau DCW et al. 2021

Glycemic improvement when used in a metabolic/T2D context

Tier 2medium confidence

Semaglutide is Tier 1 for T2D, and the combination lowers HbA1c, but the CagriSema combination's glycemic outcomes in T2D specifically are less mature than the obesity weight-loss endpoint; tiered conservatively at 2 pending full T2D-program readouts.

Garvey WT et al. 2025

Citations (2)

[1]
Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1)
Garvey WT, Frias JP, Jastreboff AM, et al. · New England Journal of Medicine · 2025
Phase 3 RCT of the CagriSema combination — the Tier 1 anchor for the weight-management indication (~22.7% loss vs ~15% semaglutide alone).
View source
[2]
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
Lau DCW, Erichsen L, Francisco AM, et al. · The Lancet · 2021 · PMID 34416195
Cagrilintide Phase 2 dose-finding trial — characterizes the amylin component's dose-response and safety.
View source