Cagrilintide
Cagrilintide
Cagrilintide is a long-acting acylated amylin analogue developed by Novo Nordisk, designed for once-weekly subcutaneous injection for the treatment of obesity and type 2 diabetes. It mimics the endogenous pancreatic hormone amylin, reducing food intake, slowing gastric emptying, and promoting weight loss. It is being investigated primarily as a combination therapy with semaglutide (CagriSema) in late-stage clinical trials for significant cardiometabolic benefit.
Mechanism of Action
Cagrilintide acts as a full agonist at amylin receptors (AMY1, AMY2, AMY3), which are heterodimeric complexes of the calcitonin receptor and receptor activity-modifying proteins (RAMPs). Activation of these receptors in the hypothalamus and brainstem suppresses appetite, reduces glucagon secretion, and delays gastric emptying, leading to reduced caloric intake and improved postprandial glucose control. Its fatty acid acylation enables albumin binding, extending its half-life to approximately 7 days and enabling once-weekly dosing.
Evidence by Health Goal(15 goals)
Dosing Protocols
Same day each week, any time of day, with or without food
Dose escalation protocol used in clinical trials: 0.16mg for 4 weeks, then 0.3mg for 4 weeks, 0.6mg for 4 weeks, 1.2mg for 4 weeks, 1.7mg for 4 weeks, then 2.4mg maintenance. Administered via subcutaneous injection into abdomen, thigh, or upper arm. Currently an investigational compound not approved for clinical use outside of trials.
Safety & Side Effects
Cagrilintide has demonstrated a manageable safety profile in Phase 2 and Phase 3 clinical trials, with gastrointestinal side effects being the primary tolerability concern, typically resolving with continued use. It is an investigational compound not yet approved by the FDA or EMA, meaning access outside clinical trials is limited to research-grade or compounded sources, which carry significant regulatory and quality-assurance risks.
Possible Side Effects
- !Nausea (most common, particularly during dose escalation)
- !Vomiting, especially in early treatment phases
- !Decreased appetite and early satiety
- !Diarrhea or constipation
- !Injection site reactions including redness, swelling, or bruising
- !Fatigue and asthenia during titration
- !Headache, reported in a minority of participants
- !Hypoglycemia risk when combined with insulin or sulfonylureas
Interactions
- -Additive glucose-lowering effect when combined with GLP-1 receptor agonists (e.g., semaglutide) — increased hypoglycemia risk requires monitoring
- -May potentiate hypoglycemia when co-administered with insulin — dose adjustment of insulin may be required
- -Enhanced hypoglycemic effect with sulfonylureas — concurrent use warrants close blood glucose monitoring
- -May delay oral drug absorption due to gastric emptying inhibition — affects timing-sensitive medications such as oral contraceptives and levothyroxine
- -Additive nausea and GI effects when combined with other amylin analogues (e.g., pramlintide) — concurrent use not recommended
Cost & Where to Buy
Not commercially approved; costs reflect research-grade peptide sourcing from compounding or peptide vendors, which vary significantly by purity, source, and quantity. Clinical trial participants receive it at no cost. Once approved, pharmaceutical pricing is expected to be significantly higher, potentially comparable to semaglutide (Ozempic/Wegovy) at $800–$1,400/month without insurance.
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