Cagrilintide (5 mg vial)

Protocol Overview

Concise summary of the regimen.

Dosing & Reconstitution

Reconstitution Steps

1. Draw 3.0 mL bacteriostatic water with a sterile syringe.
2. Inject slowly down the vial wall; avoid foaming or vigorous agitation.
3. Gently swirl or roll until fully dissolved (do not shake).
4. Label with date and concentration; refrigerate at 2 to 8 °C, protected from light.
5. Use within 30 days of reconstitution; discard if cloudy or particulate matter appears. At 1.67 mg/mL, 1 unit = 0.01 mL » 16.7 mcg on a U-100 insulin syringe.

Storage Instructions

Proper storage preserves peptide quality.

• Lyophilized: store at -20 °C in dry, dark conditions; minimize moisture exposure.
• Reconstituted: refrigerate at 2 to 8 °C; use within 30 days; avoid freeze-thaw cycles.
• Allow vials to reach room temperature before opening to reduce condensation uptake.

Supplies Needed

Plan based on an 8 to 16 week weekly protocol with gradual titration.

Peptide Vials (Cagrilintide, 5 mg each):

• 8 weeks: ~4 vials (17.4 mg total).
• 12 weeks: ~8 vials (35.4 mg total).
• 16 weeks: ~11 vials (53.4 mg total).

Syringes:

• Weeks 1 to 4 (doses at or under 72 units): U-100 insulin syringes work well.
• Weeks 5+ (doses over 100 units): 3 mL syringes with 25 to 27G subcutaneous needles.
• Per week: 1 syringe. 16 weeks: 16 syringes.

Bacteriostatic Water (10 mL bottles):

• 8 weeks (4 vials): 2 bottles. 12 weeks (8 vials): 3 bottles. 16 weeks (11 vials): 4 bottles.

Alcohol Swabs:

• Per week: 2 swabs. 16 weeks: 32 swabs (1 x 100-count box).

Important Notes

Practical considerations for consistency and safety.

• Use new sterile syringes for each injection; dispose in a sharps container.
• Rotate injection sites (abdomen, thighs, upper arms) weekly to reduce local irritation.
• Gradual dose escalation minimizes gastrointestinal side effects such as nausea.
• Document weekly dose, injection site, and any adverse effects to maintain consistency.
• For maintenance doses requiring above 1.0 mL, ensure you have appropriately sized syringes (3 mL).

How This Works

Cagrilintide is an acylated, long-acting analogue of amylin, a hormone co-secreted with insulin from pancreatic beta cells. Native amylin promotes satiation, slows gastric emptying, and inhibits postprandial glucagon secretion. By acting on central amylin receptors (particularly in the area postrema and hindbrain), cagrilintide reduces appetite and energy intake. Lipid modifications extend its half-life to approximately 160 to 195 hours, enabling once-weekly dosing.

Benefits & Side Effects

Observations from phase 2 and phase 3 clinical trials.

• Weight reduction: In the phase 2 trial, cagrilintide 4.5 mg weekly produced approximately 10.8% body

weight loss over 26 weeks versus 3.0% with placebo.

• Combination therapy: When combined with semaglutide 2.4 mg (CagriSema), phase 3 REDEFINE

trials showed approximately 20% weight loss at 68 weeks, exceeding results with either agent alone.

• Dose-dependent efficacy: Higher doses (2.4 to 4.5 mg) demonstrate greater weight loss than lower

doses (0.3 to 1.2 mg).

• Side effects: Primarily gastrointestinal (nausea, vomiting, diarrhea, constipation), generally mild to

moderate and transient. Gradual titration helps minimize these effects.

• Injection-site reactions: occasional mild redness or irritation at subcutaneous injection sites.

Lifestyle Factors

Complementary strategies for best outcomes.

• Pair with a balanced, protein-forward diet tailored to individual energy needs.
• Combine resistance training and aerobic activity to support metabolic health and preserve lean mass.
• Prioritize adequate sleep (7 to 9 hours) and stress management for adherence and recovery.
• Monitor hydration and electrolytes, especially if experiencing gastrointestinal side effects.

Injection Technique

General subcutaneous guidance from clinical best-practice resources.

1. Clean the vial stopper and skin with alcohol; allow to air dry completely.
2. Pinch a skinfold; insert the needle at 45 to 90 degrees into subcutaneous tissue.
3. Do not aspirate for subcutaneous injections; inject slowly and steadily.
4. Hold for 5 to 10 seconds before withdrawing the needle to ensure complete delivery.
5. Rotate sites systematically (abdomen, thighs, upper arms) each week to avoid lipohypertrophy.

References

Source citations for further reading.

1. Lau et al. Once-weekly cagrilintide for weight management: phase 2 dose-finding trial (The Lancet, 2021).
2. Cagrilintide phase 2 trial: 10.8% weight loss at 4.5 mg dose over 26 weeks (The Lancet, 2021).
3. REDEFINE 1: Coadministered cagrilintide and semaglutide in adults with overweight or obesity (NEJM, 2025).
4. Development of cagrilintide: a long-acting amylin analogue (J Med Chem, 2021).