CagriSema

What CagriSema does

CagriSema combines cagrilintide with semaglutide in a weekly injection. Large trials found greater weight loss than placebo, with separate studies in type 2 diabetes. The combination remains investigational as of October 18, 2026. Stomach symptoms are common; semaglutide's boxed warning describes thyroid C-cell tumors in rodents, with unknown human relevance. Home-mixed blends are not the trial product.

• In large trials, people lost more weight than on placebo, and more than on semaglutide alone in an East Asian trial. (Studied in a trial)
• In people with type 2 diabetes, trials found lower blood sugar (HbA1c) and weight, including when added to insulin. (Studied in a trial)
• In rats, the combination cut food intake without slowing the body's energy use. (animal)

Uses in the sources

• Studied for adult obesity or overweight with weight-related health conditions. (Studied in a trial) (source)
• Studied for glucose control in type 2 diabetes, including people taking basal insulin. (Studied in a trial) (source)
• Cardiovascular outcomes are under study; a heart-event benefit for this combination is not yet established. (Studied in a trial) (source)

CagriSema dosage

Typical reported dose: 0.25 mg of each drug weekly to start, up to 2.4 mg of each

• Phase 2: 2.4 mg of each: 0.25 mg of each drug once weekly, then 0.5 mg of each drug once weekly, then 1 mg of each drug once weekly, then 1.7 mg of each drug once weekly once weekly, under the skin. Studied in a trial. Studied in: Adults with type 2 diabetes and BMI ≥27 on metformin, with or without an SGLT2 inhibitor. (source)
• REDEFINE 1: 2.4 mg of each: 0.25 mg of each drug once weekly, then 0.5 mg of each drug once weekly, then 1 mg of each drug once weekly, then 1.7 mg of each drug once weekly once weekly, under the skin. Studied in a trial. Studied in: Adults without diabetes: BMI ≥30, or ≥27 with a weight-related condition. (source)
• REDEFINE 2: 2.4 mg of each: 0.25 mg of each drug once weekly, then 0.5 mg of each drug once weekly, then 1 mg of each drug once weekly, then 1.7 mg of each drug once weekly once weekly, under the skin. Studied in a trial. Studied in: Adults with type 2 diabetes, BMI ≥27 and HbA1c 7–10%. (source)
• REDEFINE 5: 2.4 mg of each: 0.25 mg of each drug once weekly, then 0.5 mg of each drug once weekly, then 1 mg of each drug once weekly, then 1.7 mg of each drug once weekly once weekly, under the skin. Studied in a trial. Studied in: Adults with high BMI and weight-related complications; 24% had type 2 diabetes. (source)
• REIMAGINE 1: 2.4 mg of each: 0.25 mg of each drug once weekly, then 0.5 mg of each drug once weekly, then 1 mg of each drug once weekly, then 1.7 mg of each drug once weekly once weekly, under the skin. Studied in a trial. Studied in: Adults with type 2 diabetes inadequately controlled by diet and exercise. (source)
• REIMAGINE 3: 2.4 mg of each: 0.25 mg of each drug once weekly, then 0.5 mg of each drug once weekly, then 1 mg of each drug once weekly, then 1.7 mg of each drug once weekly once weekly, under the skin. Studied in a trial. Studied in: Adults with type 2 diabetes on daily basal insulin, with or without metformin. (source)

These are doses reported in labels, trials or user reports, not a personal plan. Check the source behind each one.

Work out syringe units with the dosing calculator

How to mix CagriSema

Comes as: Dual-chamber, single-use prefilled trial pen., Community-reported freeze-dried equal-dose blend vials..

Mixed with: Bacteriostatic water is reported online; no approved reconstitution diluent exists for home blends..

Common vial sizes: 10 mg. Common water amounts: 2 mL.

• A reported 10 mg total vial contains 5 mg of each drug; retain both component amounts.
• A 5 mg + 5 mg vial with 2 mL contains 2.5 mg/mL of each drug, or 5 mg/mL total.
• Online advice about saline, water and acid conflicts. No validated home pH-adjustment procedure was found.
• Trial pens keep the formulations controlled; home co-mixing is not equivalent.

Before mixing: Follow trial-specific instructions for study devices. No validated home-blend storage conditions were found.

After mixing: No validated stability period for home blends was found; a clear solution does not prove sterility.

CagriSema side effects and risks

Reported side effects

• Stomach and bowel symptoms: 79.6% versus 39.9% placebo in REDEFINE 1; 72.5% versus 34.4% in REDEFINE 2., moderate (source)
• Nausea: REIMAGINE 3: 31.1% at 2.4 mg each, 26.9% at 1 mg each, 3.3% placebo., moderate (source)
• Diarrhea: REIMAGINE 3: 15.6%, 10.8% and 3.3%, respectively., moderate (source)
• Vomiting: REIMAGINE 3: 14.4%, 9.7% and 1.1%, respectively., moderate (source)
• Constipation: REIMAGINE 3: 11.1%, 11.8% and 5.5%, respectively., moderate (source)
• Injection-site reactions: 12.2% versus 3.0% placebo in REDEFINE 1., mild (source)
• Gallbladder disorders: 4.1% versus 1.0% placebo in REDEFINE 1., serious (source)
• Pancreatitis: 0.2% versus 0% placebo in REDEFINE 1; 0.3% versus 0% in REDEFINE 2., serious (source)
• Clinically significant low blood sugar: REDEFINE 2: level 2 events 6.0% versus 3.3% placebo., serious (source)
• Severe low blood sugar: REDEFINE 2: 0.2% versus 0%; both affected patients used sulfonylureas., serious (source)
• Dehydration-related kidney injury: Semaglutide component warning; no reliable combination specific rate., serious (source)
• Severe allergic reaction: Semaglutide component postmarketing reports; combination specific rate unknown., serious (source)

Stop and get help if

• Severe persistent belly pain, with or without vomiting: Stop and get urgent assessment for pancreatitis or gallbladder disease.
• Swelling of face or throat, breathing trouble or collapse: Stop and call emergency services.
• Confusion, seizure, unconsciousness or persistent low sugar: Call emergency services; do not give food or drink if unconscious.
• Repeated vomiting, very little urine or severe dizziness: Get urgent assessment for dehydration and kidney injury.
• Sudden vision loss or a new major vision change: Get emergency care for sudden loss of sight; urgent assessment for other new changes.
• Persistent squeezing chest pain, or chest pain with breathlessness: Get emergency assessment.

Who should avoid it

• pregnant: Weight-loss use is unsuitable in pregnancy; semaglutide may harm the fetus.
• breastfeeding: The combination lacks infant safety data; breastfeeding was excluded from trials.
• tryingToConceive: Semaglutide labeling calls for stopping at least 2 months before planned pregnancy.
• under18: Combination dosing in youth is still under study; adult results do not establish safety.
• mtcOrMen2: Semaglutide's label blocks use with personal/family MTC or MEN2. Its boxed warning reports thyroid C-cell tumors in rodents; human relevance is unknown, and CagriSema has no approved label.
• eatingDisorderHistory: Precaution: strong appetite suppression can worsen restrictive eating or poor nutrition.
• gastroparesis: Semaglutide is not recommended with severe gastroparesis.
• pancreatitisHistory: Review prior pancreatitis; cases occurred in combination trials.
• gallbladderDisease: Gallbladder events were more frequent than placebo in REDEFINE trials.
• diabeticRetinopathy: Rapid glucose improvement may worsen existing retinopathy; arrange eye monitoring.
• diabetes: Insulin or sulfonylureas may need clinician adjustment to avoid low blood sugar.
• kidneyDisease: Vomiting or diarrhea can cause dehydration and kidney injury; check kidney function if symptoms persist.
• liverDisease: Component PK data do not establish long-term combination safety in severe liver disease.
• heartCondition: Monitor heart rate and symptoms; combination cardiovascular outcomes are still pending.
• surgeryPlanned: Tell the anesthesia team; delayed stomach emptying can increase aspiration risk.
• testedAthlete: Cagrilintide remains unapproved, so S0 applies; semaglutide monitoring is a separate issue.
• other: Prior serious allergy to semaglutide, cagrilintide or formulation ingredients should stop use.

Interactions

• Insulin and sulfonylureas: Low-sugar risk can rise. Both severe cases in REDEFINE 2 used sulfonylureas; clinician-led dose review matters.
• Extra GLP-1 or amylin drugs: CagriSema already contains semaglutide and cagrilintide. Added GLP-1 or amylin exposure has no established safe schedule.
• Warfarin and other monitored oral drugs: Review INR or drug response during changes. The dedicated warfarin/atorvastatin study is complete but results were not located.
• Oral contraception: Combination absorption data are incomplete. Vomiting or diarrhea can undermine pill use; review backup needs with a clinician.

Product quality risks

• A community “CagriSema” blend is not the controlled dual-chamber trial product.
• Online semaglutide samples had 7.7–14.37% purity, 28.56–38.69% excess content and detectable endotoxin. This was not a CagriSema test.
• Wrong component ratio, vial/unit confusion and contamination can cause harm.
• FDA warns of counterfeit semaglutide products and dosing errors with unapproved injections.

What to expect

• Weeks 1-16: REDEFINE 1 used a 16-week period of gradually increasing weekly doses under trial supervision.
• Weeks 17-68: The trial then continued weekly injections through a 52-week maintenance phase.
• Week 68: REDEFINE 1 found average weight loss of 20.4% versus 3.0% with placebo, with stomach side effects common.

REDEFINE 1 studied weekly cagrilintide plus semaglutide for 68 weeks in adults without diabetes.

33 unique registered combination studies plus one simulated-use pen study. Includes ongoing/unreported records; reviews and secondary analyses are not new trials.

Key studies

• Phase 1b: six combination doses: Early combination testing supported weekly dosing and further trials. (source)
• Combined versus separate injections: Status: completed. No clinical benefit is established by registration. (source)
• Phase 2: combination versus each drug: The combination added weight loss; its HbA1c advantage over semaglutide was not significant. (source)
• MASH trial: exploratory CagriSema arm: This exploratory combination arm did not establish a liver-fibrosis benefit. (source)
• REDEFINE 2: obesity with diabetes: The combination reduced weight and HbA1c in people with type 2 diabetes. (source)
• REDEFINE 1: obesity without diabetes: The combination reduced weight more than placebo; its components also had separate arms. (source)

CagriSema FAQ

• Is CagriSema FDA-approved? No. CagriSema application filed December 2025; no approved combination label found.
• How do people take it? Under the skin, once weekly. 68 weeks. Source: studied in a trial.
• What's the difference between CagriSema and Tirzepatide? CagriSema: an unapproved cagrilintide–semaglutide combination with phase 3 weight-loss and diabetes results. Tirzepatide: a weekly GIP/GLP-1 injection with strong diabetes and weight-loss evidence and common stomach side effects. Why people pair them: occasional reports add a blend to an existing weight-loss drug.
• Can I take it with Tirzepatide? Occasional reports add a blend to an existing weight-loss drug. Adds GLP-1 exposure to semaglutide already in the blend; no verified human triple-stack evidence. Source: reported by users. Ask a doctor before combining anything.
• Is it banned in sport? Yes. It is banned in and out of competition (WADA 2026). Application of the S0 rule to unapproved cagrilintide; not an individual named listing. Confirm with the athlete’s anti-doping body.
• How long does a mixed vial last? No validated stability period for home blends was found; a clear solution does not prove sterility.