Cagrilintide + Semaglutide (CagriSema)

What it is

CagriSema is the name Novo Nordisk uses for its investigational combination of cagrilintide (an amylin analogue) and semaglutide (the GLP-1 drug in Ozempic and Wegovy). The two act on appetite through different pathways, so the hope is that they add up. Novo is running its own clinical trials of the combination.

The vial we stock is a research-chemical blend of 10 mg: 5 mg cagrilintide + 5 mg semaglutide. It is not the Novo Nordisk product. It has been made by a third party, has not been through the same manufacturing, formulation or testing, and has not been studied in humans as a blend. Any trial results below apply to Novo's product, not to this vial.

History

Cagrilintide and semaglutide were both developed by Novo Nordisk. Semaglutide was approved for diabetes in 2017 and obesity in 2021. Cagrilintide has not been approved as a standalone drug. The combination has been through phase 2 and a large phase 3 programme (the REDEFINE trials). Novo has reported weight loss in the region of 20% of body weight at the top dose after 68 weeks in people without diabetes, which is good but somewhat below what the company had hoped for and broadly in tirzepatide territory. Check Novo's publications for exact current numbers and regulatory status rather than relying on a summary here.

How it works

Semaglutide activates GLP-1 receptors, slowing stomach emptying, improving insulin response and reducing appetite. Cagrilintide activates amylin receptors, which act on the brain's appetite and reward centres and add to the feeling of fullness. Combining the two is aimed at producing a larger effect than semaglutide alone, because the pathways are different.

Dosage

• There is no approved dose for this vendor blend. In Novo's trials, both drugs were increased gradually together to 2.4 mg each, once weekly, over many weeks. That is the licensed-product regimen, not a recommendation for this blend.
• The fixed 1:1 ratio is a real limitation. It means you cannot titrate one drug independently of the other, and you cannot drop one if it is the one causing side effects.
• 5 mg of each in the vial is a small supply at higher doses: at 1 mg of each weekly it is only 5 doses, and at 2.4 mg of each, two. Cost and supply planning matter.
• If you are already on prescribed semaglutide or any other GLP-1, do not stack this on top without talking to your prescriber.

How it is taken

• Subcutaneous injection into the belly, thigh or upper arm, once weekly on the same day.
• Use a 29-31G insulin syringe. Rotate sites.

How to reconstitute

• For the 10 mg vial (5 mg cagrilintide + 5 mg semaglutide), add 2 ml bacteriostatic water. That gives 5 mg/ml total, or 2.5 mg/ml of each.
• On a 1 ml / 100-unit syringe, 10 units (0.1 ml) = 0.25 mg of each. 20 units = 0.5 mg of each. 40 units = 1 mg of each.
• Always work from the amounts printed on your own vial.
• Add the water slowly down the inside wall. Swirl gently. Do not shake.

How it should arrive

Sealed glass vial with an intact crimped cap and a white to off-white powder cake or film.

How it should look once reconstituted

A clear, colourless solution with no cloudiness, flecks or strings.

What to expect, and when

• Appetite reduction: usually noticeable within the first 1-2 weeks of a semaglutide-type drug.
• Weight changes: steady loss over months; the licensed trials ran 68 weeks.
• Side effects tend to peak around dose increases, which is why gradual titration matters, and why a fixed blend is awkward.

Side effects

• Nausea, vomiting, diarrhoea and constipation are the most common with GLP-1 drugs and are common in the trials of the combination.
• Reduced appetite to the point of under-eating, tiredness and dizziness.
• Heartburn, reflux, bloating and burping.
• Injection-site reactions.
• Cagrilintide has its own GI effects, so side effects may be stronger than semaglutide alone.

Risks

• This is not the licensed product. Quality, accuracy of dose and sterility are not guaranteed, and a fixed 1:1 ratio cannot be titrated sensibly.
• Semaglutide carries known serious risks: pancreatitis, gallbladder disease, dehydration with kidney injury, and low blood sugar when combined with insulin or sulfonylureas. Its label warns about thyroid C-cell tumours seen in rodents; avoid it if you or family have medullary thyroid cancer or MEN2.
• Rapid weight loss causes loss of muscle as well as fat. Protein intake and resistance training matter.
• Not for pregnancy or breastfeeding, and not for anyone with an eating disorder.
• Cagrilintide's long-term human safety data is limited to Novo's trials.
• Counterfeit and mislabelled GLP-1 products have been reported in the UK and elsewhere, and regulators have issued warnings. If you want a GLP-1, a prescriber and licensed pharmacy is the safest route.

Potential gains

• Appetite and weight reduction, strongly supported for semaglutide on its own.
• The combination looks effective in Novo's trials, but those results apply to Novo's formulation and escalation schedule.
• No evidence yet that this vendor blend performs like Novo's product.

Other useful information

What is known: semaglutide works and is licensed; cagrilintide is effective in trials and is being developed by Novo as a combination. What is not known: how this blend behaves in people, whether the vendor product is accurately dosed, and what ratio suits an individual. The 1:1 ratio is not necessarily the best ratio. If you are considering this for weight loss, a licensed GLP-1 prescribed by a clinician is better supported and safer. See the cagrilintide and semaglutide pages for the individual compounds.