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CagriSema

Metabolic & Weight LossInvestigational

Last reviewed: May 24, 2026

Also Known As: Cagri-Sema, CagriSema 2.4/2.4, Amylin-GLP-1 Combination

Peptide Class: Fixed-dose GLP-1 receptor agonist + amylin analogue blend

Regulatory Status: Investigational — Novo Nordisk NDA filed Dec 18, 2025; FDA decision pending 2026

Component peptides: Cagrilintide + Semaglutide (1:1 pre-blended ratio, both 2.4 mg at maintenance)

Latest research: Novo Nordisk filed CagriSema's FDA NDA on December 18, 2025 based on REDEFINE 1 (NEJM 2025) — 22.7% mean weight loss at 68 weeks, the largest published result for an injectable GLP-1-class combination. FDA decision expected in 2026. REIMAGINE 2 (T2D, Feb 2026) added superior HbA1c reduction versus semaglutide alone.

What is CagriSema?

CagriSema is a once-weekly injectable fixed-dose combination of cagrilintide (a long-acting amylin analogue) and semaglutide (a GLP-1 receptor agonist), developed by Novo Nordisk. The two compounds act on non-overlapping appetite pathways — amylin receptors in the brainstem and GLP-1 receptors in the gut, pancreas, and hypothalamus — and together produce larger weight reduction than either compound alone. In the Phase 3 REDEFINE 1 trial, CagriSema 2.4 mg / 2.4 mg produced 22.7% mean weight loss at 68 weeks, the largest result published for an injectable GLP-1-class combination as of May 2026. Compared head-to-head against tirzepatide, CagriSema did not demonstrate superiority — both produced comparable weight reduction.

Reported benefits:

  • 22.7% mean weight loss at 68 weeks in REDEFINE 1 (trial product estimand); 20.4% under the treatment-policy estimand
  • 91.9% of REDEFINE 1 participants achieved at least 5% weight loss; 60% achieved 20%; 23% achieved 30%
  • 15.7% weight loss in adults with overweight/obesity and type 2 diabetes (REDEFINE 2)
  • Superior HbA1c reduction (1.91 percentage points) versus semaglutide alone in type 2 diabetes (REIMAGINE 2)
  • No weight-loss plateau observed at 68 weeks in either REDEFINE 1 or REIMAGINE 2
  • Once-weekly dosing (both components have half-lives of approximately 7 days)

Common research dose: The REDEFINE Phase 3 protocol uses a 16-week synchronized titration from 0.25 mg + 0.25 mg up to a 2.4 mg + 2.4 mg maintenance dose, once weekly subcutaneously. Research-grade pre-blended vials are typically sold in 5 mg, 10 mg, or 20 mg total combined-mg labels at a fixed 1:1 ratio.

Where to buy: PP maintains a vetted list of peptide vendors with verified discount codes. See Verified Discount Codes → for current options.

How does CagriSema work?

CagriSema is a fixed-dose combination of two long-acting peptides that act on non-overlapping appetite pathways. Cagrilintide is a long-acting amylin analogue that engages amylin receptors concentrated in the brainstem. Semaglutide is a GLP-1 receptor agonist that engages GLP-1 receptors in the pancreas, gut, and hypothalamus. Each component drives appetite reduction through a distinct neuronal circuit, and the engineered fatty-acid albumin-binding extends both half-lives to roughly 7 days — supporting synchronized once-weekly subcutaneous dosing in a single pre-blended injection.

  1. Amylin receptor activation (cagrilintide component) [4][1]. Cagrilintide binds amylin receptors concentrated in the brainstem — primarily the area postrema and the nucleus of the solitary tract. Amylin signaling reduces meal size, slows gastric emptying, and promotes satiety through a pathway anatomically and pharmacologically distinct from the GLP-1 receptor system. See the standalone profile of cagrilintide for the full mechanism.
  2. GLP-1 receptor activation (semaglutide component) [1][5]. Semaglutide activates GLP-1 receptors on pancreatic beta cells, in the gut, and in hypothalamic appetite centers. Activation increases glucose-dependent insulin secretion, suppresses glucagon, slows gastric emptying, and reduces food intake. See the standalone profile of semaglutide for the full mechanism.
  3. Pre-blended 1:1 fixed-dose product [1][5]. CagriSema is formulated as a single subcutaneous injection containing equal milligrams of cagrilintide and semaglutide. The two components are co-titrated in lockstep through a 16-week synchronized escalation to a 2.4 mg / 2.4 mg maintenance dose, used in REDEFINE 1, REDEFINE 2, and REIMAGINE 2.
  4. Once-weekly half-lives [4][5]. Both cagrilintide and semaglutide use engineered fatty-acid albumin-binding to extend their plasma half-lives to approximately 7 days each, supporting synchronized once-weekly dosing. Steady state is reached at each titration step after 4–5 weeks.

How do cagrilintide and semaglutide work together?

The strongest argument for CagriSema over either component alone is mechanistic non-redundance. Amylin and GLP-1 receptors sit on different neuronal populations, signal through different downstream pathways, and converge on overlapping but not identical appetite outputs. The result is additive — and in some endpoints, more than additive — weight reduction in head-to-head Phase 3 comparisons. This is the structural reason for the blend.

  1. Non-redundant brain targets [1]. Amylin and GLP-1 act on different neuronal populations and signaling pathways. Both ultimately reduce food intake, but through complementary rather than overlapping circuits.
  2. Quantitative additivity in REDEFINE 1 [1]. CagriSema (22.7% trial product estimand) outperformed semaglutide alone (14.9%), cagrilintide alone (11.5%), and placebo (2.3%) over 68 weeks. The combined effect exceeded the sum of each component's marginal weight loss versus placebo, consistent with super-additive interaction at higher dose tiers.
  3. Glycemic stacking in T2D (REIMAGINE 2) [3]. From a baseline HbA1c of 8.2%, the 2.4 mg / 2.4 mg blend produced a 1.91 percentage-point HbA1c reduction versus 1.76 with semaglutide 2.4 mg alone — a small but statistically significant added effect from the amylin component on top of GLP-1 monotherapy.
  4. Side-effect profile is GLP-1-dominant [1]. Gastrointestinal events (nausea 55%, vomiting 26.1%, constipation 30.7%) track closely with the semaglutide profile, suggesting the amylin component adds efficacy without proportionally adding GI burden — a favorable therapeutic index argument for the combination.
  5. Why not just escalate semaglutide further? The 2.4 mg semaglutide dose used in CagriSema is already the maximum approved dose for weight management (Wegovy). Higher GLP-1 monotherapy doses do not produce better tolerability or proportionally more weight loss. Adding a second pathway (amylin) is the way to extend efficacy beyond GLP-1 monotherapy ceiling without exceeding tolerated GLP-1 exposure.

What is CagriSema used for?

CagriSema's evidence base is built on the REDEFINE Phase 3 program (REDEFINE 1, 2, 3, 11) and the REIMAGINE 2 trial in type 2 diabetes. The two flagship trials read out in 2025 and supported Novo Nordisk's December 2025 FDA NDA filing. Phase 3 evidence covers obesity with and without type 2 diabetes; the cardiovascular outcomes trial (REDEFINE 3) and long-duration extension (REDEFINE 11) are ongoing.

  1. Obesity without type 2 diabetes [1]. REDEFINE 1 enrolled 3,417 adults with overweight or obesity and at least one weight-related comorbidity but without type 2 diabetes. Over 68 weeks, CagriSema produced 22.7% mean weight loss (trial product estimand) and 20.4% under the treatment-policy estimand, versus 2.3% with placebo. 91.9% of participants achieved at least 5% weight loss, 60% at least 20%, and 23% at least 30%.
  2. Obesity with type 2 diabetes [2]. REDEFINE 2 enrolled 1,206 adults with overweight or obesity and type 2 diabetes. Over 68 weeks, CagriSema produced 15.7% mean weight loss versus approximately 3.1% with placebo. Weight loss in T2D populations is typically lower than non-diabetic populations across the GLP-1 class.
  3. Glycemic control in type 2 diabetes [3]. REIMAGINE 2 enrolled 2,728 adults with type 2 diabetes inadequately controlled on metformin. From a baseline HbA1c of 8.2%, CagriSema 2.4/2.4 mg produced a 1.91 percentage-point HbA1c reduction versus 1.76 with semaglutide 2.4 mg alone, and 14.2% weight loss versus 10.2% with semaglutide alone.
  4. Cardiovascular outcomes [7]. REDEFINE 3 is an ongoing event-driven cardiovascular outcomes trial enrolling approximately 7,000 adults with established cardiovascular disease (with or without type 2 diabetes), treating for 156 weeks. Results are expected later in the decade.
  5. Long-duration obesity [6]. REDEFINE 11 is an ongoing Phase 3 trial in 600 adults with BMI ≥30, designed to extend the maintenance evidence base. Initial results are expected in the first half of 2027.

How long does CagriSema take to work?

CagriSema's effects build gradually across the 16-week synchronized titration and the maintenance period that follows. Appetite suppression appears first, modest weight loss accumulates through escalation, and the bulk of weight reduction emerges during the maintenance dose. No plateau was observed at week 68 in either flagship trial.

In REDEFINE 1, most participants noticed reduced appetite within the first 1–2 weeks. Modest weight loss appeared by week 4 at the lowest titration step (0.25 mg / 0.25 mg). Weight loss accumulated through escalation, reaching meaningful levels by the time participants hit the 2.4 mg / 2.4 mg maintenance dose at week 17. Through weeks 17–68, weight loss continued to deepen — and importantly, no weight-loss plateau was observed at week 68 in either REDEFINE 1 or REIMAGINE 2, suggesting full effects may take longer than 68 weeks to fully express. Gastrointestinal side effects are typically most prominent during the early escalation steps and improve as the body adapts.

How is CagriSema dosed?

Phase 3 dosing follows a fixed 16-week synchronized titration schedule. Both components escalate together at every step — there is no asynchronous titration in the trial protocol or research-grade product. Maintenance is 2.4 mg cagrilintide + 2.4 mg semaglutide weekly (4.8 mg combined total).

CagriSema is administered as a once-weekly subcutaneous injection of a fixed 1:1 ratio of cagrilintide and semaglutide. The Phase 3 protocol uses a 16-week synchronized titration to allow gastrointestinal adaptation, followed by a 2.4 mg / 2.4 mg weekly maintenance dose. Both compounds are dose-escalated together at every step.

Standard escalation schedule (REDEFINE Phase 3 protocol):

WeekCagrilintideSemaglutideCombined total
1–40.25 mg0.25 mg0.5 mg
5–80.5 mg0.5 mg1.0 mg
9–121.0 mg1.0 mg2.0 mg
13–161.7 mg1.7 mg3.4 mg
17+2.4 mg2.4 mg4.8 mg (maintenance)

*Both components are co-titrated in lockstep — the pre-blended product fixes the 1:1 ratio at every step. To adjust the ratio independently (e.g., escalate amylin while holding GLP-1), researchers must buy the two component peptides separately rather than using a pre-blend.

If side effects are difficult to tolerate at any step, holding at the current dose for an additional 4 weeks is the standard mitigation. In REDEFINE 2, 61.9% of participants reached the highest maintenance dose by week 68 under a flexible-dosing protocol — meaning a substantial minority held at a lower dose for the duration of the trial and still produced meaningful weight loss.

Pre-blended formulations (research-grade vials)

Research-grade CagriSema is sold by specialty peptide vendors as pre-blended vials in a 1:1 ratio of cagrilintide to semaglutide. Common label sizes are 5 mg total (2.5 mg + 2.5 mg), 10 mg total (5 mg + 5 mg), and 20 mg total (10 mg + 10 mg). The label always shows the combined total milligrams of both compounds.

When reconstituting, use the combined total label as the vial size in the dosing calculator. Because the ratio is fixed at 1:1, every drawn dose contains equal amounts of each compound. For example, a 20 mg vial (10 mg cagrilintide + 10 mg semaglutide) drawn for a 4.8 mg combined weekly dose delivers 2.4 mg of each compound — the maintenance dose used in REDEFINE 1.

Researchers who want a non-1:1 ratio — for example, to preferentially escalate the amylin component or to maintain cagrilintide while reducing semaglutide — should buy the two components separately rather than using a pre-blended product. Pre-blended vials lock the ratio at the labeled 1:1.

CagriSema is not FDA-approved. Dosing protocols outside of clinical trials are derived from REDEFINE/REIMAGINE trial data — there are no approved retail dosing standards.

Need to calculate your dose? Convert mg to syringe units and plan reconstitution with the dosage calculator →.

How is CagriSema administered?

CagriSema is given as a subcutaneous injection — under the skin, not into muscle — once weekly, using a small insulin syringe. The injection routine, timing, and supporting habits (hydration, eating pattern, alcohol management) matter as much as the dose for tolerability. The points below cover the practical details that experienced users converge on.

  1. Route. Subcutaneous injection, once weekly. Common sites are the abdomen (avoiding a 2-inch radius around the navel), upper outer thighs, and back of the upper arms.
  2. Time of day. Any time, but consistent. Many users inject in the evening to sleep through the strongest nausea window after dose increases.
  3. With or without food. Either is fine. Both components are administered without regard to meals.
  4. Site rotation. Use a different site each week to reduce localized irritation. Stay at least 1 inch from previous injection sites — injection site reactions were reported in approximately 12% of CagriSema participants in REDEFINE 1.
  5. Missed dose. If less than 5 days late, take as soon as remembered. If more than 5 days late, skip the missed dose and resume on the next scheduled day. Do not double-dose.
  6. Alcohol. Avoid for at least 48 hours after injection — alcohol compounds nausea, dehydration, and hypoglycemia risk in users with type 2 diabetes.
  7. Hydration. Drink water consistently. The medication blunts thirst signals, so set a daily water target rather than waiting for thirst.
  8. Eating pattern. Small meals every 3–4 hours rather than waiting for hunger, which is suppressed. Empty-stomach nausea is the most common trigger for vomiting.
AspectRecommendation
FrequencyOnce weekly, same day each week
Best time of dayEvening often preferred — sleep through peak GI side effects during titration
FoodNo fasting required; inject with or without food
Site rotationRotate abdomen, thigh, upper arm — avoid same site within 2 weeks
Component co-titrationCagrilintide and semaglutide escalate together in lockstep; pre-blend locks the ratio at 1:1
Missed dose<5 days late: take as remembered. >5 days late: skip and resume next scheduled day.

Reconstitution math. Pre-blended CagriSema vials are labeled by total combined mass — for a 10 mg vial, that means 5 mg cagrilintide + 5 mg semaglutide. Reconstitute using the combined-total label as the vial size in the calculator. All units below are measured on a U-100 insulin syringe (100 units = 1 mL). The table assumes a 10 mg combined-total vial.

BAC waterConcentration0.5 mg combined2.0 mg combined3.4 mg combined4.8 mg combined
1 mL10 mg/mL5 units20 units34 units48 units
2 mL5 mg/mL10 units40 units68 units96 units
3 mL3.33 mg/mL15 units60 units~100 units144 units (2 draws)

*Combined-total dose values: at 4.8 mg combined (the REDEFINE maintenance dose), each draw delivers 2.4 mg cagrilintide + 2.4 mg semaglutide. Doses above ~100 units per draw exceed insulin syringe capacity at low concentrations — use 1 mL or 2 mL reconstitution volumes for the high tiers. The 2 mL volume is the most common research-protocol convention.

What does CagriSema stack well with?

CagriSema is a standalone protocol in clinical practice. Because it already contains both an amylin analogue and a GLP-1 receptor agonist at full maintenance doses, additional GLP-1- or amylin-class compounds are clinically redundant and increase side-effect burden. The useful adjuncts are non-peptide: training, protein, and (in T2D) compatible glycemic agents.

  1. Standalone use — the standard protocol. CagriSema already contains both semaglutide and cagrilintide at full maintenance doses, so stacking with other GLP-1- or amylin-class peptides is unnecessary and increases side-effect risk without proportional benefit.
  2. Resistance training + 1.2–1.6 g/kg protein per day. Recommended throughout dose escalation and maintenance to preserve lean muscle mass during rapid weight loss. Without this, GLP-1-class regimens can cause significant muscle loss alongside fat loss.
  3. Metformin (in type 2 diabetes). Commonly continued alongside CagriSema for additive glycemic control. REIMAGINE 2 enrolled participants on metformin with or without an SGLT2 inhibitor; CagriSema is compatible with both.
  4. Avoid: other GLP-1 agonists. Standalone semaglutide, tirzepatide, retatrutide, liraglutide — CagriSema already contains semaglutide 2.4 mg at the maximum approved dose.
  5. Avoid: other amylin analogues. Standalone cagrilintide or pramlintide — CagriSema already contains cagrilintide 2.4 mg.

What are the side effects of CagriSema?

The CagriSema side-effect profile is dominated by gastrointestinal events typical of the GLP-1 class, with overall rates comparable to or modestly higher than semaglutide monotherapy. Most discontinuations occur during early escalation; rates decline at maintenance. The amylin component does not appear to substantially worsen GI tolerability.

Common (REDEFINE 1, CagriSema vs placebo)

  1. Any gastrointestinal event — 79.6% with CagriSema vs 39.9% placebo
  2. Nausea — 55% vs 12.6%; most prominent during titration, generally transient
  3. Constipation — 30.7% vs 11.6%
  4. Vomiting — 26.1% vs 4.1%
  5. Decreased appetite — expected effect, but occasionally excessive
  6. Injection site reactions — approximately 12% of CagriSema participants

Less common (moderate)

  1. Increased heart rate — typical of the GLP-1 class, average increase of a few beats per minute
  2. Headache and fatigue — typically mild, more common after dose increases
  3. Diabetic retinopathy worsening — observed across the GLP-1 class, particularly with rapid HbA1c reduction in type 2 diabetes

Serious (rare — call a doctor)

  1. Pancreatitis — class-wide risk for GLP-1 receptor agonists. Symptoms: severe abdominal pain radiating to the back, persistent vomiting, fever.
  2. Gallbladder problems — including cholelithiasis and cholecystitis. Symptoms: severe upper-right abdominal pain, jaundice, fever.
  3. Thyroid C-cell tumors — semaglutide carries a boxed warning based on rodent data. Not confirmed in humans, but contraindicated in personal or family history of medullary thyroid carcinoma or MEN 2. CagriSema inherits this warning.
  4. Severe allergic reactions — rare. Symptoms: difficulty breathing, swelling of face/throat, hives. Seek emergency care.

Discontinuation due to side effects was 5.9% with CagriSema versus 3.5% with placebo in REDEFINE 1, and 8.4% versus 3% in REDEFINE 2. Most discontinuations occurred during the early escalation phase. The overall safety profile in trials was consistent with what is known about each component drug.

Does CagriSema interact with other drugs?

CagriSema's interaction profile mirrors semaglutide's: hypoglycemia risk with other glucose-lowering agents, absorption changes for oral medications due to slowed gastric emptying, and class-wide contraindications for stacking with other GLP-1 agonists or amylin analogues.

  1. Insulin and sulfonylureas. Risk of hypoglycemia (low blood sugar) increases when CagriSema is combined with insulin, glipizide, glyburide, or other blood-sugar-lowering drugs. Dose adjustment of the background diabetes therapy is typically needed.
  2. Oral medications. Both cagrilintide and semaglutide slow gastric emptying, which can affect the absorption of oral medications. Particularly relevant for narrow-therapeutic-window drugs (warfarin, levothyroxine, certain antibiotics).
  3. Birth control pills. Slowed gastric emptying may reduce absorption. Backup contraception is commonly recommended during the first 4 weeks of treatment and the 4 weeks after each dose increase.
  4. Other GLP-1 receptor agonists. Standalone semaglutide, tirzepatide, retatrutide, liraglutide — should not be combined with CagriSema, which already contains semaglutide.
  5. Other amylin analogues. Pramlintide and standalone cagrilintide — should not be combined with CagriSema, which already contains cagrilintide.
  6. Alcohol. Compounds nausea, dehydration, and hypoglycemia risk.

How should CagriSema be stored?

  1. Lyophilized (powder) form: Store at 2–8°C (refrigerated). Stable for the manufacturer's stated shelf life when sealed.
  2. Reconstituted solution: Store at 2–8°C. Most research-grade preparations are stable for 28–30 days after reconstitution; check vendor's product specifications.
  3. Reconstitution: Use bacteriostatic water for injection (BAC water) at the volume specified by the dose calculator. Swirl gently — do not shake.
  4. Do not freeze. Freezing damages both component peptides and renders the blend inactive.
  5. Protect from light — store in the original container or a light-protective container.
  6. Discard if the solution is cloudy, discolored, or contains particles.

What are the limitations of CagriSema research?

CagriSema is investigational. The flagship Phase 3 trials (REDEFINE 1, REDEFINE 2) and the T2D trial (REIMAGINE 2) read out in 2025–2026, and Novo Nordisk filed an FDA NDA in December 2025. As of May 2026, the FDA decision is still pending; the cardiovascular outcomes trial (REDEFINE 3) and long-duration extension (REDEFINE 11) are ongoing. A head-to-head against tirzepatide reported in early 2026 did not show superiority on weight loss.

CagriSema is an investigational drug and is NOT approved by the FDA, EMA, or any major regulatory body as of May 2026. Novo Nordisk filed a New Drug Application (NDA) with the FDA on December 18, 2025, based primarily on REDEFINE 1 data. The FDA decision is expected in 2026. If approved, CagriSema would be the first injectable GLP-1 receptor agonist and amylin analogue combination treatment.

Long-term safety data beyond 68 weeks is not yet published. The cardiovascular outcomes trial (REDEFINE 3) is ongoing, with results expected later in the decade. Body-composition data (lean mass preservation), durability of weight loss after discontinuation, and pediatric data have not yet been reported. The REDEFINE 11 trial (longer-duration obesity) is expected to report initial results in the first half of 2027.

CagriSema is not a scheduled controlled substance in the US, but it is also not approved for human use. Research-grade pre-blended product is sold in a regulatory gray area, typically labeled “for research use only, not for human consumption.” The World Anti-Doping Agency prohibits all GLP-1-class drugs in sport. Legal status varies by country.

A separate REDEFINE trial (CagriSema vs tirzepatide) reported in early 2026 that CagriSema failed to demonstrate superiority on the primary weight-loss endpoint against tirzepatide. The two drugs produced comparable weight reduction in that head-to-head comparison; tirzepatide remains the most effective approved GLP-1-class drug pending FDA action on CagriSema.

Where to source CagriSema

CagriSema is not available by prescription as of May 2026 — Novo Nordisk's NDA is under FDA review. Research-grade pre-blended product is sold by specialty peptide vendors for laboratory use only. The three vendors highlighted below carry CagriSema as a pre-blended 1:1 product and have been vetted for transparent third-party testing, traceable batch documentation, and verified discount codes.

Peptide Partners10% off
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CagriSema FAQ

Is CagriSema FDA-approved?

No. As of May 2026, CagriSema is investigational. Novo Nordisk filed a New Drug Application (NDA) with the FDA on December 18, 2025, and the FDA review is expected to conclude in 2026. If approved, CagriSema would be the first injectable GLP-1 + amylin combination treatment.

How does CagriSema compare to semaglutide alone?

In REDEFINE 1, CagriSema produced 22.7% mean weight loss (trial product estimand) at 68 weeks versus 14.9% with semaglutide alone — about a 50% greater reduction. In REIMAGINE 2 (type 2 diabetes), CagriSema produced 14.2% weight loss and a 1.91-point HbA1c reduction versus 10.2% and 1.76 points with semaglutide. The added cagrilintide component activates amylin receptors in the brainstem, a different appetite pathway than the GLP-1 receptor, which is why the combination outperforms either compound alone.

How long does CagriSema take to work?

Most research participants noticed reduced appetite within the first 1–2 weeks of starting. Modest weight loss typically appeared by week 4. The 16-week synchronized titration brings users to the maintenance 2.4 mg / 2.4 mg dose at week 17, with weight loss continuing to accumulate through the 68-week trial. In REDEFINE 1, no weight-loss plateau was observed at week 68 — the curve was still declining at trial end.

Does CagriSema cause muscle loss?

Like all GLP-1-class therapies, CagriSema can cause loss of lean muscle alongside fat loss during rapid weight reduction. Resistance training and adequate protein intake (typically 1.2–1.6 g/kg body weight per day) significantly reduce muscle loss. Cagrilintide may modestly attenuate this effect compared to GLP-1 monotherapy in some preclinical work, but human data on body composition with CagriSema specifically is still limited.

Can I stack CagriSema with semaglutide or tirzepatide?

No. CagriSema already contains semaglutide 2.4 mg, so adding additional semaglutide, tirzepatide, retatrutide, or any other GLP-1-class compound risks severe gastrointestinal side effects and compounded hypoglycemia without additional benefit. Likewise, do not add standalone cagrilintide — it is already in the formulation at the maintenance dose.

What happens if I stop CagriSema?

Long-term data on what happens after stopping CagriSema is not yet published. Based on data from semaglutide (STEP 1 extension) and tirzepatide (SURMOUNT-4), partial weight regain is expected after discontinuation. Ongoing extension studies in the REDEFINE program are expected to clarify maintenance strategies in 2026 and beyond.

Can I drink alcohol on CagriSema?

Alcohol compounds nausea, dehydration, and hypoglycemia risk in users with type 2 diabetes. Most users find it best to avoid alcohol for at least 48 hours after each weekly injection, when medication levels peak. Slowed gastric emptying can also unpredictably change how alcohol is absorbed.

Where can I get CagriSema?

CagriSema is investigational and not available by prescription. Research-grade pre-blended product is sold by specialty peptide vendors for laboratory use only. PP maintains a list of vetted vendors with verified discount codes — see Verified Discount Codes →.

References

  1. Garvey WT, Blüher M, Osorto Contreras CK, et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1). N Engl J Med. 2025;393:635-647. https://www.nejm.org/doi/full/10.1056/NEJMoa2502081
  2. Davies MJ, Aroda VR, Bajaj HS, et al. Cagrilintide–Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes (REDEFINE 2). N Engl J Med. 2025. https://www.nejm.org/doi/abs/10.1056/NEJMoa2502082
  3. Novo Nordisk. CagriSema demonstrated superior HbA1c reduction of 1.91%-points and weight loss of 14.2% in adults with type 2 diabetes in the REIMAGINE 2 trial. February 2, 2026. https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916481
  4. Lau DCW, Erichsen L, Francisco AM, et al. Once-weekly cagrilintide for weight management in people with overweight and obesity: a Phase 2 trial. Lancet. 2021;398(10317):2160-2172. https://pubmed.ncbi.nlm.nih.gov/34798060/
  5. Frias JP, Deenadayalan S, Erichsen L, et al. Efficacy and safety of co-administered once-weekly cagrilintide 2.4 mg with once-weekly semaglutide 2.4 mg in type 2 diabetes: a Phase 2 trial. Lancet. 2023;402(10403):720-730. https://pubmed.ncbi.nlm.nih.gov/37364590/
  6. Novo Nordisk. Novo Nordisk files for FDA approval of CagriSema, the first once-weekly combination of GLP-1 and amylin analogues for weight management. December 18, 2025. https://www.prnewswire.com/news-releases/novo-nordisk-files-for-fda-approval-of-cagrisema-the-first-once-weekly-combination-of-glp1-and-amylin-analogues-for-weight-management-302645862.html
  7. ClinicalTrials.gov. REDEFINE 3 — A Research Study to See How Well CagriSema Reduces the Risk of Cardiovascular Events. NCT05669755. https://clinicaltrials.gov/study/NCT05669755

Published Studies

Plain-English summaries of the peer-reviewed studies behind the claims above. Click any title to read the source paper.

New England Journal of Medicine · 2025Open Access
Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1) →

Garvey WT, Blüher M, Osorto Contreras CK, et al. — REDEFINE 1 Trial Investigators

The landmark Phase 3 trial of CagriSema in 3,417 adults with overweight or obesity (without type 2 diabetes) over 68 weeks. CagriSema produced 22.7% mean weight loss when all participants adhered to treatment (trial product estimand), and 20.4% under the treatment policy estimand — versus 14.9% with semaglutide alone, 11.5% with cagrilintide alone, and 2.3% with placebo. 91.9% of CagriSema participants achieved at least 5% weight loss, 60% achieved at least 20%, and 23% achieved at least 30%. The result established CagriSema as the most effective injectable GLP-1-class combination tested to date and formed the basis of Novo Nordisk's December 2025 NDA submission to the FDA.

New England Journal of Medicine · 2025Open Access
Cagrilintide–Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes (REDEFINE 2) →

Davies MJ, Aroda VR, Bajaj HS, et al. — REDEFINE 2 Trial Investigators

The Phase 3 companion trial of CagriSema in 1,206 adults with overweight or obesity and type 2 diabetes over 68 weeks. CagriSema produced 15.7% mean weight loss versus approximately 3.1% with placebo — a substantially larger effect than semaglutide alone has produced in comparable T2D populations (around 9–10% in STEP 2). Weight loss in T2D populations is typically lower than in non-diabetic populations for all GLP-1-class drugs, and the REDEFINE 2 result follows that pattern while still exceeding any prior amylin- or GLP-1-monotherapy benchmark in this group.

Novo Nordisk Investor Communications · 2026Open Access
CagriSema 2.4/2.4 mg in Type 2 Diabetes: REIMAGINE 2 Topline Results →

Novo Nordisk press release — full publication pending

REIMAGINE 2 was a 68-week Phase 3 trial in 2,728 adults with type 2 diabetes inadequately controlled on metformin (with or without an SGLT2 inhibitor). CagriSema 2.4 mg / 2.4 mg produced a 1.91 percentage-point reduction in HbA1c versus 1.76 with semaglutide 2.4 mg from a baseline of 8.2%, and 14.2% weight loss versus 10.2% with semaglutide from a baseline of 101 kg. No weight-loss plateau was observed at week 68. The trial supported CagriSema's positioning as superior to semaglutide on both glycemic and weight endpoints in T2D.

The Lancet · 2021Paywalled
Once-weekly cagrilintide for weight management in people with overweight and obesity: a Phase 2 trial →

Lau DCW, Erichsen L, Francisco AM, et al.

The dose-finding Phase 2 trial of cagrilintide as a monotherapy — the amylin half of CagriSema. Over 26 weeks, cagrilintide produced dose-dependent weight loss reaching 10.8% at the 4.5 mg dose, versus 3.0% with placebo and 9.0% with liraglutide 3.0 mg daily. The trial established cagrilintide as the first long-acting amylin analogue with clinically meaningful weight reduction as monotherapy, providing the foundation for testing the cagrilintide + semaglutide combination that became CagriSema.

The Lancet · 2023Paywalled
Co-administered cagrilintide 2.4 mg with semaglutide 2.4 mg in Type 2 Diabetes: Phase 2 Trial →

Frias JP, Deenadayalan S, Erichsen L, et al.

The first prospective Phase 2 trial of CagriSema in 92 adults with type 2 diabetes over 32 weeks. CagriSema produced 15.6% weight loss compared to 5.1% with semaglutide and 8.1% with cagrilintide monotherapy. HbA1c reductions were 2.2 percentage points with CagriSema versus 1.8 with semaglutide and 0.9 with cagrilintide. Side effects were mostly mild-to-moderate gastrointestinal events and only one participant withdrew across all groups. The result motivated the larger Phase 3 REDEFINE and REIMAGINE programs.

Weight LossMetabolic HealthAmylin-GLP-1 CombinationInvestigational

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