Cagrilintide Dosage Guide: Titration, CagriSema and How to Use

Cagrilintide is a long-acting amylin analog studied alongside GLP-1 compounds in the weight-research space. Like semaglutide, the protocols seen in clinical literature use a slow, stepped titration rather than a single fixed dose, which is why the math matters from the first vial.

This guide explains how the cagrilintide titration ladder is structured, what the 16 to 20 week ramp to 2.4 mg weekly looks like on paper, and how cagrilintide is paired with semaglutide in the fixed combination known as CagriSema. It is reference information only, not medical advice. Dosing decisions belong to a licensed clinician.

Why cagrilintide uses a titration ladder

Amylin analogs and GLP-1 compounds share a common pattern in the research literature: starting low and stepping up over several weeks. The phase 2 cagrilintide trials studied weekly doses up to 2.4 mg, reached through gradual increases rather than a jump to the top dose. The stepped approach is the standard way these once-weekly compounds are introduced in studies.

A typical reference ladder in the literature moves through these weekly steps before reaching 2.4 mg:

• Weeks 1 to 4: 0.25 mg weekly
• Weeks 5 to 8: 0.5 mg weekly
• Weeks 9 to 12: 1.0 mg weekly
• Weeks 13 to 16: 1.7 mg weekly
• Week 17 onward: 2.4 mg weekly (maintenance studied)

That puts the full ramp at roughly 16 to 20 weeks depending on whether each step holds for four weeks. Some research protocols extend a step or hold at a lower dose, so the exact calendar varies by study.

Turning milligrams into syringe units

Each ladder step is a milligram target, but a syringe is marked in units. The conversion depends entirely on how the vial is reconstituted. A 5 mg vial mixed with 2 mL of bacteriostatic water gives a concentration of 2.5 mg/mL, or 0.025 mg per unit on a U-100 insulin syringe.

At that concentration, the ladder maps to roughly:

• 0.25 mg = 10 units
• 0.5 mg = 20 units
• 1.0 mg = 40 units
• 1.7 mg = 68 units
• 2.4 mg = 96 units

Change the vial strength or the water volume and every number shifts. Run your own vial through the peptide dosage calculator so the unit marks match your concentration instead of a generic table. For the mixing step itself, the reconstitution calculator shows how much water to add for a target units-per-dose.

What CagriSema is

CagriSema is the research name for a fixed-dose combination of cagrilintide and semaglutide in a single weekly formulation. The studied combination pairs 2.4 mg of cagrilintide with 2.4 mg of semaglutide, the same top dose each compound reaches on its own ladder. The idea is to combine an amylin analog with a GLP-1 analog in one weekly step.

Because both halves use the 2.4 mg target, the combination follows a parallel titration: both components step up together over the same multi-week ramp rather than one being added on top of a finished course of the other.

How the combination titration is structured

In the fixed combination, the two compounds are dosed in lockstep. A simplified view of the parallel ladder studied in the literature:

1. Start: 0.25 mg cagrilintide + 0.25 mg semaglutide weekly
2. Step up every 4 weeks through 0.5 mg, 1.0 mg and 1.7 mg of each
3. Reach 2.4 mg cagrilintide + 2.4 mg semaglutide weekly as the studied maintenance

If you are tracking semaglutide on its own, the semaglutide dosage chart covers the standalone 0.25 to 2.4 mg ramp, and the semaglutide vs tirzepatide comparison explains how GLP-1 compounds differ from the dual approaches.

Logging the ladder

A 16 to 20 week ramp means the dose changes four or five times. The common failure point is a missed step-up or a unit count carried over from an old concentration after a new vial is mixed. Writing down the date, the milligram target, the vial strength and the resulting units for every step keeps the ladder consistent.

A peptide tracker app records each dose, flags when a titration step is due, and stores the concentration math so the unit count is correct after every new vial. For storage between weekly doses, see how long reconstituted peptides last.

All figures here are general reference points drawn from published research protocols. They are not a prescription. A licensed clinician decides whether any compound, dose or schedule is appropriate. See the disclaimer for the full note.