Cagrilintide

Cagrilintide is a long-acting analogue of amylin, a hormone the body makes that comes from the pancreas together with insulin and signals satiety. It is therefore a sibling concept to the GLP-1 compounds, but acts on a different path.

It is injected once a week. Cagrilintide is still in clinical research and is often thought of together with semaglutide (the combination is called CagriSema). It ships as a freeze-dried powder you dissolve in bacteriostatic water.

Amylin and its analogues act on satiety centres in the brain and slow gastric emptying. The result is an earlier and longer-lasting feeling of fullness. Because cagrilintide uses a different path than GLP-1, the two complement each other well, hence the great interest in the combination.

In a research context, cagrilintide alone led to clear weight reduction, and even more in combination with semaglutide.

For subcutaneous use you need:

• The Cagrilintide vial with the freeze-dried powder
• Bacteriostatic water to dissolve it
• U-100 insulin syringes
• Alcohol swabs for the vial cap and the skin
• A sealable sharps container for used needles

The powder is dissolved in bacteriostatic water. How much water you add sets the concentration, and with it how many units you draw for your dose on the insulin syringe.

Use the calculator above for this: pick your vial size and the water volume, and you see the concentration and units per dose.

When dissolving, just add the bac water, it does not matter if it hits the powder directly. Then swirl or shake until everything has dissolved, both are fine.

The injection is subcutaneous, into the fat layer under the skin, classically the abdomen, the front of the thigh or the back of the upper arm.

• Clean the spot with an alcohol swab and let it dry
• Pinch up a small fold of skin
• Insert the needle at a 45 to 90 degree angle
• Inject slowly, wait a moment, then withdraw
• Put the needle straight into the sharps container

Rotate the site.

In a phase 2 study (Lau, 2021), weekly cagrilintide led to clear, dose-dependent weight reduction in overweight and obesity and was well tolerated. A further study examined the combination with semaglutide in type 2 diabetes. Cagrilintide is still in clinical research, but the phase 2 data are solid.

The studies with links are in the source block below.

As with the appetite-dampening substances, gastrointestinal effects come first: nausea, fullness, occasionally diarrhoea or constipation, mainly at the start and after dose increases. The slow titration is exactly for that.

Cagrilintide takes the appetite away, the rest is on you:

• Enough protein so you do not lose too much muscle along with fat.
• Drink enough, with low appetite you often drink less automatically.
• Resistance training keeps muscle mass.
• Eat slowly, with delayed gastric emptying you fill up faster.

The undissolved powder is robust, normal room temperature (around 20 to 25 degrees) is fine, ideally kept in the dark. The reconstituted solution goes into the fridge (2 to 8 degrees) and stays stable there for at least 8 to 10 weeks with barely any loss of potency, in practice considerably longer. The bacteriostatic water brings a preservative that keeps the dissolved form stable for longer.