PMID: 34703584
Zhao S, Kanagal-Shamanna R, Navsaria L, Ok CY, Zhang S, Nomie K, Han G, Hao D, Hill HA, Jiang C, Yao Y, Nastoupil L, Westin J, Fayad L, Nair R, Steiner R, Ahmed S, Samaniego F, Iyer SP, Oriabure O, Chen W, Song X, Zhang J, Badillo M, Moghrabi O, Aranda J, Tang G, Yin CC, Patel K, Medeiros LJ, Li S, Vega F, Thirumurthi S, Xu G, Neelapu S, Flowers CR, Romaguera J, Fowler N, Wang L, Wang ML , Jain P
Your doctor can show you (in person or through telemedicine) how to inject yourself and safely throw away sharp tools after your shot
Sequential start protocol (adding cagrilintide later) When to use: Already on semaglutide 2.4mg Plateaued on semaglutide alone Want to attribute side effects clearly More conservative approach Phase 1: Semaglutide foundation (weeks 1-20) Standard semaglutide titration to 2.4mg Weeks 1-4: 0.25mg Weeks 5-8: 0.5mg Weeks 9-12: 1.0mg Weeks 13-16: 1.7mg Week 17-20: 2.4mg (stabilize for 4 weeks) Phase 2: Add cagrilintide (week 21 onward) Continue semaglutide 2.4mg weekly Week 21-24: Add cagrilintide 0.6mg weekly Week 25-28: Increase to 1.2mg weekly Week 29-32: Increase to 1.8mg weekly Week 33+: 2.4mg weekly (both at maximum) Sequential protocol comparison: Benefits of sequential: Already accustomed to semaglutide effects Can clearly identify cagrilintide-specific side effects Option to stop cagrilintide if intolerable (keep semaglutide) Less overwhelming overall Good for plateaued semaglutide users Expected additional weight loss: On semaglutide 2.4mg alone: Lost 10-15% already After adding cagrilintide: Additional 5-10% over next 6-12 months Total: 15-25% combined Conservative dosing approach (lower maximum) For GI-sensitive individuals: Reduced target doses: Semaglutide: 1.7-2.0mg weekly (instead of 2.4mg) Cagrilintide: 1.8-2.0mg weekly (instead of 2.4mg) Same titration schedule, lower endpoint Better tolerability Extended titration (20+ weeks to maximum): Stay at each dose level 6 weeks instead of 4 Weeks 1-6: Starting doses Weeks 7-12: First increase Weeks 13-18: Second increase Weeks 19-24: Third increase Week 25+: Target doses Conservative protocol table: When to choose conservative: History of severe nausea on GLP-1s Older age (60+) Multiple medications Concerns about tolerability Budget constraints Don't need maximum possible weight loss Use SeekPeptides to design your personalized CagriSema protocol based on GI tolerance
She continues to receive the same amount of vitamin B12 intramuscular injections at regular visits (Figure 1)
