Cagrilintide and Semaglutide Dosing Chart and Trial Evidence Explained

What the REDEFINE programme's dosing ladder actually looked like

Phase 3 REDEFINE trials used a parallel titration structure in which cagrilintide and semaglutide were each started at low doses and increased together on roughly four-week intervals. Semaglutide began at 0.25 mg per week (the same tolerability starting point used in licensed Wegovy treatment, described in detail on the Wegovy dosing chart) and stepped through 0.5 mg, 1 mg, 1.7 mg and finally 2.4 mg. Cagrilintide ran alongside it, beginning at 0.16 mg weekly and escalating through 0.3 mg, 0.6 mg, 1.2 mg, 1.8 mg and then 2.4 mg. The full escalation phase took approximately 32 weeks before both agents settled at their target doses for the remainder of the 68-week study.

The rationale for such gradual stepping is practical: combining two agents that both affect appetite and gut motility raises the risk of nausea, vomiting and other gastrointestinal effects. Slow titration allows the body to adapt at each rung before the next increase is applied. Participants who could not tolerate an increase remained at a lower dose rather than discontinuing.

Because no approved version of this combination exists yet, there is no licensed SmPC setting out dosing for clinical practice. The figures above come from the published trial protocol and Novo Nordisk's regulatory submissions, not from a prescriber-ready chart. Any comparison with the semaglutide dosing chart for weight loss currently in clinical use should keep that distinction in mind.

What REDEFINE 1 found at those doses

REDEFINE 1 was a phase 3, placebo-controlled trial involving roughly 3,400 adults with obesity or overweight plus at least one weight-related condition, without type 2 diabetes. Over 68 weeks, participants on the full 2.4 mg cagrilintide plus 2.4 mg semaglutide combination lost an average of 22.7% of body weight compared with around 2.3% on placebo. That figure sits above the STEP 1 results for semaglutide 2.4 mg alone (approximately 15% over 68 weeks, as reported in the New England Journal of Medicine STEP 1 paper) and is broadly comparable to the highest tirzepatide dose results from the SURMOUNT programme.

A question our prescribers hear most weeks is whether CagriSema will simply replace everything currently available. The honest answer is that 22.7% is a mean; individual responses in every trial span a wide range. Some participants in REDEFINE lost considerably more, others less. More usefully, REDEFINE also tested a lower combination dose (1.2 mg cagrilintide plus 2.4 mg semaglutide) and found meaningfully lower average weight loss, reinforcing that the cagrilintide component adds dose-dependent effect above semaglutide alone.

Gastrointestinal side effects were common, as expected from the mechanism, nausea, vomiting and diarrhoea were more frequent in the combination arm than placebo, though serious discontinuations were relatively low. The NHS medicines page for semaglutide sets out the established GI profile of that component, which remained broadly similar within the combination.

Why this combination is not yet available in the UK, and what that means practically

As of mid-2026, Novo Nordisk had submitted CagriSema for regulatory review but neither the MHRA nor the EMA had granted a marketing authorisation. No UK pharmacy (regulated online or otherwise) can legally dispense it. The titration chart from the REDEFINE trials is therefore a research tool at this stage, not a prescribing guide. It tells us what doses proved both effective and acceptable in a controlled setting; it does not constitute a prescribable schedule.

For people researching this combination now, the most useful step is understanding what is currently licensed. Semaglutide as Wegovy has MHRA approval for weight management in adults and follows an established schedule that reaches 2.4 mg weekly maintenance. The question of whether semaglutide dose increases are mandatory is worth reading alongside any dosing discussion, titration is a prescriber's decision based on individual tolerability, not a fixed rule. Tirzepatide (Mounjaro) follows a different schedule entirely and is the only dual-agonist licensed in the UK for weight management at present.

If CagriSema does receive MHRA authorisation, a licensed dosing chart will follow in the approved SmPC. Until then, the REDEFINE protocol figures are the closest proxy available. You can read more about the combination's background and mechanism on the cagrilintide and semaglutide overview page. For anyone considering weight-management treatment that is available right now, a free clinical consultation with a GPhC-registered prescriber is the right place to start. Check your eligibility with our prescribers today.