Adding Cagrilintide to Tirzepatide

[Wallydog]

I would like to hear from those who added Cagrilintide to Tirzepatide. What was your motivation? What dosing schedule did you follow? How are the results?

Currently I am on 10mg/week of Tirzepatide. While it is mostly working well, the on-going "food noise" is sabotaging my efforts to maintain my eating discipline. Before I continuing upping my TZ dose, I would like to see if adding Cagrilintide will provide the needed appetite suppression to allow me to meet my intake goals.

I had stalled and was about 10# short of my goal and my tirz was maxxed out (15mg) so I added Cagri. Slow at first and nothing but at 2.4 it helped me get restarted (did not take on the same day)

More recently I'm trying to find a maintenance level or regimen but it's been a little erratic. I sort of wait to see when the food noise comes back and then dose, usually 4 weeks? But cutting to 10mg tirz alone didn't do it. So a bit later (weeks) I went back to 15 mg tirz and 2.4mg cagri same day. Oof. I was pretty slammed. Took them on Thursday. Felt terrible by Friday and even puked early Sun AM, food I had eaten on Thursday. I didn't eat anything until Monday and not much at that. About a month before this I had a bad bout of colitis from what the MDs think was a virus so maybe my GIT was not ready for tirz/cag but I will say it worked to keep me from eating!

 

[Mara_aa]

Because after a while it feels like its doing nothing. I can take a full dose and be hungry the next morning. I can skip a dose and not feel a difference. If i take tirz for instance I can definitely feel my hunger reduced and if i skip a dose of tirz hunger gradually comes back too. So yeah, i wont reorder it because its just not that effective long term for weight loss. Short term thats a different story.

Got it, thanks for sharing. I was actually considering it as an add-on to tirz.

It’s a shame if it wears off that quickly.

 

[Mara_aa]

I added cagrilintide to tirzepatide about 8 months ago. I currently divide the doses and take each one twice a week on different days (so 4 total injections between the two peptides). I've been pretty satisfied with the results. As of yesterday I'm down 100 pounds/45 Kg over the year since I started (the first 4 months on tirzepatide alone). I was starving all the time before I added cagrilinitide. Now I sometimes forget to eat. Being diagnosed with T2D was the impetus for starting this. I'm not sure whether I'd still meet any critieria for that since my glycohemoglobin level has been well within the normal range for months. However, because of this diagnosis I use a continuous glucose monitor. Often its warning of low blood glucose is my reminder that I haven't eaten. I've recognized no adverse effects.

Wow, that’s an incredible result, huge congrats, seriously impressive.

Really interesting to hear how well that combo worked for you. Do you reconstitute with BAC only? And if you don’t mind sharing, what doses are you running for both? And how did you introduce cagri what dose did you start with and how did you titrate up?

 

[Mara_aa]

I don’t blame anyone being trepidatious about Cagri, I’m just ridiculous sometimes and my desire to try it overrode my fear of the fibrils deal I didn’t have AA on hand and the curiosity was too much to bear. And then I just kept using bac. My nuanced risk tolerance, admittedly, doesn’t make much sense lol. I’ve already pivoted away from things I said on here a month ago like “I think I’ll stick with only FDA approved stuff”.

Haha that’s quite the pivot from “only FDA-approved” to just going for it.

I guess everyone has their own risk tolerance, sometimes on completely opposite ends.

 

[Mara_aa]

Yeah, the loss in effectiveness doesn't really make sense with the CagriSema studies, including one of 68 weeks:

https://www.medicalnewstoday.com/ar...-more-effective-than-wegovy-in-clinical-trial

One study with cagri by itself : https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01751-7/abstract

Yeah that’s interesting, I’ve come across similar data, so it’s a bit surprising to hear such different experiences. I guess it really varies a lot from person to person. I’m hoping I’ll be one of the lucky ones

 

[Mara_aa]

I had stalled and was about 10# short of my goal and my tirz was maxxed out (15mg) so I added Cagri. Slow at first and nothing but at 2.4 it helped me get restarted (did not take on the same day)

More recently I'm trying to find a maintenance level or regimen but it's been a little erratic. I sort of wait to see when the food noise comes back and then dose, usually 4 weeks? But cutting to 10mg tirz alone didn't do it. So a bit later (weeks) I went back to 15 mg tirz and 2.4mg cagri same day. Oof. I was pretty slammed. Took them on Thursday. Felt terrible by Friday and even puked early Sun AM, food I had eaten on Thursday. I didn't eat anything until Monday and not much at that. About a month before this I had a bad bout of colitis from what the MDs think was a virus so maybe my GIT was not ready for tirz/cag but I will say it worked to keep me from eating!

Omg that reaction sounds really rough. Definitely shows how strong that combo can be.

When you were breaking the stall, were you doing one weekly injection of tirz and one of cagri?

 

[Wallydog]

Omg that reaction sounds really rough. Definitely shows how strong that combo can be.

When you were breaking the stall, were you doing one weekly injection of tirz and one of cagri?

Yeah - I think I did one shot on Monday and the other on Thursday maybe?

 

[Chunkomatic]

I do about 11 mg of tirz every 5 days. I had hunger creeping back in so I tried Cagri. .25 did nothing but when I tried .50 it was like that first good dose of Tirz again. I didn’t want anything to do with food. I now just use it when I’m feeling stress hunger creeping back in. So I take more of an “as needed” approach with it. Haven’t had a shot of it in a couple months the but it’s nice to know it’s there whenever I get hunger ramping back up.

 

[CJsMom]

How do you store it n betwen? Do you reconstitute a new vial every time? Do you freeze it in between uses? TIA.

 

[cythehun]

I do about 11 mg of tirz every 5 days. I had hunger creeping back in so I tried Cagri. .25 did nothing but when I tried .50 it was like that first good dose of Tirz again. I didn’t want anything to do with food. I now just use it when I’m feeling stress hunger creeping back in. So I take more of an “as needed” approach with it. Haven’t had a shot of it in a couple months the but it’s nice to know it’s there whenever I get hunger ramping back up.

I like this approach. How long did it take after you went up to .50 on Cag to feel the effect?

Also, when you take it "as needed" do you stay at the .50 dose? How long after you take the "as needed" dose do you feel the effect?

 

[Chunkomatic]

How do you store it n betwen? Do you reconstitute a new vial every time? Do you freeze it in between uses? TIA.

If I use it then I just keep the vial in case I feel I need it. I’ll keep it refrigerated for a couple months and then toss it. I only reconstitute with Hospira. It’s always kept well. I don’t like to add additional variables to the peptide equation with questionable water.

 

[Chunkomatic]

I like this approach. How long did it take after you went up to .50 on Cag to feel the effect?

Also, when you take it "as needed" do you stay at the .50 dose? How long after you take the "as needed" dose do you feel the effect?

I’ve stayed at .5. But I don’t use it too often. It’s pretty potent stuff. I feel zero hunger the day after dosing. When I was doing Tirz every 7 days it did a great job of holding me over those last couple days. I went to the 5 day Tirz cycle a few months ago and haven’t really been needing the Cagri for now.

 

[wileyhorse]

I do about 11 mg of tirz every 5 days. I had hunger creeping back in so I tried Cagri. .25 did nothing but when I tried .50 it was like that first good dose of Tirz again. I didn’t want anything to do with food. I now just use it when I’m feeling stress hunger creeping back in. So I take more of an “as needed” approach with it. Haven’t had a shot of it in a couple months the but it’s nice to know it’s there whenever I get hunger ramping back up.

Hey thanks for this comment. I’m doing 7.5 Tz every 5-6 days because of the hunger that comes at the end of each cycle. Equals out to about 10.5 per 7days. But I’ve titrated up there according to the every 4 weeks rule, so I was worried about hitting the end of the runway too soon. I been looking hard at cagri. I feel like the Tz is doing its job for the most part, but dang if those hunger pains don’t pop in out of the blue some days. I like the idea of having cagri available for an “as needed” basis. Appreciate the inspiration and i think it solidified my decision to order.

 

[skeptick]

Hey thanks for this comment. I’m doing 7.5 Tz every 5-6 days because of the hunger that comes at the end of each cycle. Equals out to about 10.5 per 7days. But I’ve titrated up there according to the every 4 weeks rule, so I was worried about hitting the end of the runway too soon. I been looking hard at cagri. I feel like the Tz is doing its job for the most part, but dang if those hunger pains don’t pop in out of the blue some days. I like the idea of having cagri available for an “as needed” basis. Appreciate the inspiration and i think it solidified my decision to order.

Let me jump in here, please. Wife's research rat took 3.75mg/ .75ml BAC water Cagri instead of her usual 7.5mg Tirz yesterday. Is now very nauseous and vomiting to point of dry heaves. What dangers should I be monitoring for and what can I do to ease her discomfort. She's the main care giver around here so not in my wheelhouse of experience. Any help much appreciated. Have made water and electrolyte fluid available for her to sip on. Up to now she has shown no sides from working up to 7.5mg Tirz. She's normally very susceptible to drug interactions. Never been exposed to Cagri before this... 65year old healthy female

My math says 5mg vial Cagri/ 1ml Hospira Bac 75unit subq= 3.75 mg dose of Cagri Injectionshop calculator agrees.

Skipping 7.5mg weekly Terz for now.

 

[cythehun]

Let me jump in here, please. Wife's research rat took 3.75mg/ .75ml BAC water Cagri instead of her usual 7.5mg Tirz yesterday. Is now very nauseous and vomiting to point of dry heaves. What dangers should I be monitoring for and what can I do to ease her discomfort. She's the main care giver around here so not in my wheelhouse of experience. Any help much appreciated. Have made water and electrolyte fluid available for her to sip on. Up to now she has shown no sides from working up to 7.5mg Tirz. She's normally very susceptible to drug interactions. Never been exposed to Cagri before this... 65year old healthy female

My math says 5mg vial Cagri/ 1ml Hospira Bac 75unit subq= 3.75 mg dose of Cagri Injectionshop calculator agrees.

Skipping 7.5mg weekly Terz for now.

3.75mg of Cag may be too high a starting dose. I've seen a chart showing 0.6mg as the starting dose along with 10mg Tirz after working up to that Tirz dose alone for many weeks.

I would monitor all vitals and consider going to the emergency room just to be on the safe side. They can administer any needed medications.

 

[wileyhorse]

Let me jump in here, please. Wife's research rat took 3.75mg/ .75ml BAC water Cagri instead of her usual 7.5mg Tirz yesterday. Is now very nauseous and vomiting to point of dry heaves. What dangers should I be monitoring for and what can I do to ease her discomfort. She's the main care giver around here so not in my wheelhouse of experience. Any help much appreciated. Have made water and electrolyte fluid available for her to sip on. Up to now she has shown no sides from working up to 7.5mg Tirz. She's normally very susceptible to drug interactions. Never been exposed to Cagri before this... 65year old healthy female

My math says 5mg vial Cagri/ 1ml Hospira Bac 75unit subq= 3.75 mg dose of Cagri Injectionshop calculator agrees.

Skipping 7.5mg weekly Terz for now.

It’s my understanding (not o doctor here) that the biggest danger in overdose is dehydration. Given her age… If she’s unable to keep any fluids down, it may be worth a trip to her doctor just for IV fluids. Especially if this goes on for a few days. I plan on starting Cagri at .25 mg with my 7.5 Tirz.

 

[skeptick]

3.75mg of Cag may be too high a starting dose. I've seen a chart showing 0.6mg as the starting dose along with 10mg Tirz after working up to that Tirz dose alone for many weeks.

I would monitor all vitals and consider going to the emergency room just to be on the safe side. They can administer any needed medications.

Had Zofran on hand. Dissolve under tongue. Mave be seeing some improvement. Sipping clear fluids, most not staying down. Vomit is clear yellow vile fluids. ThanX

 

[skeptick]

It’s my understanding (not o doctor here) that the biggest danger in overdose is dehydration. Given her age… If she’s unable to keep any fluids down, it may be worth a trip to her doctor just for IV fluids. Especially if this goes on for a few days. I plan on starting Cagri at .25 mg with my 7.5 Tirz.

Had Zofran on hand. Dissolve under tongue. Maybe be seeing some improvement. Sipping clear fluids, most not staying down. Vomit is clear yellow vile fluids. ThanX

 

[Calm Logic]

Sipping clear fluids, most not staying down. Vomit is clear yellow vile fluids.

It's better to go to the ER sooner than later, where she can get relief rather than linger. Or urgent care can at least help with dosing or other medications.

Zofran can be taken quite often or at higher doses. Reglan (metoclopramide) can be prescribed for gastroparesis. It can also can help with nausea, vomiting, and heartburn.

One worst case scenario to avoid may be dangerously low potassium.

 

[cythehun]

Please pay attention to any signs of chest pain, shortness of breath, severe abdominal pain, high fever, or altered mental status. Given the age of the subject, don't hesitate to call 911 if the situation escalates.