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Protocol 1: Maximum weight loss (aggressive) Goal: Lose 50-80+ lbs in 12-18 months Approach: Semaglutide: Titrate to 2.4mg weekly over 16 weeks Cagrilintide: Titrate to 2.4mg weekly over 12 weeks (starting week 5) Both at maximum approved doses Maintain for 12-18 months Supporting strategies: High-protein diet (1g per lb goal weight) Resistance training 3-4x weekly 10,000+ steps daily Sleep 7-9 hours Stress management Expected results: Month 6: 30-45 lbs lost Month 12: 50-70 lbs lost Month 18: 60-85 lbs lost Percentage: 20-25% body weight Cost: $6,000-12,000 total Protocol 2: Conservative approach (better tolerated) Goal: Steady weight loss with minimal side effects Approach: Semaglutide: Titrate to 1.7mg weekly over 20 weeks Cagrilintide: Titrate to 1.8mg weekly over 16 weeks Slower escalation Lower maintenance doses Benefits: Reduced GI side effects Better tolerability Easier to sustain More affordable Expected results: Month 12: 35-50 lbs lost Percentage: 15-20% body weight Better adherence long-term Cost: $5,000-8,400/year Protocol 3: Adding cagrilintide to existing semaglutide Goal: Break through plateau on semaglutide Approach: Already on semaglutide 2.4mg (or lower) Add cagrilintide starting at 0.6mg weekly Titrate cagrilintide to 2.4mg over 12 weeks Continue both Timeline: Plateau broken within 4-8 weeks of adding cagrilintide Additional 10-20 lbs lost over 6-12 months Renewed progress Who this helps: Plateaued on semaglutide alone Lost initial weight but stuck Want to avoid stopping semaglutide Protocol 4: Maintenance after goal weight Goal: Maintain weight loss long-term Approach: Reduce to maintenance doses: Semaglutide: 1.0-1.7mg weekly Cagrilintide: 1.2-1.8mg weekly Monitor weight weekly Adjust up if regaining Benefits: Lower cost Fewer side effects Sustainable long-term Prevents regain Duration: Indefinite (may need lifelong) See our peptide cycle planning guide and can you cycle different peptides

Cutaneous manifestations include hyperpigmentation, glossitis and hair changes

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Sep 1 2022;29(9):1083-1085

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doi: 10.1139/h05-002