Thinking about adding cagrilintide to my semaglutide, anyone done dual pathway?

Question

So I've been on semaglutide for about 5 months now and the scale has basically stopped moving. Was losing steady through month 3, then it just flattened. I titrated up, cleaned up my deficit, tracked everything with my CGM. Nothing changed. I keep reading about cagrilintide and how it works on a completely different pathway, amylin receptors instead of GLP-1. The idea of hitting satiety from two angles makes sense to me on paper. There's the combo version called CagriSema but I don't think that's accessible the same way, so I'm wondering about just layering cagrilintide on top of what I'm already doing. My concern is the GI side effects though. Semaglutide alone already gave me enough nausea in the first few weeks. Adding something that also slows gastric emptying feels like a recipe for feeling awful 😅 Has anyone here actually run them together? I'd love to hear how the appetite suppression compared to semaglutide alone. Did you titrate the cagrilintide slowly or just start at a standard dose? I track my HRV and sleep every night so I'd be able to see pretty quickly if something is off. Just want to know if it's worth the experiment or if I should look at other options first.

quiet_ironman · Accepted Answer

I haven't run cagrilintide personally but I did stack a low dose of tirzepatide on top of a stalled sema run a while back, and the GI overlap was no joke, like you said. The nausea was way worse than either one alone until I really stretched the titration, way slower than what I'd read in the trials 🔬 Before you go adding a whole second peptide though, have you actually looked hard at why sema stalled? Five months with a CGM and the scale not moving makes me wonder if it's more about set point adaptation or muscle retention than the drug losing effect. Some people I've read about got more mileage just from a diet break or a brief up in calories before adding anything new. What does your actual food log look like on a typical day, are you still in a real deficit?

tiredmira · Answer

Fair pushback honestly. My deficit is around 400-500 cal below what my CGM and training load would suggest, protein is hitting 1g per pound, steps are consistent at 8-10k. Sleep and HRV are stable too. That's why I'm leaning toward the drug side of things being the issue, not lifestyle. The set point angle is interesting though. I didn't really think about it as adaptation so much as just the drug wearing off. Slow titration makes sense if I do layer something, thanks for that 😅

Thinking about adding cagrilintide to my semaglutide, anyone done dual pathway?

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