Cagrilintide and tirzepatide are compared because cagrilintide is the newest weight-loss peptide and tirzepatide is the one it is measured against. The search usually means CagriSema, the cagrilintide and semaglutide combination that Novo Nordisk ran head to head with tirzepatide. This page keeps the two molecules apart: what each is, what doses have been tested, and what the trials that mention both actually compared.
The single-compound records are on the cagrilintide dosage page and the tirzepatide dosage page; the question of giving the two together is on the cagrilintide and GLP-1 stack, and cagrilintide's other comparison is cagrilintide vs retatrutide.
| Cagrilintide | Tirzepatide | |
|---|---|---|
| Hormone system | Amylin (amylin and calcitonin receptors) | GIP and GLP-1 receptors |
| Approved product | None | Zepbound, Mounjaro |
| Doses tested or labelled | 0.3 to 4.5 mg weekly (phase 2); 2.4 mg in phase 3 | 2.5 mg start, 2.5 mg steps, 5/10/15 mg maintenance |
| Weight result alone | −6.0% to −10.8% at 26 weeks | −15.0% to −20.9% at 72 weeks |
| Molecular weight | 4,409 | 4,813 |
| Form | Research powder; trial pens | Labelled solutions in pens and vials |
Two hormone systems
Tirzepatide imitates two gut hormones, GIP and GLP-1, in one molecule. Its labels describe a weekly injection with a fixed ladder: 2.5 mg for four weeks, then 2.5 mg increases at least four weeks apart, to a maintenance dose of 5, 10 or 15 mg. Every figure on the Zepbound dose chart comes from those labels.
Cagrilintide imitates amylin, a hormone the pancreas releases with insulin that slows stomach emptying and adds to fullness. It was built to last a week, like the GLP-1 drugs, and it has no label. Its phase 2 trial escalated over up to six weeks to one of five doses, 0.3, 0.6, 1.2, 2.4 or 4.5 mg, and held it for 26 weeks; 4.5 mg gave 10.8% weight loss against 9.0% on liraglutide 3.0 mg daily.
What the head-to-head trial actually compared
Three completed trials name both compounds, and none tests cagrilintide alone against tirzepatide. Each compares CagriSema, cagrilintide plus semaglutide, with tirzepatide:
| Trial | Population | CagriSema arm | Tirzepatide arm | Result |
|---|---|---|---|---|
| REDEFINE 4 (NCT06131437) | 809 adults, obesity, 84 weeks | 2.4/2.4 mg after a 16-week escalation | 15 mg after a 20-week escalation | −20.2% vs −23.6%; non-inferiority not met (company announcement, 2026-02-23) |
| NCT06221969 | 1,024 adults, type 2 diabetes, 68 weeks | Escalated over 16 weeks | Escalated over 20 weeks | Completed 2026-03-04; no result posted |
| NCT06534411 | 1,023 adults, type 2 diabetes | Lower doses, 4-week steps | Lower dose, 4-week step | Completed 2026-06-02; no result posted |
The REDEFINE 4 figures are from Novo Nordisk's announcement as reported in the trade press; no journal paper or registry result was found on 2026-10-09. A search for "cagrilintide vs tirzepatide" therefore lands on a comparison of a two-drug combination with a one-molecule drug, not of the two molecules.
Cagrilintide alone, in phase 3
The trials that will put a number on cagrilintide by itself are running. REDEFINE 1 included a 302-person cagrilintide-only arm (cagrilintide 2.4 mg with a semaglutide placebo); its abstract reports the combination's −20.4% at 68 weeks but not the single-drug arms. Novo Nordisk then registered two cagrilintide-only phase 3 trials, NCT07220642 in 300 adults with overweight or obesity and NCT07220759 in 330 with type 2 diabetes, once weekly for 64 weeks against placebo, with primary completion estimated for May 2027. A third, NCT07607587, enrolls people who stopped a GLP-1 drug because of stomach side effects and measures how many reach the standard dose by week 26. None of the three states its dose in the registry.
A milligram for a milligram, nearly
| Amount | Molecular weight | Molecules (µmol) |
|---|---|---|
| Cagrilintide 2.4 mg | 4,409 | ≈0.54 |
| Cagrilintide 4.5 mg | 4,409 | ≈1.02 |
| Tirzepatide 2.5 mg | 4,813 | ≈0.52 |
| Tirzepatide 5 mg | 4,813 | ≈1.04 |
| Tirzepatide 15 mg | 4,813 | ≈3.12 |
The two molecules are close in size, so cagrilintide's phase 3 dose and tirzepatide's starting dose carry nearly the same number of molecules, and so do cagrilintide's top tested dose and tirzepatide's first maintenance dose. Tirzepatide's ladder then climbs to three times cagrilintide's highest tested amount. The match is arithmetic, not equivalence; the molecules act on different receptors.
Each figure as syringe units
| Amount | 5 mg/mL | 10 mg/mL | 20 mg/mL |
|---|---|---|---|
| Cagrilintide 1.2 mg | 24 units | 12 units | 6 units |
| Cagrilintide 2.4 mg | 48 units | 24 units | 12 units |
| Cagrilintide 4.5 mg | 90 units | 45 units | 22.5 units |
| Tirzepatide 2.5 mg | 50 units | 25 units | 12.5 units |
| Tirzepatide 5 mg | 100 units | 50 units | 25 units |
| Tirzepatide 15 mg | 300 units | 150 units | 75 units |
5 mg/mL is a 5 mg vial with 1 mL or a 10 mg vial with 2 mL; 10 mg/mL is a 10 mg vial with 1 mL; 20 mg/mL is a 20 mg vial with 1 mL. The labelled tirzepatide products are solutions, not powders: every single-dose pen and vial holds its whole dose in 0.5 mL, so a 2.5 mg vial is 5 mg/mL and its 0.5 mL is 50 units. The full two-way tirzepatide table is on tirzepatide units; any vial and volume are worked on the cagrilintide reconstitution tool and the tirzepatide calculator.
What is not established
No trial has compared cagrilintide alone with tirzepatide, and no human study has given the two together; the only data on that pairing are in rats, as set out on the stack page. The cagrilintide-only phase 3 trials have no results yet, and its dose for any label is not known. The REDEFINE 4 result is a company announcement, not a peer-reviewed paper. The compounds are covered in Medibact's Cagrilintide guide and Tirzepatide guide. Nothing on this page is an instruction; product and dose belong with a prescriber.
Sources and dates
Opened 2026-10-09: ClinicalTrials.gov records NCT06131437, NCT06221969, NCT06534411, NCT05567796, NCT07220642, NCT07220759 and NCT07607587, and the cagrilintide intervention search (44 records); the REDEFINE 1 abstract (Garvey et al., NEJM 2025, PMID 40544433); PubChem records for cagrilintide (CID 171397054) and tirzepatide (CID 166567236). Carried from this site's pages, each with its read date: the Zepbound and Mounjaro labels and SURMOUNT-1 (tirzepatide page, 2026-09-18), the cagrilintide phase 2 trial (cagrilintide page, 2026-09-18), and the REDEFINE 4 announcement (stack page, 2026-09-18). Units and molar arithmetic by this site. Corrections go to the contact page.