Titration Speed to Maximum Dose

CJsMom

CJsMom

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I came across a study that addresses this. In brief, cagrilintide can be brought up to its max dose (2.4mg) either over 4 weeks or over 16 weeks, and the gastrointestinal side effects did not differ in any meaningful way. That said, responses vary from person to person, so erring on the side of caution is wise.

“Lau et al.[7] had a faster titration regimen (up-titration to cagrilintide 2.4 mg by four weeks of therapy) compared to the study by Frias et al.[9] (up-titration to cagrilintide 2.4 mg by 16 weeks of treatment). We compared the gastrointestinal side effects among the two studies. The occurrence of gastrointestinal side effects was not significantly different among both the studies (rapid vs. slow up-titration of cagrilintide) [OR 2.08 (95% CI: 0.89, 4.88); P = 0..”

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC11642503/

This appears in the safety section.

Even so, I intend to keep my own pace gradual, since 0.25mg clearly affected my RS’s appetite. I might stop titrating here.
 
Just because it's possible doesn't mean it's wise—a lesson that applies to plenty of situations, including this one.
 
Clinical Trial Dosing (Published, Phase 2 & 3)

  • The Phase 2 dose-finding trial evaluated weekly cagrilintide across several dose levels: 0.3 mg, 0.6 mg, 1.2 mg, 2.4 mg, and 4.5 mg. In that trial, the 4.5 mg/week arm represented the highest dose studied and demonstrated dose-dependent weight loss.
  • In Phase 3 development (REDEFINE / CagriSema program), the dose that has been maintained and selected is 2.4 mg once weekly (frequently paired with semaglutide 2.4 mg in the CagriSema regimen).

So on its own it’s 4.5mg weekly, or 2.4mg when stacked with Sema.
 
Nausea and vomiting occurred at rather high rates with cagri, and fatigue is frequently reported on this forum too, even when the dose is very low. Because of that, fast escalation accompanied by high rates of nausea and vomiting does not seem very attractive. Going up in dose more gradually will not guarantee that side effects are avoided, but typically you will receive some signal — perhaps mild nausea at a given dose — hinting that an immediate increase may not be wise, and appetite effects can also inform how much to raise the dose. It is possible to increase slowly with no side effects and then abruptly be struck by severe nausea or vomiting after an increase, yet I do not believe that is the most typical outcome. Whether the study allowed much flexibility in dose increases is unclear to me; such trials tend to follow fairly fixed schedules instead of tailoring increases to side effects, to effects, or by delaying escalation. Still, the key benefit of a more flexible titration approach is that it can be shaped by the effects and side effects already being experienced.
 
Wow. .5 nearly did me in. .33 is still hitting me hard. Going that high, that quickly, would be the end of me.
 
domin8brix said:

Wow. .5 nearly did me in. .33 is still hitting me hard. Going that high, that quickly, would be the end of me.
Click to expand...
Previously I've taken 1.5 together with 4-5 mg Reta, and it really knocked me flat 😂😂
 
Like other people have mentioned, the maximum amount is 2.4, though you really should take it slow. If the current amount is still having an effect on you, then I would not increase it. When I moved from .5 up to .8, the experience was quite strong.
 
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