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Simultaneous start protocol (standard approach) When to use: Starting both peptides fresh (no prior use) Following clinical trial model exactly Want maximum proven efficacy Can tolerate both from beginning Week-by-week dosing schedule: Weeks 1-4: Semaglutide: 0.25mg weekly Cagrilintide: 0.6mg weekly Inject same day OR different days (preference) Separate injection sites if same day Tips: Start ginger supplementation, small meals, hydrate well Weeks 5-8: Semaglutide: 0.5mg weekly (2x increase) Cagrilintide: 1.2mg weekly (2x increase) Nausea typically increases this phase Tips: Anti-nausea meds ready, protein shakes if needed, slow eating Weeks 9-12: Semaglutide: 1.0mg weekly Cagrilintide: 1.8mg weekly Peak side effect window Tips: May need to extend by 1-2 weeks if struggling, Zofran helpful Weeks 13-16: Semaglutide: 1.7mg weekly Cagrilintide: 2.4mg weekly (cagrilintide at target) Semaglutide still escalating Tips: Cagrilintide side effects should be stabilizing Week 17+: Semaglutide: 2.4mg weekly (both at maximum) Cagrilintide: 2.4mg weekly Maintenance dosing Continue indefinitely Tips: Side effects typically moderate by now (adapted) Injection logistics: Both subcutaneous injections Can inject same day (different sites: left/right abdomen) OR split: Semaglutide Monday, Cagrilintide Thursday Rotate sites to prevent irritation 29-31 gauge insulin syringes See our peptide injections guide , how to reconstitute peptides , and peptide dosing guide

Breed Sci 64(1):4859