Cagrilintide vs pramlintide
Last updated: October 2, 2026 · 5 min read · By the Grey Peptides Editorial Board
- Pramlintide and cagrilintide both copy amylin, a hormone released with insulin that slows the stomach and signals fullness.
- Pramlintide (Symlin) is an approved, short-acting mealtime injection for people with diabetes who already use mealtime insulin, and its label carries a boxed warning for severe low blood sugar.
- Cagrilintide lasts long enough for once-weekly dosing; it cut weight by up to 10.8% in a phase 2 trial and is in trials, mainly combined with semaglutide as CagriSema. As of October 2, 2026 it is not approved.
Side by side
Pramlintide High and cagrilintide Medium are both analogs of amylin, a hormone the pancreas releases alongside insulin. Amylin slows stomach emptying, blunts the glucagon rise after meals and signals fullness. The two drugs were built for different jobs a generation apart: pramlintide is short-acting, with a half-life of about 48 minutes according to our entry, and is injected at meals; cagrilintide was engineered to last a week. The table is read from our encyclopedia entries.
| Field | Cagrilintide | Pramlintide |
|---|---|---|
| Encyclopedia entry | Cagrilintide Mid-length entry | Pramlintide Mid-length entry |
| Molecule class | Peptide | Peptide |
| Category | Metabolic | Metabolic |
| FDA status | In Clinical Trials | FDA Approved |
| Approved elsewhere | None recorded | None recorded |
| Evidence grade | Medium | High |
| Half-life | Long-acting; supports once-weekly dosing | ≈ 48 minutes |
| Formula | C194H312N54O59S2 | C171H267N51O53S2 |
| Molecular weight | 4,409.0 g/mol | 3,949.4 g/mol |
| WADA 2026 | Prohibited (S0 catch-all) | Not on the 2026 List |
| WADA 2027 | Prohibited (S0 catch-all) | Not on the 2027 List |
| In one line | Novo Nordisk's weekly, lipidated amylin analogue: up to 10.8% weight loss alone in a 26-week phase 2 trial, and with semaglutide as CagriSema 20.4% over 68 weeks in REDEFINE 1. Investigational; not approved anywhere. | The FDA-approved amylin analog (Symlin, 2005) — taken at mealtimes alongside insulin in T1D and T2D. The pharmacological proof-of-concept for amylin agonism that petrelintide and cagrilintide are now building on. |
| Mechanism | Dual agonism at amylin and calcitonin receptors. Amylin pathway activation suppresses food intake via hindbrain circuitry distinct from (and complementary to) GLP-1 appetite signaling, slows gastric emptying, and reduces glucagon secretion. Combination with semaglutide in CagriSema produced 22.7% weight loss at 68 weeks in REDEFINE 1 — numerically greater than semaglutide alone. | Binds the amylin receptor (a heterodimer of calcitonin receptor and a RAMP protein). Slows gastric emptying, suppresses post-prandial glucagon, and promotes satiety via area postrema signaling. The glucagon suppression and delayed glucose absorption blunt post-meal hyperglycemia, while the satiety effect produces modest weight loss in insulin-dependent patients who historically gain weight on insulin intensification. |
| Sources in the entry | 9 | 6 |
| Study cards | None (short entry) | None (short entry) |
| Dosage page | None | None |
How they work
According to our entries, pramlintide binds the amylin receptor, a pairing of the calcitonin receptor with a RAMP protein, and acts mainly around meals: it slows stomach emptying, suppresses the glucagon rise after eating and promotes fullness through signals in the brainstem. Cagrilintide acts at both amylin and calcitonin receptors and works through hindbrain appetite circuits that are distinct from, and complementary to, those of GLP-1 drugs, which is the rationale for pairing it with semaglutide. Both slow the stomach and lower glucagon; the difference that matters most in practice is duration, minutes for pramlintide against a week for cagrilintide.
Pramlintide: an approved mealtime add-on
Pramlintide is sold as Symlin. Its label limits it to people with type 1 or type 2 diabetes who use mealtime insulin and have not reached their glucose targets despite optimal insulin therapy 1. It carries a boxed warning: used with insulin it increases the risk of severe hypoglycemia, particularly in type 1 diabetes, usually within three hours of an injection 1. That makes it a specialist tool for diabetes care rather than a weight-loss drug, and it requires its own injections at mealtimes on top of insulin.
Cagrilintide: a weekly amylin analog for weight
Cagrilintide was tested on its own in a phase 2 trial of adults with overweight or obesity and no diabetes: 706 people received one of five weekly doses from 0.3 to 4.5 mg, 99 took daily liraglutide 3.0 mg and 101 took placebo 2. Every dose beat placebo, with weight losses of 6.0% to 10.8% (6.4 to 11.5 kg) against 3.0% (3.3 kg) on placebo, treatment differences of 3.0 to 7.8 percentage points 2. At the top dose it also beat liraglutide, 10.8% against 9.0% (11.5 kg against 9.6 kg), a difference of 1.8 points 2. About one in ten stopped treatment, most often because of side effects, at similar rates across the groups 2.
Its main use in development is in combination with semaglutide, as CagriSema; our CagriSema decision guide follows that application.
How the differences add up
The two drugs share a mechanism and almost nothing else. Pramlintide is an approved diabetes add-on, taken at every main meal, whose biggest risk is low blood sugar when combined with insulin 1. Cagrilintide is an investigational weekly drug aimed at weight, tested mostly in people without diabetes 2. They have never been compared directly, and the pramlintide label and the cagrilintide trial describe different patients, so no efficacy ranking is possible. What cagrilintide shows is that the amylin pathway, which pramlintide first brought into medicine, can be dosed weekly and can add to the weight loss of GLP-1 drugs.
Status as of October 2, 2026
Pramlintide is FDA-approved as Symlin; the label we read is dated December 18, 2019 1. Cagrilintide is in clinical trials and not approved on its own, according to our entry as of October 2, 2026. Our entries for pramlintide and cagrilintide cover both in full.
Frequently asked questions
Is cagrilintide the same as pramlintide?
No. Both copy the hormone amylin, but pramlintide is a short-acting mealtime injection approved for diabetes, while cagrilintide is a weekly analog in trials for weight loss.
Can pramlintide be used for weight loss?
Its label limits it to people with type 1 or 2 diabetes on mealtime insulin, and it carries a boxed warning for severe low blood sugar when used with insulin.
How much weight did cagrilintide cause?
In a phase 2 trial, weekly doses from 0.3 to 4.5 mg cut weight by 6.0% to 10.8%, against 3.0% on placebo; the top dose beat liraglutide 3.0 mg (10.8% vs 9.0%).
Related on Grey Peptides
Sources
- Symlin (pramlintide acetate) US prescribing information, openFDA label set 4aea30ff-eb0d-45c1-b114-3127966328ff, effective December 18, 2019; read October 2, 2026.
- Lau, D. C. W., Erichsen, L., Francisco, A. M., et al. (2021). Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial. Lancet, 398(10317), 2160-2172. PMID: 34798060
Educational information, not medical advice. Each dose in this guide names its source, an approved label or a published study. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose.
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