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Standard Cagrilintide Monotherapy Protocol Phase 1: Initiation (Weeks 1-2) Dose: 0.6 mg once weekly Goal: Establish tolerance to amylin activation Expected effects: Mild appetite reduction, possible mild nausea Adjustments: Extend this phase if significant GI effects occur Phase 2: First Escalation (Weeks 3-4) Dose: 1.2 mg once weekly Goal: Increase therapeutic effect Expected effects: Notable appetite suppression, improved satiety Adjustments: May stay at this dose if excellent results achieved Phase 3: Second Escalation (Weeks 5-8) Dose: 2.4 mg once weekly Goal: Approach optimal therapeutic range Expected effects: Significant appetite control, steady weight loss Adjustments: Many researchers find this dose optimal long-term Phase 4: Optimization (Weeks 9-12) Dose: 3.0 mg once weekly Goal: Maximize therapeutic benefit Expected effects: Peak appetite suppression Adjustments: Only escalate if 2.4 mg insufficient and well-tolerated Phase 5: Maintenance (Week 13+) Dose: 3.0-4.5 mg once weekly Goal: Sustain long-term effects Expected effects: Stable appetite control and weight management Adjustments: Find minimum effective dose for maintenance Cagrilintide Dosage with Retatrutide: Combination Protocol When combining cagrilintide with retatrutide, a more conservative escalation approach minimizes overlapping side effects: Weeks 1-2: Single Agent Start Cagrilintide: 0.6 mg weekly Retatrutide: None (or 0.6 mg if starting both) Rationale: Establish tolerance to one compound first Weeks 3-4: Gentle Combination Cagrilintide: 0.6-1.2 mg weekly Retatrutide: 2 mg weekly Rationale: Introduce second compound at low dose Weeks 5-8: Dual Escalation Cagrilintide: 1.2-2.4 mg weekly Retatrutide: 4 mg weekly Rationale: Gradually increase both compounds Weeks 9-12: Therapeutic Range Cagrilintide: 2.4 mg weekly Retatrutide: 6-8 mg weekly Rationale: Approach optimal combination dosing Weeks 13+: Optimized Maintenance Cagrilintide: 2.4-3.0 mg weekly Retatrutide: 8-12 mg weekly Rationale: Maintain therapeutic effects long-term Researchers can access properly dosed cagrilintide 10mg vials that allow flexible dosing across this range

CMS indicates in its March 2025 letter that rescinding HRSN guidance does not nullify existing HRSN approvals but going forward they will consider HRSN / SDOH requests on a case-by-case basis