Cagrilintide + semaglutide (CagriSema)
The most evidence-backed GLP-1 stack as of 2026 is the Novo Nordisk co-formulation of cagrilintide (a long-acting amylin analog) with semaglutide.
| Trial | Arm | Mean weight loss at 68 weeks |
|---|---|---|
| REDEFINE-1 | Cagrilintide 2.4 mg + Semaglutide 2.4 mg | -22.7% |
| REDEFINE-1 | Semaglutide 2.4 mg alone | -16.1% |
| REDEFINE-1 | Cagrilintide 2.4 mg alone | -11.8% |
| REDEFINE-1 | Placebo | -2.3% |
CagriSema is investigational — not FDA-approved as of May 2026. Novo Nordisk Phase 3 readout was March 2025; FDA submission expected late 2026, approval 2027.
BPC-157 for GI symptoms (research-only)
BPC-157 (Body Protecting Compound-157) is a synthetic peptide based on a fragment of human gastric juice. Some patients on GLP-1 report subjective improvement in GI symptoms (nausea, gastritis) when adding BPC-157. Evidence base: rat studies showing GI tissue protection; no FDA-approved indication; not on the §503A or §503B compoundable list. BPC-157 is a research compound, not a clinically approved adjunct.
GHK-Cu for skin during rapid weight loss
GHK-Cu (glycyl-histidyl-lysyl-copper) is a copper peptide with well-established cosmetic and dermatological evidence for collagen synthesis. Some patients on rapid GLP-1 weight loss use topical GHK-Cu for skin elasticity support. Topical use is generally well-tolerated; systemic/subcutaneous use is research-only.
What's not worth stacking (lacking evidence)
- MK-677 (ibutamoren): raises ghrelin — counterproductive for appetite suppression goal
- "Fat-burning" peptide stacks (AOD-9604, etc.): evidence is weak; cost is high
- Tesamorelin + GLP-1: no evidence base; tesamorelin is FDA-approved for HIV lipodystrophy, not weight loss
- SS-31 (elamipretide): mitochondrial-targeting; promising but evidence is in cardiomyopathy not obesity