Strategic Stacking: Multi-Pathway Approach to Obesity
The speaker advocates for using low doses of medications targeting different pathways rather than maxing out one. He categorizes his stack into 'appetite/satiety' (Tirzepatide, Kagrilintide) and 'body composition/GH axis' (Tesamorelin, Ipamorelin). This approach aims to tackle the biology of calorie consumption while preserving lean mass.
Cagrilintide Dosing Safety Warning: Start Low and Titrate to Response
The speaker issues a safety-oriented dosing recommendation for cagrilintide: begin with a very low dose and titrate based on individual response rather than following a fixed protocol. This guidance is presented as a harm-reduction measure given the compound's variable individual response profile. No specific starting dose in mcg or mg is provided.
Cagrilintide as Low-Dose Add-On to GLP-1 Therapy
The speaker recommends adding a low dose of cagrilintide to existing GLP-1 therapy (tirzepatide or semaglutide) for patients who have already achieved a high dose with GLP-1 compounds. This stacking approach is suggested as a way to augment appetite suppression through a complementary receptor pathway. No specific dosage numbers are provided, only the descriptor 'low dose.'
Cagrilintide Mechanism of Action: Amylin Receptor Agonism
Cagrilintide is described as an amylin receptor agonist that works by controlling hunger signaling. This mechanism is distinct from GLP-1 receptor agonism, making it a mechanistically different option for appetite suppression. The speaker notes this receptor pathway as the basis for its utility as a GLP-1 alternative.
Cagrilintide as GLP-1 Alternative for Fat Loss in Intolerant Patients
Cagrilintide (an amylin receptor agonist) is presented as a primary alternative for patients who cannot tolerate GLP-1 agonists due to nausea. The speaker recommends it specifically for individuals who experience unbearable nausea even at low doses of GLP-1 compounds. It is described as working 'very well' for hunger signal control based on the speaker's clinical experience.
Triple Stack Addition: Cagrilintide Alongside Tirzepatide and Retatrutide
The speaker mentions cagrilintide as a potential third agent that may be added to the tirzepatide and retatrutide combination for select patients, suggesting a triple-peptide stacking protocol. No specific patient selection criteria, dosages, or frequencies are provided. This is presented as a clinical option within a personalized approach.
Stacking Retatrutide with Cagrilintide (Amylin Analog)
Dr. Jones reports seeing patients in retatrutide communities combining it with cagrilintide (an amylin analog) on top of retatrutide. While he states there can be strategic low-dose stacking approaches, combining these without understanding which receptors are activated, at what doses, and without monitoring side effects is dangerous guessing with a triple agonist.
Stacking AOD-9604 with Cagrilintide is Possible but Not Preferred
When asked whether AOD-9604 and cagrilintide can be combined, Dr. Jones confirms it is possible but expresses a preference for other GLP-1 options over cagrilintide ('Kaggy'). He frames this as theoretically acceptable but not his first-choice protocol.