Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
CARDENE SR vs CADUET
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Nicardipine is a dihydropyridine calcium channel blocker that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. It produces relaxation of coronary vascular smooth muscle and dilation of coronary arteries, and also dilates peripheral arteries, reducing systemic vascular resistance and blood pressure.
Amlodipine: Dihydropyridine calcium channel blocker that inhibits calcium ion influx across cardiac and vascular smooth muscle cell membranes, causing vasodilation and reduced peripheral vascular resistance. Atorvastatin: HMG-Co A reductase inhibitor that competitively inhibits the conversion of HMG-Co A to mevalonate, reducing cholesterol synthesis in the liver.
Hypertension,Chronic stable angina
Hypertension,Coronary artery disease,Hyperlipidemia (as adjunct to diet to reduce elevated total-C, LDL-C, apo B, and TG levels, and to increase HDL-C),Prevention of cardiovascular events in patients with multiple risk factors
Initial: 30 mg orally twice daily (SR capsules). Titrate up to 60 mg twice daily. Usual maintenance: 30-60 mg twice daily.
CADUET (amlodipine/atorvastatin) is available as tablets of 2.5/10, 2.5/20, 2.5/40, 5/10, 5/20, 5/40, 5/80, 10/10, 10/20, 10/40, and 10/80 mg amlodipine/atorvastatin. Initial dose depends on current antihypertensive and lipid-lowering therapy. Usual starting dose is 5/10 mg orally once daily; titrate at intervals of 2-4 weeks based on blood pressure and LDL-C goals. Maximum daily dose: amlodipine 10 mg; atorvastatin 80 mg.
Terminal elimination half-life 8.6 hours (range 6-15 hours). Clinical context: No accumulation at steady state with TID dosing.
Amlodipine: terminal half-life 30-50 h (enables once-daily dosing). Atorvastatin: terminal half-life ~14 h, but active metabolites (ortho- and para-hydroxy atorvastatin) have half-life 20-30 h; clinically, pharmacodynamic half-life (HMG-Co A reductase inhibition) is ~20-30 h.
Primarily hepatic via cytochrome P450 (CYP3A4) isoenzyme.
Amlodipine: Extensively metabolized in the liver via CYP3A4 to inactive metabolites. Atorvastatin: Metabolized in the liver primarily by CYP3A4 to active ortho- and para-hydroxylated metabolites.
Renal: 60% (metabolites, unchanged drug <1%); Biliary/Fecal: 35%
Amlodipine: 60% renal (metabolites), 20-25% biliary/fecal. Atorvastatin: 1% renal (unchanged), 90% biliary/fecal (≥70% as metabolites).
95-98%, primarily to albumin and alpha-1-acid glycoprotein
Amlodipine: ~93% bound to plasma proteins. Atorvastatin: ≥98% bound to plasma proteins (mainly albumin).
0.3-0.7 L/kg. Clinical meaning: Indicates extensive tissue distribution.
Amlodipine: Vd ~21 L/kg (large, indicating extensive tissue distribution). Atorvastatin: Vd ~6.2 L/kg (moderately large, suggesting distribution into tissues).
Oral: 35% (first-pass metabolism); Food does not significantly affect bioavailability.
Oral: amlodipine 64-90%; atorvastatin ~14% (low due to first-pass metabolism); food reduces rate but not extent of absorption.
No specific GFR-based dose adjustment provided by manufacturer; use with caution in renal impairment, especially if concurrent hepatic impairment.
No dosage adjustment required for mild to moderate renal impairment (Cr Cl ≥30 m L/min). For severe renal impairment (Cr Cl <30 m L/min), use atorvastatin with caution; maximum atorvastatin dose is 20 mg daily. Amlodipine is not dialyzable.
Child-Pugh Class A: No adjustment. Child-Pugh Class B/C: Consider starting at 15 mg twice daily and titrate slowly due to increased bioavailability.
Contraindicated in active liver disease or unexplained persistent elevations of serum transaminases. For Child-Pugh Class A or B hepatic impairment: atorvastatin dose should be reduced; maximum atorvastatin dose is 20 mg daily. Amlodipine clearance is decreased; initial amlodipine dose should be 2.5 mg daily. No data for Child-Pugh Class C; use contraindicated.
Not established; safety and efficacy in pediatric patients have not been determined.
Not recommended for pediatric patients. Safety and efficacy in children <10 years have not been established. For patients 10-17 years with heterozygous familial hypercholesterolemia, atorvastatin monotherapy is used; CADUET is not indicated.
Start at lower initial dose (15 mg twice daily) and titrate cautiously due to increased bioavailability and slower elimination.
Elderly patients (≥65 years) may have increased sensitivity to amlodipine; start at the lower end of dosing range (2.5 mg amlodipine component). Atorvastatin dose adjustment not required based on age alone. Monitor for hypotension and other adverse effects.
None.
HMG-Co A reductase inhibitors (statins) can cause fetal harm; use in pregnant women is contraindicated. Caduet contains atorvastatin; therefore, it is contraindicated in pregnant women.
Use caution in patients with coronary artery disease; may cause increased angina or acute myocardial infarction upon initiation or dose titration. Also caution in patients with congestive heart failure, hepatic impairment, or renal impairment. Monitor blood pressure during titration.
Myopathy/Rhabdomyolysis: Risk increased with higher doses, age >65, renal impairment, hypothyroidism, and concurrent use of CYP3A4 inhibitors or other drugs that cause myopathy.,Hepatic effects: Elevated liver enzymes; perform liver function tests before initiation and as clinically indicated.,Fetal toxicity: May cause fetal harm; advise females of reproductive age to use effective contraception.,Peripheral edema: More common with higher doses of amlodipine, especially in females.,Hypotension: In patients with severe aortic stenosis.
Hypersensitivity to nicardipine or any component; advanced aortic stenosis.
Active liver disease or unexplained persistent elevations of hepatic transaminases,Pregnancy,Breastfeeding (due to potential for serious adverse reactions in nursing infants),Hypersensitivity to amlodipine, atorvastatin, or any component of the formulation
Grapefruit and grapefruit juice increase nicardipine serum concentrations by inhibiting CYP3A4 metabolism. Avoid concurrent use. High-fat meals may increase absorption; take consistently with regard to meals. Alcohol may enhance hypotensive effects; limit intake.
Avoid grapefruit and grapefruit juice as they increase atorvastatin plasma concentrations and risk of adverse effects. No significant food interactions with amlodipine.
Nifedipine, the active ingredient in Cardene SR, is classified as FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. In animal studies, nifedipine has been shown to cause embryotoxicity, placentotoxicity, and fetotoxicity at doses several times the maximum recommended human dose. First trimester: Risk cannot be ruled out; potential for teratogenic effects based on animal data. Second and third trimesters: May cause maternal hypotension and fetal distress due to placental hypoperfusion; use only if benefit outweighs risk. Case reports of fetal distress, perinatal asphyxia, and cesarean delivery associated with use in preterm labor.
FDA Pregnancy Category X. Amlodipine: No evidence of teratogenicity in animal studies, but limited human data; atorvastatin: contraindicated in pregnancy as HMG-Co A reductase inhibitors are associated with fetal abnormalities, including skeletal and CNS defects. First trimester: Atorvastatin is contraindicated; risk of congenital anomalies. Second/third trimester: Avoid exposure; potential for fetal toxicity. Effective contraception required for women of childbearing potential.
Nifedipine is excreted into human breast milk. The milk-to-plasma ratio (M/P) is approximately 1.0. Limited data suggest infant doses are low (less than 5% of maternal weight-adjusted dose). However, due to potential for adverse effects in infants (e.g., hypotension), caution is advised. Use only if clearly needed and monitor infant for bradycardia and hypotension.
Excreted in human milk: Amlodipine: present in low levels (M/P ratio approximately 1.0); atorvastatin: unknown. Due to potential for serious adverse reactions in nursing infants (e.g., skeletal muscle toxicity from statins), breastfeeding is contraindicated during therapy. Alternative agents preferred.
Pregnancy does not necessitate routine dose adjustment of oral nifedipine. However, due to increased plasma volume and clearance in pregnancy, lower doses may be effective for hypertension. For tocolysis (off-label), dosing regimens vary (e.g., 10-20 mg oral immediate-release every 4-6 hours). Monitor for hypotension; dose should be individualized based on blood pressure response.
Contraindicated during pregnancy; therefore, no dosing adjustments recommended. Discontinue therapy immediately if pregnancy is suspected or confirmed. Pharmacokinetic changes during pregnancy may alter drug metabolism, but no dose adjustments are justified due to teratogenic risk.
CARDENE SR (nicardipine) is a dihydropyridine calcium channel blocker used for hypertension. Avoid in advanced aortic stenosis due to risk of reduced coronary perfusion. Monitor for peripheral edema, especially in elderly. Use caution in heart failure with reduced ejection fraction due to negative inotropic effects (though less than verapamil). May increase cyclosporine levels; monitor levels. For IV use (not SR), titrate rapidly for hypertensive emergency. Do not crush or chew SR capsules.
CADUET is a fixed-dose combination of amlodipine (a calcium channel blocker) and atorvastatin (a statin) used for hypertension and dyslipidemia. Avoid concomitant use with strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole) due to increased statin exposure and risk of myopathy. Monitor liver enzymes before and during therapy, and for muscle symptoms. Use with caution in patients with severe renal impairment. Avoid grapefruit juice as it increases atorvastatin levels.
Take exactly as prescribed, usually twice daily. Swallow SR capsules whole; do not crush or chew.,Avoid grapefruit and grapefruit juice as they can increase drug levels and side effects.,May cause dizziness or lightheadedness; avoid driving until you know how you react. Rise slowly from sitting or lying.,Notify your doctor if you experience swelling in ankles or feet, rapid heartbeat, or shortness of breath.,Do not stop abruptly; sudden withdrawal may worsen chest pain or blood pressure.,Keep a daily blood pressure log to track effectiveness.
Take this medication once daily at the same time, with or without food.,Avoid grapefruit and grapefruit juice while taking this medication.,Report unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise.,Notify your doctor if you become pregnant, plan to become pregnant, or are breastfeeding.,Do not stop taking this medication without consulting your doctor, even if you feel well.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about CARDENE SR vs CADUET, answered by our medical review team.
CARDENE SR is a Calcium Channel Blocker that works by Nicardipine is a dihydropyridine calcium channel blocker that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. It produces relaxation of coronary vascular smooth muscle and dilation of coronary arteries, and also dilates peripheral arteries, reducing systemic vascular resistance and blood pressure.. CADUET is a Calcium Channel Blocker + HMG-CoA Reductase Inhibitor that works by Amlodipine: Dihydropyridine calcium channel blocker that inhibits calcium ion influx across cardiac and vascular smooth muscle cell membranes, causing vasodilation and reduced peripheral vascular resistance. Atorvastatin: HMG-Co A reductase inhibitor that competitively inhibits the conversion of HMG-Co A to mevalonate, reducing cholesterol synthesis in the liver.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between CARDENE SR and CADUET depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of CARDENE SR is: Initial: 30 mg orally twice daily (SR capsules). Titrate up to 60 mg twice daily. Usual maintenance: 30-60 mg twice daily.. The standard adult dose of CADUET is: CADUET (amlodipine/atorvastatin) is available as tablets of 2.5/10, 2.5/20, 2.5/40, 5/10, 5/20, 5/40, 5/80, 10/10, 10/20, 10/40, and 10/80 mg amlodipine/atorvastatin. Initial dose depends on current antihypertensive and lipid-lowering therapy. Usual starting dose is 5/10 mg orally once daily; titrate at intervals of 2-4 weeks based on blood pressure and LDL-C goals. Maximum daily dose: amlodipine 10 mg; atorvastatin 80 mg.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between CARDENE SR and CADUET in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. CARDENE SR is classified as Category C. Nifedipine, the active ingredient in Cardene SR, is classified as FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. In animal studies, . CADUET is classified as Category C. FDA Pregnancy Category X. Amlodipine: No evidence of teratogenicity in animal studies, but limited human data; atorvastatin: contraindicated in pregnancy as HMG-CoA reductase inhib. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.