Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
DILACOR XR vs CADUET
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Diltiazem inhibits calcium ion influx across cardiac and vascular smooth muscle cells, resulting in dilation of coronary and systemic arteries, decreased myocardial contractility, and reduced sinoatrial and atrioventricular conduction velocity.
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.
Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina),Chronic stable angina,Essential hypertension
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
180 to 240 mg orally once daily, administered on an empty stomach; maximum dose 480 mg once 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 half-life: 6-12 hours (prolonged in elderly, hepatic impairment, or with CYP3A4 inhibitors)
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.
Extensively metabolized in the liver via CYP3A4; undergoes deacetylation and N-demethylation.
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 (70% as metabolites, 3-4% as unchanged drug); biliary/fecal (25-30%)
Amlodipine: 60% renal (metabolites), 20-25% biliary/fecal. Atorvastatin: 1% renal (unchanged), 90% biliary/fecal (≥70% as metabolites).
98-99% bound to serum albumin and alpha-1-acid glycoprotein
Amlodipine: ~93% bound to plasma proteins. Atorvastatin: ≥98% bound to plasma proteins (mainly albumin).
1.1-1.8 L/kg (high Vd indicates extensive tissue binding)
Amlodipine: Vd ~21 L/kg (large, indicating extensive tissue distribution). Atorvastatin: Vd ~6.2 L/kg (moderately large, suggesting distribution into tissues).
Oral: 40-50% (first-pass metabolism; food does not affect extent)
Oral: amlodipine 64-90%; atorvastatin ~14% (low due to first-pass metabolism); food reduces rate but not extent of absorption.
GFR 30-60 m L/min: initiate at 120 mg once daily, titrate cautiously; GFR <30 m L/min: not recommended due to risk of accumulation.
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: initiate at 120 mg once daily; Child-Pugh Class B or C: avoid use.
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.
Safety and effectiveness in pediatric patients have not been established; no dosing recommendations.
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 low end of dosing range (120 mg once daily) due to increased systemic exposure and risk of hypotension; titrate slowly.
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.
May cause hypotension, bradycardia, and heart block; avoid in patients with sick sinus syndrome or second- or third-degree AV block without a pacemaker; caution in patients with congestive heart failure; may increase risk of digitalis toxicity; abrupt withdrawal may worsen angina.
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.
Sick sinus syndrome (except in presence of functioning ventricular pacemaker), second- or third-degree AV block (except with pacemaker), hypotension (systolic < 90 mm Hg), acute myocardial infarction with pulmonary congestion, hypersensitivity to diltiazem, concurrent use of ivabradine.
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
Avoid grapefruit and grapefruit juice as they inhibit CYP3A4 and can increase diltiazem plasma concentrations, leading to increased risk of adverse effects. Avoid high-fat meals as they may affect the absorption of the extended-release formulation.
Avoid grapefruit and grapefruit juice as they increase atorvastatin plasma concentrations and risk of adverse effects. No significant food interactions with amlodipine.
DILACOR XR (diltiazem) is a calcium channel blocker with limited human pregnancy data. In animal studies, at doses up to 5 times the maximum recommended human dose, no teratogenic effects were observed. However, embryofetal toxicity (increased fetal loss, growth retardation) occurred at maternally toxic doses. First trimester: No adequate human studies; risk cannot be excluded. Second and third trimesters: Use only if clearly needed; may cause maternal hypotension and reduced uteroplacental blood flow, potentially leading to fetal hypoxia and growth restriction. U. S. FDA Pregnancy Category C.
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.
Diltiazem is excreted in human breast milk. The milk-to-plasma (M/P) ratio ranges from 0.7 to 0.9. Limited data suggest infant exposure is low (approximately 1% of maternal weight-adjusted dose). No adverse effects reported in breastfed infants. Caution advised; monitor infant for bradycardia, hypotension, and sedation. Alternative agents may be preferred.
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.
Plasma volume and renal clearance increase during pregnancy, potentially reducing diltiazem concentrations. However, specific pharmacokinetic studies are lacking. Clinical response and blood pressure should guide dosing. Start at the lowest effective dose and titrate based on maternal heart rate and blood pressure. Avoid sustained-release formulations if rapid titration needed; immediate-release may be used. Monitor for hypotension, which may worsen uteroplacental perfusion. No specific dose adjustment recommended in published guidelines; use caution and individualized dosing.
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.
DILACOR XR is a sustained-release formulation of diltiazem, a calcium channel blocker. Do not crush or chew the capsule; swallowing whole is essential for extended-release properties. Monitor heart rate and blood pressure regularly due to risk of bradycardia and hypotension. Use with caution in patients with reduced hepatic function as diltiazem undergoes extensive first-pass metabolism. Avoid concurrent use with strong CYP3A4 inhibitors (e.g., ketoconazole) as they can increase diltiazem levels. In patients with atrial fibrillation or flutter, it may be used for rate control but contraindicated in sick sinus syndrome or second/third-degree AV block without a pacemaker.
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.
Swallow DILACOR XR capsules whole; do not crush, chew, or break them.,Take this medication exactly as prescribed, usually once daily. Do not stop suddenly without consulting your doctor.,Avoid grapefruit and grapefruit juice as they can increase the effects and side effects of diltiazem.,Limit alcohol intake as it may increase the risk of dizziness or fainting.,Notify your doctor if you experience slow heartbeat, shortness of breath, swelling of ankles/feet, or severe dizziness.,Keep a record of your blood pressure and pulse at home and bring it to appointments.,Do not take other medications, including over-the-counter products or herbal supplements, without consulting your healthcare provider.
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 DILACOR XR vs CADUET, answered by our medical review team.
DILACOR XR is a Calcium Channel Blocker that works by Diltiazem inhibits calcium ion influx across cardiac and vascular smooth muscle cells, resulting in dilation of coronary and systemic arteries, decreased myocardial contractility, and reduced sinoatrial and atrioventricular conduction velocity.. 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 DILACOR XR 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 DILACOR XR is: 180 to 240 mg orally once daily, administered on an empty stomach; maximum dose 480 mg once 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 DILACOR XR 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. DILACOR XR is classified as Category C. DILACOR XR (diltiazem) is a calcium channel blocker with limited human pregnancy data. In animal studies, at doses up to 5 times the maximum recommended human dose, no teratogenic . 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.