Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
DILTZAC 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 is a calcium channel blocker that inhibits calcium ion influx across cardiac and vascular smooth muscle cells, resulting in dilation of coronary and systemic arteries and decreased myocardial contractility and 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.
Hypertension,Chronic stable angina,Atrial fibrillation or flutter,Paroxysmal supraventricular tachycardia,Off-label: Prevention of migraine, Raynaud's phenomenon
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
Oral: 30-120 mg 3-4 times daily; maximum 480 mg/day. IV: 0.25 mg/kg over 2 min, then 0.35 mg/kg after 15 min if needed; continuous infusion 5-15 mg/hour.
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: 3.5-5.0 hours (healthy adults). Prolonged in elderly (6-8 hours) and in hepatic impairment (10-12 hours).
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.
Hepatic via CYP3A4; undergoes extensive first-pass metabolism
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: 60-70% as metabolites, 2-4% unchanged; Biliary/Fecal: 20-30% as metabolites.
Amlodipine: 60% renal (metabolites), 20-25% biliary/fecal. Atorvastatin: 1% renal (unchanged), 90% biliary/fecal (≥70% as metabolites).
80-85% bound to plasma proteins (albumin and alpha-1-acid glycoprotein).
Amlodipine: ~93% bound to plasma proteins. Atorvastatin: ≥98% bound to plasma proteins (mainly albumin).
5-6 L/kg (suggests 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 immediate-release: 40-60% (due to extensive first-pass hepatic metabolism). Extended-release: 30-40%. Intravenous: 100%.
Oral: amlodipine 64-90%; atorvastatin ~14% (low due to first-pass metabolism); food reduces rate but not extent of absorption.
No adjustment required for GFR >30 m L/min. For GFR 10-30 m L/min, reduce dose by 25%. For GFR <10 m L/min, reduce dose by 50%.
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 A: no adjustment. Child-Pugh B: reduce dose by 50%. Child-Pugh C: reduce dose by 75%.
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.
Oral: 1-3 mg/kg/day divided 3-4 times; maximum 3 mg/kg/day. IV: 0.25 mg/kg over 2 min; may repeat 0.35 mg/kg after 15 min; infusion 5-15 mcg/kg/min.
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 lowest dose (30 mg 3-4 times daily) due to increased bioavailability and reduced clearance; titrate slowly. IV dose: 0.2 mg/kg over 2 min.
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 heart block, bradycardia, exacerbation of heart failure, hypotension, and hepatotoxicity. Monitor liver function, ECG, and blood pressure. Avoid abrupt discontinuation; taper gradually.
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 with pacemaker), second- or third-degree AV block (except with pacemaker), hypotension (systolic <90 mm Hg), cardiogenic shock, acute myocardial infarction with pulmonary congestion, hypersensitivity to diltiazem, concomitant use of ivabradine, and concurrent use with strong CYP3A4 inhibitors when diltiazem is given intravenously.
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; they may increase diltiazem levels and risk of side effects. Alcohol may enhance blood pressure-lowering effects and cause dizziness. A high-fat meal may increase absorption, but this is not clinically significant.
Avoid grapefruit and grapefruit juice as they increase atorvastatin plasma concentrations and risk of adverse effects. No significant food interactions with amlodipine.
First trimester: No definitive evidence of teratogenicity in animal studies; human data limited. Second and third trimesters: Chronic use may cause fetal bradycardia, hypoxia, and growth restriction due to maternal hypotension and reduced placental perfusion.
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 breast milk with low levels. Milk-to-plasma ratio is approximately 0.28. Caution advised; 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.
No standard dose adjustment required; however, increased plasma volume may reduce drug levels. Titrate to therapeutic effect with careful blood pressure monitoring.
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.
Diltzac is a calcium channel blocker (diltiazem) used for hypertension, angina, and atrial fibrillation. Avoid in patients with sick sinus syndrome (without pacemaker), second/third-degree AV block, or severe hypotension. Use with caution in hepatic impairment and renal failure. Monitor heart rate and ECG for bradycardia. Adjust dose with CYP3A4 inhibitors (e.g., grapefruit) or inducers. Advise gradual withdrawal to avoid rebound hypertension.
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; do not stop abruptly or change dose without consulting your doctor.,Avoid grapefruit and grapefruit juice while taking Diltzac.,Do not drive or operate heavy machinery if you experience dizziness or lightheadedness.,Monitor for signs of heart failure (swelling of ankles, feet, or sudden weight gain) and report immediately.,Your doctor may need to do regular blood tests to check liver function and monitor your heart rate and blood pressure.
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 DILTZAC vs CADUET, answered by our medical review team.
DILTZAC is a Calcium Channel Blocker that works by Diltiazem is a calcium channel blocker that inhibits calcium ion influx across cardiac and vascular smooth muscle cells, resulting in dilation of coronary and systemic arteries and decreased myocardial contractility and 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 DILTZAC 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 DILTZAC is: Oral: 30-120 mg 3-4 times daily; maximum 480 mg/day. IV: 0.25 mg/kg over 2 min, then 0.35 mg/kg after 15 min if needed; continuous infusion 5-15 mg/hour.. 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 DILTZAC 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. DILTZAC is classified as Category C. First trimester: No definitive evidence of teratogenicity in animal studies; human data limited. Second and third trimesters: Chronic use may cause fetal bradycardia, hypoxia, and . 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.