title: Amiodarone-induced thyroid dysfunction: brand-name versus generic formulations.
abstract: BACKGROUND
  Amiodarone is associated with dysfunction of the thyroid. Concerns have arisen regarding the potential for adverse effects with generic formulations of amiodarone. We evaluated and compared the risk of thyroid dysfunction between patients using brand-name versus generic formulations of amiodarone and identified risk factors for thyroid dysfunction.
  
  
  METHODS
  We conducted a retrospective cohort study of patients with atrial fibrillation aged 66 years and older. We used administrative databases that linked information on demographics and clinical characteristics, claims for prescription drugs and discharges from hospital. We estimated thyroid dysfunction using person-year incidence.
  
  
  RESULTS
  Of the 60,220 patients in the cohort, 2804 (4.7%) used the brand-name formulation of amiodarone and 6278 (10.4%) used the generic formulation. Baseline characteristics between these two groups were comparable. The median maintenance dose of amiodarone was 200 mg/d for both groups. The total incidence rate for thyroid dysfunction was 14.1 per 100 person-years for both formulations. The mean time to clinical dysfunction of the thyroid was 4.32 years for the brand-name formulation and 4.09 years for the generic formulation. In a multivariate analysis, there was no significant difference in the incidence rates of thyroid dysfunction between the generic and brand formulations (hazard ratio 0.97, 95% confidence interval 0.87-1.08). Factors associated with an increased risk of thyroid dysfunction were being a woman, increasing age and having chronic obstructive pulmonary disease.
  
  
  CONCLUSIONS
  In this population-based study, we saw no difference between brand-name and generic formulations of amiodarone in terms of incidence of thyroid dysfunction.
authors: Division of Internal Medicine, McGill University Health Center, Montréal, Que.
authors: Meytal A
authors: MA
authors: Tsadok
authors: Cynthia A
authors: CA
authors: Jackevicius
authors: Elham
authors: E
authors: Rahme
authors: Vidal
authors: V
authors: Essebag
authors: Mark J
authors: MJ
authors: Eisenberg
authors: Karin H
authors: KH
authors: Humphries
authors: Jack V
authors: JV
authors: Tu
authors: Hassan
authors: H
authors: Behlouli
authors: Jennifer
authors: J
authors: Joo
authors: Louise
authors: L
authors: Pilote
mesh_terms: D000367:Age Factors; D000368:Aged; D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D016009:Chi-Square Distribution; D016568:Drugs, Generic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007182:Income; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013959:Thyroid Diseases / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000889:Anti-Arrhythmia Agents; D016568:Drugs, Generic; D000638:Amiodarone