What is the next step for a 36-year-old patient with a history of pericarditis, who was prescribed colchicine for 3 months but only took it for 1 month and has since stopped, and is still experiencing intermittent chest pain?

From the Guidelines

The patient should restart colchicine immediately and complete the full 3-month course as originally prescribed, with a standard dose of 0.5 mg twice daily for patients ≥70 kg or 0.5 mg once daily for patients <70 kg, as recommended by the 2015 ESC guidelines 1. The recurrent chest pain likely indicates ongoing inflammation that requires continued anti-inflammatory therapy. In addition to restarting colchicine, the patient should also be taking an NSAID like ibuprofen (600-800mg three times daily) or aspirin (750-1000mg three times daily) until symptoms resolve completely, as suggested by the 2015 ESC guidelines 1. Premature discontinuation of anti-inflammatory therapy is a common cause of pericarditis recurrence, as the full course is needed to adequately suppress the inflammatory process. The patient should be monitored for symptom improvement, and if chest pain persists despite restarting therapy, further evaluation may be needed to rule out complications or alternative diagnoses. Colchicine works by inhibiting neutrophil motility and activity, reducing the inflammatory response in the pericardium, which is why completing the full treatment course is essential for preventing recurrence, as supported by the European Society of Cardiology guidelines 1.

Some key points to consider in the management of this patient include:

• The importance of completing the full 3-month course of colchicine to prevent recurrence, as emphasized by the 2015 ESC guidelines 1.
• The use of NSAIDs, such as ibuprofen or aspirin, in conjunction with colchicine to manage symptoms and reduce inflammation, as recommended by the 2015 ESC guidelines 1.
• The need for careful monitoring of the patient's symptoms and adjustment of the treatment plan as needed to ensure optimal outcomes, as suggested by the European Society of Cardiology guidelines 1.

Overall, the goal of treatment is to reduce inflammation, manage symptoms, and prevent recurrence, while also minimizing the risk of complications and promoting optimal quality of life for the patient.

From the FDA Drug Label

Patients should be advised to take Colchicine Tablets, USP as prescribed, even if they are feeling better. Patients should not alter the dose or discontinue treatment without consulting with their doctor The patient should consult with their doctor as they have stopped taking colchicine for a few weeks and are still experiencing chest pain. The doctor will determine the best course of action and decide whether the patient should resume taking colchicine or consider alternative treatments 2.

From the Research

Patient's Current Situation

• The patient is a 36-year-old who was recently diagnosed with pericarditis and started on colchicine for 3 months, but only took it for 1 month.
• The patient has stopped taking colchicine for a few weeks and is still experiencing chest pain.

Considerations for Next Steps

• According to 3, colchicine may have a role in the management of acute myopericarditis, and its use was associated with full recovery in two case reports.
• The study 4 found that colchicine had no effect on all-cause mortality, but reduced the risk of myocardial infarction, and had substantial cardiovascular benefits, although with some uncertainty about its benefit and harm.
• The review 5 discussed the potential benefits and harms of colchicine in patients with coronary artery disease, highlighting its anti-inflammatory and immunomodulatory effects, as well as its potential to reduce cardiovascular events.
• Studies 6 and 7 also supported the use of colchicine in cardiovascular diseases, including atrial fibrillation and coronary artery disease, with improvements in quality of life and reduction in cardiovascular events.

Potential Next Steps

• Consider restarting colchicine for the remaining 2 months as originally prescribed, given its potential benefits in reducing cardiovascular events and improving outcomes in patients with pericarditis 3, 4, 5, 6, 7.
• Monitor the patient's symptoms and adjust the treatment plan as needed, taking into account the potential risks and benefits of colchicine therapy 4, 5.
• Further evaluation and testing, such as echocardiography and cardiac magnetic resonance imaging, may be necessary to assess the patient's condition and guide treatment decisions 3.