From the Guidelines
The best treatment for pericarditis typically involves a combination of rest, pain management, and anti-inflammatory medications, with high-dose aspirin and colchicine being the preferred choices, as recommended by the most recent guidelines 1. The treatment approach for pericarditis should prioritize the reduction of symptoms and the prevention of recurrence, while also addressing the underlying cause of the condition.
- Key considerations in the management of pericarditis include:
- The use of high-dose aspirin (500-1000 mg every 6-8 hours) until symptoms improve, as recommended by the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline 1.
- The addition of colchicine (0.5-0.6 mg once or twice daily) for 3 months, which has been shown to reduce symptoms and lower the risk of recurrence 1.
- The importance of adjusting the dosing schedule based on patient weight, kidney function, and liver function, as well as potential interactions with other medications 1.
- In terms of specific treatment regimens, the following may be considered:
- High-dose aspirin (500-1000 mg every 6-8 hours) until symptoms improve, followed by a tapering schedule to minimize the risk of rebound 1.
- Colchicine (0.5-0.6 mg once or twice daily) for 3 months, with daily dosing used in patients who weigh <70 kg and further adjusted in patients with stage 4-5 kidney disease, severe hepatic impairment, or with concomitant P-glycoprotein and/or moderate and severe CYP3A4 inhibitors 1.
- It is also important to note that corticosteroids, such as prednisone, may be used in severe or recurrent cases, but should be tapered slowly to avoid rebound, and that the underlying cause of pericarditis should be addressed if identified, as some cases may be due to infections, autoimmune conditions, or other disorders requiring specific treatment approaches 1.
From the Research
Treatment Options for Pericarditis
The treatment for pericarditis typically involves the use of anti-inflammatory medications to reduce inflammation and relieve symptoms. The following are some of the treatment options:
- High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) that are tapered rapidly once symptoms are controlled 2, 3, 4
- Colchicine, which is necessary to both relieve symptoms and reduce the rate of recurrences, and is continued for at least 3-6 months 2, 4, 5, 6
- Low- to moderate-dose glucocorticoids, which are reserved for patients with a first recurrence for which NSAIDs and colchicine failed and/or who have an autoimmune disorder, with a slow tapering 2, 3, 4
- Interleukin-1 blockers (anakinra, rilonacept, and goflikicept), which are used as a third-line option in patients who cannot come off glucocorticoids or as second-line therapy after NSAIDs and colchicine in patients with contraindications to glucocorticoids or in those with high-risk features 2, 6
Treatment Duration and Recurrence Prevention
The duration of treatment for pericarditis varies depending on the severity of the condition and the response to treatment. The following are some general guidelines:
- For acute pericarditis, treatment with NSAIDs and colchicine is typically continued for several weeks until symptoms resolve and C-reactive protein levels normalize 4
- For recurrent pericarditis, colchicine should be continued for at least 6 months to reduce the risk of recurrence 4, 6
- In patients with multiple recurrences, interleukin-1 blockers may be used as a steroid-sparing therapy to reduce the risk of recurrence 4, 6
Important Considerations
When treating pericarditis, it is essential to consider the following:
- The treatment should be individualized based on the patient's specific condition and response to treatment 3
- The use of glucocorticoids should be reserved for patients with a first recurrence or those with autoimmune disorders, and should be tapered slowly to minimize side effects 2, 3, 4
- Colchicine is generally well-tolerated, but may cause adverse events such as gastrointestinal upset, and should be used with caution in patients with renal or hepatic impairment 5