Is ibuprofen (nonsteroidal anti-inflammatory drug, NSAID) effective for treating pericarditis?

From the Guidelines

Ibuprofen is a recommended first-line treatment for pericarditis, with a dosage of 600 mg every 8 hours for 1-2 weeks, followed by a gradual taper. The treatment should be guided by symptoms and C-reactive protein (CRP) levels, with tapering considered when symptoms resolve and CRP normalizes 1. It is essential to use ibuprofen with colchicine (0.5 mg once or twice daily, depending on body weight) for at least 3 months to reduce the risk of recurrence, as recommended by the European Society of Cardiology (ESC) guidelines 1.

Key Considerations

• Ibuprofen should be taken with food to minimize gastrointestinal side effects.
• Gastric protection with a proton pump inhibitor is recommended for patients at high risk of gastrointestinal complications.
• Patients should be monitored for pain relief, fever reduction, and improvement in ECG changes.
• If symptoms persist despite adequate dosing, or if the patient has recurrent pericarditis, consider adding corticosteroids or consulting a cardiologist.
• Patients should avoid strenuous physical activity until symptoms resolve completely and follow-up echocardiography confirms absence of pericardial effusion.

Treatment Approach

• The initial treatment approach should focus on symptom management and reduction of inflammation.
• Colchicine is recommended on top of standard anti-inflammatory therapy, without a loading dose and using weight-adjusted doses, to improve response to medical therapy and prevent recurrences 1.
• Corticosteroids may be used in cases of incomplete response to aspirin/NSAIDs and colchicine, but should be added at low to moderate doses and used with caution due to potential side effects 1.

From the Research

Ibuprofen for Pericarditis

• Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to treat pericarditis, as it helps to reduce inflammation and relieve symptoms 2, 3, 4.
• The therapeutic armamentarium for pericarditis includes high-dose NSAIDs, such as ibuprofen, which are tapered rapidly once symptoms are controlled 2.
• Aspirin and NSAIDs, including ibuprofen, are the mainstay of therapy for acute and recurrent pericarditis, with the possible adjunct of colchicine, especially for recurrences 3, 4.
• Colchicine has been shown to be effective in reducing the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis, and is often used in combination with NSAIDs like ibuprofen 5.

Treatment Guidelines

• The treatment of pericarditis should be individualized, with the goal of providing full daily control of symptoms and achieving remission and C-reactive protein normalization 3.
• Medical therapy of pericarditis should be tailored to the specific needs of each patient, taking into account factors such as the underlying cause of the pericarditis, the presence of any contraindications or intolerances to therapy, and the risk of recurrence 2, 3, 4.
• Corticosteroids and immunosuppressive agents may be used as second-line therapy in patients with recurrent pericarditis who do not respond to NSAIDs and colchicine, or who have specific medical conditions that require their use 2, 6.

Efficacy and Safety

• There is moderate quality evidence that colchicine reduces episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up, with a number needed to treat (NNT) of 4 5.
• Colchicine has been shown to be effective in reducing the number of pericarditis recurrences in patients with acute pericarditis, with a hazard ratio (HR) of 0.40 at 18 months follow-up 5.
• Adverse effects of colchicine are mainly gastrointestinal, and include abdominal pain and diarrhea, but the quality of evidence for these adverse effects is low due to imprecision 5.