From the Guidelines
Colchicine and indomethacin are not typically recommended for viral myocarditis treatment, but may be considered in specific cases with pericardial involvement. The standard approach for viral myocarditis focuses on supportive care, treating heart failure symptoms, and managing arrhythmias rather than using anti-inflammatory medications like colchicine or indomethacin. While these medications have anti-inflammatory properties that might theoretically help reduce inflammation in the heart muscle, there is insufficient clinical evidence supporting their routine use in viral myocarditis. In fact, non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin may potentially worsen myocardial inflammation in some viral infections based on experimental models.
- Current treatment guidelines emphasize rest, heart failure management with medications like ACE inhibitors or beta-blockers when indicated, and addressing complications.
- In severe cases, immunosuppressive therapy might be considered, but this is typically reserved for specific circumstances like giant cell myocarditis or autoimmune-mediated cases, not routine viral myocarditis.
- Patients with suspected viral myocarditis should be evaluated by a cardiologist for appropriate individualized treatment, as noted in the 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults 1.
- For patients with associated pericardial involvement, treatment with NSAIDs, colchicine, and/or prednisone is reasonable, as suggested in the 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults 1.
- Low-dose colchicine or prednisone may be added for persistent chest pain, with a plan to taper the dose based on symptoms and clinical findings, as noted in the 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults 1.
From the Research
Treatment of Viral Myocarditis
- The treatment of viral myocarditis depends on the acuity, severity, clinical presentation, and etiology of the disease 2.
- Supportive care is often the first-line therapy for viral myocarditis, and may include treatment for heart failure, arrhythmias, and other complications 3, 2.
- Immunosuppression, such as corticosteroids, may be used in certain cases of myocarditis, including those with eosinophilic or giant cell myocardial infiltrations or due to systemic autoimmune disorders 2.
- Colchicine, an anti-inflammatory medication, has been used to treat pericarditis and other cardiovascular conditions, and may be a promising treatment for myocarditis, including viral myocarditis 4.
- Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is not typically used to treat viral myocarditis, and may even exacerbate the condition in some cases 3.
Use of Colchicine in Viral Myocarditis
- There is limited evidence on the use of colchicine in the treatment of viral myocarditis, but it has been shown to be effective in some cases 4.
- Colchicine has anti-inflammatory properties and may be useful in reducing inflammation and improving outcomes in patients with viral myocarditis 4.
- Further studies are needed to determine the efficacy and safety of colchicine in the treatment of viral myocarditis 4.
Use of Indomethacin in Viral Myocarditis
- There is no evidence to suggest that indomethacin is effective in the treatment of viral myocarditis, and it may even worsen the condition in some cases 3.
- Indomethacin is not typically used to treat viral myocarditis, and other treatments such as supportive care and immunosuppression may be more effective 3, 2.