What is the initial treatment for pericarditis?

From the Guidelines

The initial treatment for pericarditis should involve aspirin or NSAIDs as first-line therapy, with colchicine added as an adjunct to reduce recurrence risk, as recommended by the most recent guidelines 1. The treatment approach for pericarditis is focused on reducing inflammation, relieving symptoms, and preventing complications.

• Aspirin or NSAIDs, such as ibuprofen (600-800mg three times daily) or indomethacin (25-50mg three times daily), are used for 1-2 weeks, followed by a gradual taper over 2-4 weeks 1.
• Colchicine is often added to this regimen (0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg) for 3-6 months to reduce recurrence risk 1.
• Aspirin (750-1000mg three times daily) may be used instead of NSAIDs in patients with coronary artery disease 1.
• Pain control is essential, and patients should restrict strenuous physical activity until symptoms resolve and inflammatory markers normalize 1.
• For patients with contraindications to NSAIDs (such as renal failure, active peptic ulcer disease, or significant bleeding risk), low-dose corticosteroids (prednisone 0.25-0.5mg/kg/day) may be considered, though they're generally reserved for refractory cases due to higher recurrence rates 1.
• Gastric protection with proton pump inhibitors should be provided during NSAID therapy 1. It's worth noting that the most recent guidelines from 2025 1 provide the most up-to-date recommendations for the management of pericarditis, and should be prioritized in clinical practice. Key considerations in the treatment of pericarditis include:
• Monitoring for signs of complications, such as cardiac tamponade or constrictive pericarditis 1.
• Adjusting treatment based on patient response and inflammatory marker levels 1.
• Providing patient education on the importance of adherence to treatment and follow-up appointments 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. The FDA drug label does not answer the question.

From the Research

Initial Treatment for Pericarditis

The initial treatment for pericarditis typically involves anti-inflammatory therapy. Key points to consider include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin are commonly used as the mainstay of therapy for acute pericarditis 2, 3, 4.
• Colchicine is often used as an adjunct to NSAIDs or aspirin, especially for recurrent cases or to prevent recurrences 2, 3, 4, 5.
• Corticosteroids may be used as a second-line treatment for difficult cases or for patients with specific medical conditions, such as systemic autoimmune diseases or postpericardiotomy syndrome 2, 6, 3, 4.

Treatment Approach

The treatment approach for pericarditis may vary depending on the underlying cause and severity of the condition. Considerations include:

• For uncomplicated acute pericarditis, NSAIDs or aspirin are typically used as first-line therapy, with colchicine added if necessary 3, 4, 5.
• For recurrent pericarditis, colchicine is often used as initial therapy, and corticosteroids or immunosuppressive agents may be considered for patients who do not respond to first-line treatment 6, 4.
• The treatment should be individualized and tailored to the specific needs of each patient, with the goal of providing rapid symptom relief and preventing recurrences 2, 4.

Medication Options

Medication options for pericarditis include:

• Aspirin: often used as first-line therapy for acute pericarditis, especially in patients with a history of myocardial infarction 2, 3, 4.
• NSAIDs: commonly used as first-line therapy for acute pericarditis, with the goal of reducing inflammation and relieving symptoms 2, 3, 4.
• Colchicine: often used as an adjunct to NSAIDs or aspirin, especially for recurrent cases or to prevent recurrences 2, 3, 4, 5.
• Corticosteroids: may be used as a second-line treatment for difficult cases or for patients with specific medical conditions, such as systemic autoimmune diseases or postpericardiotomy syndrome 2, 6, 3, 4.