From the Guidelines
The most effective treatment for pericarditis involves the use of high-dose aspirin and colchicine, with the addition of corticosteroids in severe cases or when NSAIDs are contraindicated, as recommended by the latest guidelines 1. The treatment approach for pericarditis typically includes medications to reduce inflammation and manage pain.
- Initial therapy usually includes high-dose aspirin (500-1000 mg every 6-8 hours) until symptoms improve, as well as colchicine (0.5-0.6 mg once or twice daily for 3 months) to reduce recurrence risk 1.
- The dosing schedule for colchicine should be adjusted based on patient weight, with daily dosing used in patients who weigh <70 kg, and further adjustments made in patients with stage 4-5 kidney disease, severe hepatic impairment, or with concomitant P-glycoprotein and/or moderate and severe CYP3A4 inhibitors 1.
- For severe cases or when NSAIDs are contraindicated, corticosteroids like prednisone (0.25-0.5 mg/kg/day) may be used, though they should be tapered slowly to avoid rebound 1.
- Pain management may include acetaminophen or, rarely, opioids for severe discomfort.
- Rest and activity restriction, particularly avoiding strenuous exercise, is recommended until symptoms resolve.
- Patients should be monitored for complications such as cardiac tamponade or constrictive pericarditis.
- Addressing the underlying cause, whether viral, autoimmune, or medication-related, is also essential for effective management.
From the Research
Treatment Options for Pericarditis
The treatment for pericarditis typically involves anti-inflammatory medications to reduce inflammation and relieve symptoms. The main treatment options include:
- Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) as the first line of treatment 2, 3
- Colchicine, which can be used in conjunction with aspirin or NSAIDs to reduce the risk of recurrence 2, 3
- Corticosteroids, which may be used as a second-line treatment for patients who do not respond to aspirin or NSAIDs, or for those with specific medical conditions such as systemic autoimmune diseases or postpericardiotomy syndrome 2, 4
Treatment Approach
The treatment approach for pericarditis should be individualized, with the goal of providing full daily control of symptoms and achieving remission 2. The treatment should be tapered once symptoms have resolved and C-reactive protein levels have normalized 2, 3. For patients with recurrent pericarditis, colchicine should be continued for at least 6 months 3.
Second-Line Treatment Options
For patients with idiopathic recurrent pericarditis who do not respond to first-line treatment, second-line treatment options may include:
- Corticosteroids, which can be effective in reducing the frequency of recurrences 4
- Immunosuppressive agents, such as azathioprine, methotrexate, or mycophenolate mofetil, which may be used in patients who are unresponsive to corticosteroids or have unacceptable side effects 4
- Interleukin 1 (IL-1) blockers, which may be preferred to corticosteroids in certain patients with multiple recurrences 3
Special Considerations
In patients with tuberculosis-related pericarditis, antituberculosis therapy is the primary treatment, with corticosteroids considered for associated constrictive pericarditis 3. In patients with pericarditis after cardiac procedures or operations, treatment with high-dose NSAIDs and colchicine is recommended 3.