What is the recommended dose of colchicine (Colchicine) for post-pericardiotomy syndrome?

Colchicine Dosing for Post-Pericardiotomy Syndrome

The recommended dose of colchicine for post-pericardiotomy syndrome is 0.5 mg twice daily for patients ≥70 kg or 0.5 mg once daily for patients <70 kg, to be continued for at least 1 month. 1

Dosing Details and Administration

• Weight-based dosing:

  • Patients ≥70 kg: 0.5 mg twice daily
  • Patients <70 kg: 0.5 mg once daily
  • Duration: At least 1 month 1, 2

• Initial loading dose option:

  • Some protocols use a loading dose of 1.0 mg twice daily for the first day, followed by the maintenance dose 2
  • However, this approach may increase gastrointestinal side effects 3

Timing of Initiation

• Post-operative approach: Starting colchicine on the third post-operative day has shown efficacy in preventing PPS 2
• Perioperative approach: Starting colchicine 48-72 hours before surgery and continuing for 1 month after surgery has also shown efficacy but with increased risk of gastrointestinal side effects 3
• Recommendation: The post-operative approach is preferred due to better tolerability 1, 3

Efficacy and Benefits

Colchicine at these doses has demonstrated:

• 58% relative risk reduction in post-pericardiotomy syndrome 2
• Number needed to treat (NNT) of 8-10 patients to prevent one case of PPS 2, 4
• Reduction in secondary complications including:
  • Pericardial effusions (44% reduction)
  • Pleural effusions (52% reduction)
  • Post-operative atrial fibrillation (45% reduction) 5, 6

Important Considerations and Contraindications

• Not recommended for:

  • Postoperative effusions in the absence of systemic inflammation 1
  • Patients with severe renal or hepatic dysfunction
  • Patients with pre-existing gastrointestinal conditions

• Side effects:

  • Primarily gastrointestinal (diarrhea, nausea, vomiting)
  • Side effect rates: 8.9-20% depending on timing of initiation 2, 3
  • Consider dose reduction if side effects occur but are tolerable

Monitoring and Follow-up

• Monitor for clinical response and inflammatory markers (CRP)
• Treatment duration should be guided by symptom resolution and normalization of CRP 1
• For patients with incomplete response to colchicine plus NSAIDs, consider adding low-dose corticosteroids (prednisone 0.2-0.5 mg/kg/day) 1

Treatment Algorithm

1. Confirm diagnosis of post-pericardiotomy syndrome:

   • Fever without alternative causes
   • Pericarditic or pleuritic chest pain
   • Pericardial or pleural rubs
   • Evidence of pericardial/pleural effusion
   • Elevated CRP (At least 2 of 5 criteria should be fulfilled) 1

2. First-line therapy:

   • NSAIDs or aspirin at anti-inflammatory doses
   • PLUS colchicine at weight-adjusted doses (as detailed above)

3. If inadequate response:

   • Consider adding low-dose corticosteroids (prednisone 0.2-0.5 mg/kg/day)
   • Avoid high-dose steroids due to risk of promoting chronicity 1

4. Treatment duration:

   • Continue colchicine for at least 1 month
   • NSAIDs/aspirin until symptom resolution and CRP normalization

By following this evidence-based dosing regimen, colchicine can effectively reduce the incidence of post-pericardiotomy syndrome and its related complications while maintaining an acceptable safety profile.