What is the recommended dose of colchicine for post cardiotomy syndrome?

Colchicine Dosing for Post-Cardiotomy Syndrome

The recommended dose of colchicine for post-cardiotomy 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 Protocol

• Weight-based dosing:

  • ≥70 kg: 0.5 mg twice daily
  • <70 kg: 0.5 mg once daily

• Duration: Minimum of 1 month

• Timing of initiation: Ideally started on the third post-operative day for better tolerability 1

Evidence Supporting Recommendation

The weight-based dosing recommendation is supported by high-quality evidence from multiple clinical trials:

• The European Society of Cardiology recommends this weight-adjusted dosing regimen based on clinical trial data 1

• The COPPS trial demonstrated that colchicine significantly reduced the incidence of post-pericardiotomy syndrome at 12 months (8.9% vs 21.1% with placebo; NNT = 8) using this dosing protocol 2

• In the COPPS trial, colchicine was initiated on the third post-operative day with a loading dose of 1.0 mg twice daily for the first day, followed by the maintenance dose for 1 month 2

Contraindications and Precautions

Colchicine should not be used in patients with:

• Severe renal dysfunction (creatinine clearance <15 mL/min)
• Severe hepatic impairment
• Pre-existing gastrointestinal conditions
• Blood dyscrasias
• Concomitant use of P-glycoprotein and/or strong CYP3A4 inhibitors 3, 1

Side Effects and Monitoring

• Common side effects: Gastrointestinal symptoms (diarrhea, nausea, vomiting) occur in 8.9-20% of patients 1

• Monitoring:

  • Clinical response
  • Inflammatory markers (CRP)
  • Gastrointestinal tolerance

• Management of side effects: Consider dose reduction if side effects occur but are tolerable 1

Clinical Efficacy

Colchicine has demonstrated significant benefits in preventing post-cardiotomy complications:

• Reduces post-pericardiotomy syndrome by approximately 50-60% 2, 4
• Reduces postoperative pericardial and pleural effusions 5
• May reduce postoperative atrial fibrillation, particularly in patients who maintain treatment 6

Diagnostic Criteria for Post-Pericardiotomy Syndrome

Diagnosis requires at least 2 of the following 5 criteria:

• Fever without alternative causes
• Pericarditic or pleuritic chest pain
• Pericardial or pleural rubs
• Evidence of pericardial/pleural effusion
• Elevated CRP 1

Treatment Algorithm

1. Confirm diagnosis using criteria above
2. Initiate colchicine at weight-adjusted dose
3. Combine with first-line therapy: NSAIDs or aspirin at anti-inflammatory doses
4. If inadequate response: Consider adding low-dose corticosteroids (prednisone 0.2-0.5 mg/kg/day)
5. Continue treatment until symptom resolution and normalization of CRP, with colchicine for at least 1 month 1

Colchicine's efficacy in preventing post-pericardiotomy syndrome makes it a valuable addition to the management strategy for patients undergoing cardiac surgery, with a favorable risk-benefit profile when used at appropriate doses.