What is the recommended dose of ibuprofen (Non-Steroidal Anti-Inflammatory Drug, NSAID) for treating pericarditis?

Ibuprofen Dosing for Pericarditis

The recommended dose of ibuprofen for pericarditis is 600 mg every 8 hours (range 1200-2400 mg/day) for several weeks to months, with gradual tapering by 200-400 mg every 1-2 weeks after symptoms resolve and C-reactive protein normalizes. 1

Dosing and Administration Algorithm

1. Initial Dosing:

   • 600 mg every 8 hours (1800 mg/day) 1
   • Ensure full 24-hour coverage with q8h dosing to maintain anti-inflammatory effect
   • Continue at full dose until complete symptom resolution AND normalization of CRP

2. Treatment Duration:

   • Continue for weeks to months depending on clinical response 1
   • Monitor symptoms and CRP levels to guide duration

3. Tapering Protocol:

   • Begin tapering only after complete symptom resolution and CRP normalization
   • Decrease dose by 200-400 mg every 1-2 weeks 1
   • Longer tapering periods may be necessary for difficult or resistant cases

Combination Therapy

Ibuprofen should be combined with colchicine for optimal outcomes:

• Colchicine dosing:
  • 0.5 mg twice daily for patients ≥70 kg
  • 0.5 mg once daily for patients <70 kg 1, 2
  • Continue for at least 3 months for first episode, 6 months for recurrent cases 3

Adding colchicine significantly reduces recurrence rates from 37.5% to 16.7% 4 and improves symptom resolution at 72 hours 4.

Monitoring and Follow-up

• Assess response at 72 hours for initial symptom improvement
• Follow-up every 1-2 weeks initially to monitor:
  • Symptom resolution
  • CRP normalization
  • ECG changes
  • Presence of pericardial effusion 2

Alternative NSAIDs

If ibuprofen is not tolerated or contraindicated, consider:

1. Aspirin: 500-1000 mg every 6-8 hours (range 1.5-4 g/day) 1

   • Preferred in post-cardiac procedure settings due to antiplatelet effects 2

2. Indomethacin: 25-50 mg every 8 hours 1

   • Start at lower end of dosing range
   • Titrate upward cautiously to avoid headache and dizziness

Important Considerations and Pitfalls

• Premature discontinuation: A leading cause of recurrence; continue treatment until both symptoms and inflammatory markers normalize 2

• Inadequate dosing: Full anti-inflammatory doses given every 8 hours are necessary until symptoms resolve 2

• Corticosteroid use: Avoid as first-line therapy due to higher recurrence rates; reserve for specific indications (systemic inflammatory diseases, pregnancy) or NSAID contraindications 1

• Risk of recurrence: 15-30% of patients with idiopathic pericarditis will develop recurrent disease without colchicine 1, 3

• Gastrointestinal protection: Consider gastroprotection with proton pump inhibitors in high-risk patients (elderly, history of peptic ulcer disease, concomitant anticoagulation)

• Exercise restriction: Advise patients to restrict physical activity until symptoms resolve and CRP normalizes 2

By following this evidence-based dosing regimen and monitoring protocol, most patients with pericarditis will experience symptom relief and reduced risk of recurrence.