What is the recommended dose of colchicine for treating myocarditis?

Colchicine Dosing for Myocarditis

For myocarditis treatment, colchicine should be dosed at 0.5 mg twice daily for patients ≥70 kg or 0.5 mg once daily for patients <70 kg, and continued for at least 6 months. 1, 2

Dosing Guidelines

• Weight-based dosing:

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

• Duration: At least 6 months of treatment is recommended 1

• No loading dose is required when initiating colchicine therapy for myocarditis 1

Treatment Approach

Colchicine should be used as an adjunct to standard anti-inflammatory therapy:

1. First-line therapy: NSAIDs/Aspirin

   • Aspirin: 500-1000 mg every 6-8 hours (1.5-4 g/day)
   • Ibuprofen: 600 mg every 8 hours (1200-2400 mg/day)
   • Indomethacin: 25-50 mg every 8 hours 1

2. Add colchicine at weight-adjusted doses as specified above

3. Corticosteroids should be avoided as first-line therapy and only used when:

   • NSAIDs/Aspirin + colchicine combination fails
   • Specific indications exist (systemic inflammatory diseases, pregnancy)
   • NSAIDs are contraindicated
   • If used, prednisone 0.2-0.5 mg/kg/day is recommended 1, 3

Monitoring and Treatment Duration

• Continue treatment until complete resolution of:

  • Symptoms
  • Inflammatory markers (CRP normalization)
  • ECG changes
  • Pericardial effusion (if present) 3

• Follow-up visits should be scheduled every 1-2 weeks initially, then every 1-2 months until treatment completion 3

Tapering and Discontinuation

• Tapering of colchicine may not be necessary, but can be done gradually:

  • For patients <70 kg: Consider 0.5 mg every other day during the last weeks of treatment 1
  • Gradual tapering over several months may be needed in difficult cases

• When discontinuing multiple medications, taper one drug at a time, with colchicine being the last to be discontinued 1

Safety and Side Effects

• Colchicine is generally safe and well-tolerated when properly dosed
• Most common side effect is gastrointestinal intolerance (5-10% of cases) 2, 4
• If GI side effects occur, dose reduction or temporary discontinuation may be needed 2
• Dose adjustment is necessary in patients with renal or hepatic impairment 3

Evidence for Efficacy in Myopericarditis

Recent evidence from a 2024 study demonstrated that colchicine is both safe and effective for treating pericarditis with myocardial involvement (myopericarditis). Patients treated with colchicine had significantly fewer recurrences (19.2% vs 43.8%) compared to those not receiving colchicine 5.

Important Considerations

• Premature discontinuation is a leading cause of recurrence 3
• Colchicine reduces recurrence rates from 15-30% to approximately 8-15% 3, 4
• Exercise restriction is recommended until symptoms resolve and inflammatory markers normalize 3
• Colchicine has been shown to modulate the NLRP3 inflammasome pathway, which plays a role in myocarditis pathogenesis 6