What is the recommended dose of colchicine (Colcrys) for pericarditis?

Colchicine Dosing for Pericarditis

For pericarditis, colchicine should be dosed at 0.5 mg once daily for patients weighing <70 kg or 0.5 mg twice daily for patients weighing ≥70 kg, for a duration of 3 months in acute pericarditis and at least 6 months for recurrent pericarditis. 1, 2

Dosing Guidelines for Acute Pericarditis

• Colchicine is recommended as first-line therapy for acute pericarditis as an adjunct to aspirin/NSAID therapy 1
• Weight-adjusted dosing is essential:
  • For patients <70 kg: 0.5 mg once daily 1, 2
  • For patients ≥70 kg: 0.5 mg twice daily 1, 2
• Treatment duration should be 3 months for acute pericarditis 1, 2
• No loading dose is necessary in acute pericarditis 1

Dosing Guidelines for Recurrent Pericarditis

• For recurrent pericarditis, colchicine should be administered for at least 6 months 1
• Weight-adjusted dosing remains the same:
  • For patients <70 kg: 0.5 mg once daily 1
  • For patients ≥70 kg: 0.5 mg twice daily 1
• Colchicine significantly reduces recurrence rates (21.6% vs 42.5% with placebo) 3
• Number needed to treat to prevent one recurrence is approximately 5 patients 4

Tapering Considerations

• Tapering of colchicine is not mandatory for acute pericarditis but may be considered to prevent persistence of symptoms and recurrence 1
• If tapering is implemented, consider:
  • For patients <70 kg: 0.5 mg every other day during the last weeks 1
  • For patients ≥70 kg: 0.5 mg once daily during the last weeks 1
• Gradual tapering is particularly important in difficult cases to prevent recurrence 1

Clinical Pearls and Pitfalls

• Colchicine should always be added to NSAIDs/aspirin therapy, not used as monotherapy 1, 2
• Monitor for gastrointestinal side effects, which are the most common adverse events (approximately 7-8% of patients) 5, 3
• Inadequate treatment of the first episode is a common cause of recurrence, emphasizing the importance of appropriate dosing and duration 2
• Colchicine can reduce recurrence rates by approximately 50% compared to conventional therapy alone 6
• Avoid corticosteroids as first-line therapy as they may increase the risk of chronicity and recurrences 1, 2

Treatment Response Monitoring

• Use C-reactive protein (CRP) levels to guide treatment length and assess response to therapy 1
• Only consider tapering medications when symptoms are absent and CRP has normalized 2
• Exercise restriction should be maintained until symptoms resolve and diagnostic tests normalize 1

By following these weight-adjusted dosing guidelines and recommended treatment durations, colchicine effectively reduces both the recurrence rate and symptom persistence in patients with pericarditis, significantly improving patient outcomes.