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 treating pericarditis is 600 mg every 8 hours (range 1200-2400 mg/day) for a duration of weeks to months, with tapering by decreasing doses by 200-400 mg every 1-2 weeks after symptoms resolve and C-reactive protein normalizes. 1, 2

First-Line Treatment Approach

• Ibuprofen is one of the first-line NSAIDs recommended by the European Society of Cardiology for treating pericarditis 2
• Treatment should be administered at full anti-inflammatory doses until symptoms resolve and C-reactive protein normalizes 2
• Colchicine should be added to ibuprofen as part of first-line therapy at weight-adjusted doses (0.5 mg once daily if <70 kg or 0.5 mg twice daily if ≥70 kg) for at least 3 months 1, 2
• Gastroprotection should be considered when prescribing high-dose ibuprofen to reduce gastrointestinal side effects 2

Treatment Duration and Tapering

• The initial high-dose treatment should continue until complete symptom resolution and normalization of inflammatory markers 1
• Tapering should only begin after the patient is asymptomatic and C-reactive protein has normalized 1
• Gradual tapering is essential to prevent recurrence, with dose reductions of 200-400 mg every 1-2 weeks 1
• Longer tapering times may be necessary for more difficult or resistant cases 1

Monitoring and Follow-up

• Regular monitoring of symptoms and C-reactive protein levels is necessary to guide treatment duration and assess response 2
• Exercise restriction should be maintained until symptoms resolve and CRP, ECG, and echocardiogram normalize 2
• For athletes, exercise restriction should last at least 3 months 2

Alternative NSAIDs and Second-Line Options

• If ibuprofen is not tolerated or contraindicated, alternative NSAIDs include:
  • Aspirin: 500-1000 mg every 6-8 hours (range 1.5-4 g/day) 1
  • Indomethacin: 25-50 mg every 8 hours (start at lower doses to avoid headache and dizziness) 1
• Corticosteroids should be considered only when:
  • NSAIDs are contraindicated (true allergy, recent peptic ulcer, high bleeding risk with anticoagulants) 1
  • There is persistent disease despite appropriate NSAID doses 1
  • Specific indications exist (systemic inflammatory diseases, post-pericardiotomy syndromes, pregnancy) 1

Pitfalls and Caveats

• Inadequate treatment of the first episode is a common cause of recurrence 2
• Premature discontinuation or too-rapid tapering of anti-inflammatory therapy increases recurrence risk 1, 2
• Corticosteroids provide rapid symptom control but may increase risk of chronicity and recurrence, so they should not be used as first-line therapy 1, 2
• Recurrence rates after initial episode range from 15-30% without colchicine, making combination therapy important 2, 3
• In bacterial pericarditis (including tuberculous), appropriate antimicrobial therapy is the primary treatment rather than NSAIDs 4

Special Considerations

• For patients with multiple recurrences despite standard therapy, alternative options include azathioprine, intravenous immunoglobulins, or IL-1 blockers 3, 5
• Risk of constrictive pericarditis varies by etiology: low (<1%) for idiopathic/viral, intermediate (2-5%) for autoimmune/neoplastic, and high (20-30%) for bacterial causes 1, 2
• Cardiac tamponade rarely occurs in idiopathic pericarditis but is more common with specific etiologies like malignancy or purulent pericarditis 1, 2