What is the recommended dosage of ibuprofen (Nonsteroidal Anti-Inflammatory Drug) for the treatment of pericarditis?

Ibuprofen Dosage for Pericarditis

For pericarditis treatment, ibuprofen should be administered at 600 mg every 8 hours (range 1200-2400 mg per day) for a period of weeks to months until symptoms resolve and C-reactive protein normalizes. 1, 2

Dosing and Administration

• Initial dosage: 600 mg every 8 hours (1800 mg daily) 1
• Dosage range: 1200-2400 mg per day 1, 3
• Treatment duration: Continue for weeks to months, guided by symptom resolution and CRP normalization 2
• Gastroprotection should be provided with all NSAID regimens to prevent gastrointestinal complications 3

Tapering Protocol

• Begin tapering only after symptoms have completely resolved and CRP has normalized 1, 2
• Decrease doses gradually by 200-400 mg every 1-2 weeks 1, 3
• Longer tapering times may be necessary for more difficult or resistant cases 1

Combination Therapy

• Colchicine should be added to ibuprofen as part of first-line therapy 2, 4
• Weight-adjusted colchicine dosing: 0.5 mg once daily if <70 kg or 0.5 mg twice daily if ≥70 kg 1, 2
• Colchicine reduces recurrence rates by approximately 50% compared to NSAID therapy alone 4, 5
• Colchicine should be continued for at least 3 months for first episodes and 6 months for recurrent cases 2, 3

Alternative NSAIDs

• If ibuprofen is not tolerated or contraindicated, alternatives include:
  • Aspirin: 500-1000 mg every 6-8 hours (range 1.5-4 g/day) 1, 3
  • Indomethacin: 25-50 mg every 8 hours (start at lower end of dosing range) 1, 3

Second-Line Therapy

• Corticosteroids should only be considered if:
  • NSAIDs are contraindicated (true allergy, recent peptic ulcer, high bleeding risk with anticoagulants) 1, 6
  • Incomplete response to NSAIDs and colchicine 2, 3
  • Infections have been excluded 1
• Low to moderate doses of prednisone (0.2-0.5 mg/kg/day) should be used rather than high doses 2, 6
• Corticosteroids should be added to, not replace, NSAIDs and colchicine as triple therapy 1, 3

Monitoring and Follow-up

• Assess response to therapy after 1 week 6
• Monitor CRP levels regularly to guide treatment duration 2, 3
• Continue treatment until symptoms resolve and CRP normalizes 1, 2
• Exercise restriction should be maintained until symptoms resolve and CRP, ECG, and echocardiogram normalize 3

Clinical Pitfalls

• Inadequate treatment of the first episode is a common cause of recurrence 1, 3
• Premature discontinuation of therapy before complete resolution increases risk of recurrence 2
• Early use of corticosteroids may provide rapid symptom control but increases risk of chronicity and recurrence 1, 3
• Recurrence rates after initial episode range from 15-30% without colchicine, increasing to 50% after first recurrence 3, 4

Special Considerations

• For patients on anticoagulants, consider using corticosteroids instead of NSAIDs due to bleeding risk 6
• After obtaining complete response, taper one drug at a time, with colchicine being the last to discontinue 1, 3
• Influenza vaccine is not recommended specifically for pericarditis prevention 1