Colchicine Dosing for Pericarditis
For acute pericarditis, colchicine should be dosed at 0.5 mg once daily for patients weighing less than 70 kg, or 0.5 mg twice daily for patients weighing 70 kg or more, continued for 3 months. 1
Weight-Based Dosing Algorithm
Patients <70 kg:
- 0.5 mg once daily 1, 2
- Duration: 3 months for acute pericarditis 1, 2
- Duration: At least 6 months for recurrent pericarditis 1
Patients ≥70 kg:
- 0.5 mg twice daily (b.i.d.) 1, 2
- Duration: 3 months for acute pericarditis 1, 2
- Duration: At least 6 months for recurrent pericarditis 1
Treatment Context and Rationale
Colchicine is a Class I, Level A recommendation as first-line therapy for acute pericarditis, always given as an adjunct to aspirin or NSAIDs, never as monotherapy. 1, 2 The 2015 European Society of Cardiology guidelines establish this as the highest level of evidence-based recommendation. 1
The weight-adjusted dosing strategy is critical because it balances efficacy with tolerability. 1 Multiple randomized controlled trials (COPE, ICAP, CORP, CORP-2) have validated this dosing regimen, demonstrating that colchicine reduces recurrence rates from 32-55% down to 11-22%, yielding a number needed to treat of 3-5 patients. 3, 4, 5, 6
Tapering Considerations
Tapering of colchicine is not mandatory but may be considered in the final weeks of treatment. 1
If tapering is chosen:
- Patients <70 kg: Reduce to 0.5 mg every other day in the last weeks 1
- Patients ≥70 kg: Reduce to 0.5 mg once daily in the last weeks 1
Special Situations
For recurrent pericarditis (second or subsequent episodes):
- Use the same weight-based dosing (0.5 mg once daily if <70 kg, or 0.5 mg twice daily if ≥70 kg) 1
- Extend duration to at least 6 months 1
- Do NOT use a loading dose for recurrent cases 1
For first episodes of acute pericarditis:
- A loading dose approach (1.0-2.0 mg on day 1) was used in some older trials 4, 6, but current ESC guidelines recommend starting directly with the maintenance dose without loading 1
Critical Pitfalls to Avoid
Do not use inadequate treatment duration. The most common cause of recurrence is inadequate treatment of the first episode. 2 Completing the full 3-month course is essential, as premature discontinuation significantly increases recurrence risk. 2
Do not use colchicine as monotherapy. It must always be combined with aspirin (750-1000 mg every 8 hours) or ibuprofen (600 mg every 8 hours). 1, 2
Do not continue treatment if gastrointestinal intolerance occurs. Gastrointestinal side effects occur in 5-10% of patients and are the most common reason for discontinuation. 3, 7 If this occurs, temporary dose reduction or discontinuation is appropriate, as no severe adverse events have been reported in major trials. 3, 4, 5, 6
Do not adjust dosing based on renal function in the guidelines provided, though clinical judgment should be applied for severe renal impairment given colchicine's known toxicity in this population. 7
Monitoring and Duration
Treatment should continue until complete symptom resolution and normalization of C-reactive protein (CRP). 1, 2 The standard 3-month duration for acute pericarditis is based on the natural history of the disease and recurrence patterns observed in clinical trials. 1, 6