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

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-Adjusted Dosing Strategy

The European Society of Cardiology guidelines establish clear weight-based dosing:

• Patients <70 kg: 0.5 mg once daily 1, 2
• Patients ≥70 kg: 0.5 mg twice daily (b.i.d.) 1, 2

This weight-adjusted approach is critical because it balances efficacy with tolerability, as gastrointestinal side effects are dose-dependent. 3, 4

Treatment Duration

Standard duration is 3 months for acute pericarditis. 1, 2 This represents a Class I, Level A recommendation from the ESC guidelines. 1

For recurrent pericarditis, the duration extends to at least 6 months without a loading dose. 1, 5

Tapering Considerations

Tapering colchicine is not mandatory but may be considered in the final weeks of therapy to prevent symptom persistence and recurrence. 1 If tapering is chosen:

• Patients <70 kg: Reduce to 0.5 mg every other day 1
• Patients ≥70 kg: Reduce to 0.5 mg once daily 1

Critical Implementation Points

Colchicine must be added to NSAIDs or aspirin, not used as monotherapy. 1, 2 This combination approach is essential—colchicine is an adjunct to conventional anti-inflammatory therapy, not a replacement.

The evidence supporting this dosing is robust, with multiple randomized controlled trials (COPE, ICAP, CORP, CORP-2) demonstrating that colchicine reduces recurrence rates from 32-55% down to 11-24% (number needed to treat = 3-5). 3, 4, 5, 6, 7

Common Pitfalls to Avoid

Do not use loading doses for recurrent pericarditis. 1 While acute first episodes may use 1.0-2.0 mg on day one in some older protocols 1, 4, current ESC guidelines favor the simpler weight-based approach without loading. 1

Do not discontinue colchicine prematurely. The full 3-month course is necessary even if symptoms resolve earlier, as this prevents recurrences. 1, 2 Inadequate treatment duration is a common cause of recurrent pericarditis. 2

Monitor for gastrointestinal intolerance, which is the most common side effect (occurring in approximately 7-8% of patients). 3, 5 However, serious adverse events are rare, and discontinuation rates are similar to placebo. 5, 7

Special Populations

For patients with multiple recurrences (≥2 episodes), continue the same weight-based dosing but extend duration to at least 6 months. 1, 5 This longer course reduces recurrence risk from 42.5% to 21.6% in patients with multiple prior episodes. 5