Aspirin Dosing for Pericarditis
The recommended dose of aspirin for acute pericarditis is 750-1000 mg every 8 hours (total daily dose 2250-3000 mg) for 1-2 weeks, with gradual tapering thereafter. 1
Initial Dosing Regimen
- Aspirin 750-1000 mg every 8 hours is the Class I, Level A recommendation from the European Society of Cardiology for first-line therapy of acute pericarditis 1, 2
- This high-dose regimen (2250-3000 mg/day total) ensures full daily control of symptoms and inflammatory response 3
- Always provide gastroprotection (e.g., proton pump inhibitor) when prescribing aspirin at these doses 1, 2
- Treatment duration should be 1-2 weeks initially, guided by symptom resolution and C-reactive protein (CRP) normalization 1, 2
Tapering Protocol
- Begin tapering only after complete symptom resolution and CRP normalization 1, 2
- Decrease doses by 250-500 mg every 1-2 weeks 1
- Premature tapering before inflammatory markers normalize is a common pitfall that increases recurrence risk 2, 4
Mandatory Adjunctive Therapy
- Colchicine must be added to aspirin as part of first-line therapy (Class I, Level A recommendation) 1, 2
- Colchicine dosing: 0.5 mg once daily if <70 kg or 0.5 mg twice daily if ≥70 kg 1, 2
- Continue colchicine for 3 months to prevent recurrences 1, 2
- Without colchicine, recurrence rates are 15-30% after the first episode, increasing to 50% after the first recurrence 2
Monitoring and Treatment Duration
- Use CRP levels to guide treatment length and assess therapeutic response 1, 2
- Continue the full dose until both symptoms resolve AND CRP normalizes 1, 3
- Total treatment duration (including tapering) typically spans 4-6 weeks for uncomplicated cases 1
Special Considerations
When to Choose Aspirin Over Other NSAIDs
- Favor aspirin when the patient already requires antiplatelet therapy for cardiovascular disease 1
- Base the choice on patient history, contraindications, previous efficacy/side effects, and concomitant diseases 1
- Ibuprofen 600 mg every 8 hours is an equally acceptable alternative if aspirin is not preferred 1, 2
Pregnancy
- Aspirin 800 mg three times daily (2400 mg/day total) has been used safely in pregnant women with pericarditis 5
- In pregnancy, aspirin should be gradually stopped at 20 weeks gestation to avoid complications, with low-dose prednisone as an alternative 5
Common Pitfalls to Avoid
- Inadequate treatment of the first episode is the most common cause of recurrence 2, 4
- Stopping treatment too early before CRP normalization leads to relapse 2, 4
- Failing to add colchicine to aspirin therapy significantly increases recurrence risk 2, 4
- Using corticosteroids as first-line therapy instead of aspirin/NSAIDs increases risk of chronicity and drug dependence 1, 2
When Aspirin Fails or Is Contraindicated
- Low-dose corticosteroids (prednisone 0.2-0.5 mg/kg/day) should be considered only after aspirin/NSAID failure or when contraindicated 1, 2
- Corticosteroids are second-line because they promote chronic evolution and recurrence 1, 2
- For refractory recurrent cases, consider immunomodulatory agents (IVIG, anakinra, azathioprine) 6, 7, 8