What is the recommended dose of ibuprofen (Non-Steroidal Anti-Inflammatory Drug (NSAID)) for treating pericarditis?

Ibuprofen Dosing for Pericarditis

For pericarditis, ibuprofen should be dosed at 600 mg every 8 hours (total daily dose 1800 mg), with a range of 1200-2400 mg per day depending on symptom severity, continued for weeks to months until symptoms resolve and C-reactive protein normalizes. 1

Initial Dosing Strategy

• Start with 600 mg every 8 hours as the standard initial dose 1, 2
• The total daily dose range is 1200-2400 mg per day, allowing titration based on symptom control 1
• Always provide gastroprotection (proton pump inhibitor) when using ibuprofen for pericarditis 2
• Colchicine must be added to ibuprofen as first-line combination therapy: 0.5 mg twice daily if ≥70 kg or 0.5 mg once daily if <70 kg 1, 2

Treatment Duration and Monitoring

• Continue ibuprofen for weeks to months until complete symptom resolution and CRP normalization 1
• Monitor CRP levels to guide treatment duration and assess therapeutic response 2
• Treatment should be continued until both symptoms are absent AND inflammatory markers normalize before attempting any taper 1

Tapering Protocol

• Decrease doses by 200-400 mg every 1-2 weeks once symptoms resolve and CRP normalizes 1
• Longer tapering periods may be necessary for more difficult or resistant cases 1
• Only attempt tapering when the patient is completely asymptomatic and CRP is normal 1
• Taper one drug class at a time before discontinuing colchicine (which should continue for at least 3-6 months) 1, 3, 4

Critical Caveats and Pitfalls

• Inadequate treatment of the first episode is the most common cause of recurrence 2
• Premature tapering or discontinuation before complete resolution leads to recurrence rates of 15-30% even with colchicine 2, 4
• Avoid ibuprofen in patients on oral anticoagulants due to high bleeding risk; use low-dose corticosteroids (prednisone 0.2-0.5 mg/kg/day) instead 1, 5
• Do not use ibuprofen in patients with recent peptic ulcer, gastrointestinal bleeding, or true NSAID allergy 1
• Never use corticosteroids as first-line therapy as they promote chronicity, increase recurrence rates, and cause more side effects 1, 2

When Ibuprofen Fails

• If inadequate response after 7 days of ibuprofen plus colchicine, consider adding low-dose corticosteroids (prednisone 0.2-0.5 mg/kg/day) as triple therapy rather than replacing the NSAID 1
• For multiple recurrences refractory to NSAIDs, colchicine, and corticosteroids, consider IL-1 blockers (anakinra, rilonacept) as third-line therapy 3, 4

Special Populations

• Exercise restriction should be maintained until symptoms resolve and CRP, ECG, and echocardiogram normalize; athletes require at least 3 months of restriction 2
• For autoimmune-related pericarditis (e.g., lupus), the same ibuprofen dosing applies, though these patients have intermediate risk (2-5%) for developing constrictive pericarditis compared to <1% for idiopathic cases 6