From the Guidelines
NSAIDs and colchicine are used in acute pericarditis because they effectively target the underlying inflammation causing the condition, as recommended by the 2015 ESC guidelines 1.
Key Points
- NSAIDs like ibuprofen, indomethacin, or aspirin serve as first-line therapy by inhibiting cyclooxygenase enzymes, reducing prostaglandin production, and decreasing inflammation and pain.
- Colchicine is added to NSAIDs to enhance treatment efficacy, reduce recurrence rates, and shorten symptom duration, as it disrupts microtubule assembly in inflammatory cells and inhibits the NLRP3 inflammasome pathway.
- The recommended dosing for NSAIDs includes:
- Aspirin: 750-1000mg three times daily
- Ibuprofen: 600-800mg three times daily
- Indomethacin: 25-50mg three times daily
- Colchicine is typically dosed at 0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg.
Treatment Duration and Monitoring
- NSAIDs are typically continued at full doses until symptoms resolve and CRP normalizes (usually 1-2 weeks), followed by a gradual taper over 2-4 weeks.
- Colchicine is continued for 3 months in first episodes and 6 months for recurrences.
- Patients with gastrointestinal issues, renal impairment, or bleeding risks may require gastroprotection with proton pump inhibitors or alternative anti-inflammatory approaches.
- Treatment should be adjusted based on clinical response, with close monitoring for symptom improvement and inflammatory marker normalization, as guided by CRP levels 1.
From the Research
Treatment of Acute Pericarditis
- NSAIDs and colchicine are used in the treatment of acute pericarditis due to their anti-inflammatory properties 2, 3, 4, 5, 6.
- Aspirin and NSAIDs are the mainstay of therapy, with colchicine often used as an adjunctive treatment to prevent recurrences 2, 6.
- The use of colchicine in addition to NSAIDs has been shown to reduce the risk of recurrent pericarditis 4, 5.
Mechanism of Action
- NSAIDs work by inhibiting the production of prostaglandins, which are involved in the inflammatory process 6.
- Colchicine works by inhibiting microtubule polymerization, which reduces the migration of white blood cells to the site of inflammation 5.
Clinical Evidence
- Studies have shown that the combination of NSAIDs and colchicine is effective in reducing the risk of recurrent pericarditis 4, 5.
- A systematic review and meta-analysis found that colchicine reduced the risk of recurrent pericarditis by 50% compared to standard treatment 4.
- Another study found that the use of colchicine in addition to NSAIDs reduced the risk of recurrent pericarditis by 63% at 18 months follow-up 5.
Treatment Guidelines
- The treatment of acute pericarditis should be individualized, with the goal of providing full daily control of symptoms and preventing recurrences 2.
- NSAIDs and colchicine should be used in combination, with the dose of NSAIDs tapered accordingly to minimize side effects 6.
- The choice of NSAID should be dictated by comorbid conditions, tolerability, and adverse effects 6.