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 as adjunctive therapy to NSAIDs or aspirin. 1
Weight-Based Dosing Algorithm
The dosing is straightforward and based solely on body weight:
This weight-adjusted approach is recommended by the European Society of Cardiology guidelines and applies to both acute and recurrent pericarditis. 1
Treatment Duration
The standard treatment duration is 3 months for acute pericarditis. 1, 2
For recurrent pericarditis, colchicine should be continued for at least 6 months without a loading dose. 1
Critical Implementation Details
Colchicine must be added to NSAIDs or aspirin—it is not monotherapy. 1, 2 The combination of colchicine with aspirin (750-1000 mg every 8 hours) or ibuprofen (600 mg every 8 hours) represents first-line therapy with Class I, Level A evidence. 1
Tapering of colchicine is not mandatory but may be considered in the final weeks by reducing to 0.5 mg every other day for patients <70 kg or 0.5 mg once daily for patients ≥70 kg. 1
Evidence Supporting This Dosing
The efficacy of this weight-adjusted dosing strategy is robust:
- Colchicine reduces recurrence rates from 32-55% to 11-24% in patients with acute or recurrent pericarditis, with a number needed to treat of 3-5. 3, 4, 5, 6
- Meta-analysis demonstrates a 54% relative risk reduction in recurrent pericarditis (RR 0.46,95% CI 0.36-0.58). 7
- Symptom persistence at 72 hours is reduced by 56% with colchicine therapy. 4, 6
Monitoring and Duration Guidance
Use C-reactive protein (CRP) to guide treatment length and assess response. 1, 2 Treatment should continue until complete symptom resolution and CRP normalization. 8
Do not discontinue therapy prematurely—inadequate treatment of the first episode is a common cause of recurrence. 2
Safety Profile
Gastrointestinal intolerance is the primary side effect, occurring in approximately 8-12% of patients, with drug discontinuation rates of 8-11%. 3, 4, 5, 6 No serious adverse events have been reported in major trials. 5, 6
The adverse effect rate is slightly higher than placebo (12.5% vs 8.5%, RR 1.45), but the clinical benefit far outweighs this modest increase in side effects. 7
Special Considerations
For post-operative pericarditis (post-pericardiotomy syndrome), the same weight-based dosing applies, but colchicine should only be initiated when systemic inflammation is confirmed—it is not recommended for asymptomatic postoperative effusions. 8
Avoid corticosteroids as first-line therapy as they increase the risk of chronicity, recurrence, and drug dependence. 1, 2 Corticosteroids are reserved for patients with contraindications to NSAIDs/colchicine or treatment failure. 1