From the Guidelines
The treatment of pericarditis should start with aspirin or NSAIDs, followed by the addition of colchicine, and corticosteroids should be considered as a second option in patients with contraindications or failure of first-line therapy. The initial treatment approach typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin for 1-2 weeks, then tapered over 2-4 weeks 1. Colchicine is often added to improve the response to medical therapy and prevent recurrences, with a recommended dose of 0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg, for 3-6 months 1.
Some key points to consider in the treatment of pericarditis include:
- The choice of NSAID should be based on the patient's history, concomitant diseases, and physician expertise 1
- Gastric protection with a proton pump inhibitor like omeprazole is recommended when using NSAIDs
- Corticosteroids should be used with caution and at low to moderate doses, as they can favour the chronic evolution of the disease and promote drug dependence 1
- Rest and activity restriction, particularly avoiding strenuous physical activity until symptoms resolve and inflammatory markers normalize, is important to prevent complications 1
In terms of specific treatment regimens, the following can be considered:
- Aspirin 600-800mg three times daily or indomethacin 25-50mg three times daily for 1-2 weeks, then tapered over 2-4 weeks
- Colchicine 0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg, for 3-6 months
- Corticosteroids like prednisone 0.25-0.5mg/kg/day may be used in patients with refractory symptoms or contraindications to NSAIDs, but should be tapered slowly to avoid recurrence 1.
From the Research
Treatments for Pericarditis
The following are some treatments that are commonly used for pericarditis:
- Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) as the mainstay of therapy 2, 3, 4, 5
- Colchicine, especially for recurrences 2, 6, 4, 5
- Corticosteroids as a second choice for difficult cases requiring multi-drug therapies and specific medical conditions 2, 3
Treatment Approach
The treatment approach for pericarditis should be individualized, with the goal of providing full daily control of symptoms and achieving remission and C-reactive protein normalization 2. The use of colchicine and NSAIDs, with or without aspirin, is considered first-line therapy for acute and recurrent pericarditis 4, 5.
Efficacy of Treatments
Studies have shown that:
- Colchicine reduces episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up 6
- Colchicine reduces recurrence in people with acute pericarditis at 18 months follow-up 6
- Anti-interleukin-1 agents (anakinra, rilonacept) are effective in reducing recurrences in case of recurrent pericarditis refractory to conventional drugs 5