What is the recommended colchicine (Colchicine) dosing regimen for chronic pericarditis?

Colchicine Dosing for Chronic Pericarditis

For chronic/recurrent pericarditis, use weight-adjusted colchicine dosing: 0.5 mg once daily if body weight <70 kg or 0.5 mg twice daily if ≥70 kg, continued for at least 6 months without a loading dose. 1

Dosing Regimen

Weight-Based Dosing

• Patients <70 kg: 0.5 mg once daily 1, 2
• Patients ≥70 kg: 0.5 mg twice daily 1, 2
• No loading dose should be used for recurrent/chronic pericarditis (unlike acute pericarditis where loading may be considered) 1

Treatment Duration

• Minimum duration: 6 months for recurrent pericarditis 1
• Continue treatment until complete symptom resolution and inflammatory marker normalization 3
• In the most difficult, resistant cases, gradual discontinuation may take several months 1

Combination Therapy

Colchicine should always be added on top of standard anti-inflammatory therapy (aspirin or NSAIDs), not used as monotherapy. 1

• Aspirin: 500-1000 mg every 6-8 hours (range 1.5-4 g/day) 1
• Ibuprofen: 600 mg every 8 hours (range 1200-2400 mg/day) 1
• Taper NSAIDs by 250-500 mg (aspirin) or 200-400 mg (ibuprofen) every 1-2 weeks once symptoms resolve 1

Evidence for Efficacy

The CORP trial demonstrated robust efficacy in recurrent pericarditis, showing colchicine reduced recurrence rates from 55% to 24% at 18 months (absolute risk reduction 31%, NNT=3). 4, 5 This represents a 56% relative risk reduction. 5 Meta-analysis confirms colchicine approximately halves the recurrence rate in patients with recurrent pericarditis. 1, 6

Tapering Strategy

When discontinuing therapy after achieving complete response, taper one drug class at a time before gradually stopping colchicine. 1

• First taper and discontinue NSAIDs/aspirin over weeks to months 1
• Then gradually discontinue colchicine last, potentially over several months in resistant cases 1
• Alternative final taper: 0.5 mg every other day for patients <70 kg 1

Critical Thresholds and Pitfalls

Corticosteroid Management

If corticosteroids are necessary (contraindication to NSAIDs, autoimmune disease, pregnancy), use low to moderate doses only (prednisone 0.2-0.5 mg/kg/day) as triple therapy with NSAIDs and colchicine. 1 Corticosteroids favor chronicity and more recurrences despite providing rapid symptom control. 1

Critical tapering threshold: When prednisone reaches 10-15 mg/day, use very slow decrements of only 1.0-2.5 mg at intervals of 2-6 weeks. 1 This is where most recurrences occur if tapering is too rapid.

Common Pitfalls to Avoid

• Never use colchicine as monotherapy - it must be combined with NSAIDs/aspirin 1
• Never stop treatment before 6 months minimum duration - inadequate treatment duration is a common cause of recurrence 1
• Never increase corticosteroid doses or reinstate them if recurrence occurs - every effort should be made to manage recurrences with NSAIDs and colchicine alone 1
• Never use loading doses for recurrent pericarditis (loading is only for acute first episodes) 1

Monitoring

• Use CRP levels to guide treatment length and assess response 3, 2
• Continue therapy until complete symptom resolution AND CRP normalization 2
• Monitor for gastrointestinal side effects (abdominal pain, diarrhea), which are the most common adverse effects 4, 5

Safety Profile

Colchicine has similar rates of side effects (7%) and drug withdrawal (8% vs 5%) compared to placebo in recurrent pericarditis. 4 Gastrointestinal intolerance is the main side effect, but no severe adverse events occurred in major trials. 4, 5