What is the recommended dosing of colchicine (Colchicine) for recurrent pericarditis?

Colchicine Dosing for Recurrent Pericarditis

For recurrent pericarditis, colchicine should be dosed at 0.5 mg twice daily for patients ≥70 kg or 0.5 mg once daily for patients <70 kg, continued for at least 6 months as adjunctive therapy to aspirin or NSAIDs. 1, 2

Weight-Based Dosing Regimen

The European Society of Cardiology provides clear weight-adjusted dosing recommendations:

• Patients ≥70 kg: 0.5 mg twice daily 1, 2
• Patients <70 kg: 0.5 mg once daily 1, 2
• Intolerant patients: 0.5 mg once daily regardless of weight 1

This dosing differs from older trials that used loading doses (1.0-2.0 mg on day 1) followed by maintenance dosing 3, 4, but current guidelines favor the simpler weight-based approach without loading doses. 2

Treatment Duration

The minimum treatment duration is 6 months for recurrent pericarditis. 1, 2 However, longer durations should be considered based on clinical response, particularly in patients with multiple recurrences. 1

• Standard duration: 6 months minimum 1, 2
• Extended therapy: Consider >6 months for difficult cases with multiple recurrences 1
• Discontinuation: Only after achieving complete symptom resolution and CRP normalization 1, 5

Critical Context: Combination Therapy Required

Colchicine must never be used as monotherapy—it should always be added to aspirin or NSAIDs, not replace them. 2, 5, 6 This is a Class I, Level A recommendation from the European Society of Cardiology. 1

The first-line regimen for recurrent pericarditis consists of:

• Aspirin 500-1000 mg every 6-8 hours OR Ibuprofen 600 mg every 8 hours 2, 5, 6
• Plus colchicine at weight-adjusted doses 1, 2
• Plus gastroprotection with all NSAID regimens 5, 6

Evidence for Efficacy

The dosing recommendations are supported by robust randomized controlled trial data showing substantial benefit:

• The CORP-2 trial demonstrated that colchicine 0.5 mg twice daily (for patients >70 kg) reduced recurrence rates from 42.5% to 21.6% in patients with multiple recurrences (relative risk 0.49, p=0.0009, NNT=5). 7
• The CORP trial showed colchicine reduced recurrence rates from 55% to 24% at 18 months, representing a 56% relative risk reduction (NNT=3). 2, 3
• These trials used the same weight-based dosing now recommended in guidelines. 7

Tapering Strategy

When discontinuing therapy after achieving complete response:

• Taper one drug class at a time—never stop all medications simultaneously 1, 5
• Colchicine should be tapered last, after NSAIDs have been successfully discontinued 5
• Only taper when patient is asymptomatic AND CRP is normalized 1, 5
• For difficult cases, colchicine can be gradually tapered over several months 5

Common Pitfalls to Avoid

Do not use loading doses in routine practice—while older trials used 1.0-2.0 mg loading doses 3, 4, current guidelines recommend starting directly with maintenance dosing. 1, 2

Do not stop colchicine prematurely—the full 6-month course is essential even if symptoms resolve earlier, as premature discontinuation increases recurrence risk. 1, 2

Do not use colchicine alone—it must be combined with NSAIDs or aspirin for optimal efficacy. 2, 5, 6

Safety Profile

Colchicine is generally well-tolerated at these doses:

• Gastrointestinal intolerance is the most common side effect (approximately 7-10% of patients) 3, 7
• Serious adverse events are rare 3, 7
• Drug discontinuation rates are similar to placebo (5-8%) 3, 7

Monitoring

Use CRP levels to guide treatment duration and assess therapeutic response. 1, 2, 5 Continue therapy until CRP normalizes, and only attempt tapering when both symptoms and CRP have resolved. 1, 5