What is the dose of Colchicine (colchicine) for pericardial effusion?

From the Guidelines

Colchicine for pericardial effusion is typically dosed at 0.5 mg twice daily for patients over 70 kg, and 0.5 mg once daily for patients under 70 kg or those with gastrointestinal intolerance, as an adjunct to aspirin/NSAIDs therapy for 3 months. The recommended dose is based on the most recent and highest quality study, which suggests that colchicine should be used at a low, weight-adjusted dose to improve the response to medical therapy and prevent recurrences 1.

Key Considerations

• Treatment duration generally ranges from 3-6 months total, though this may be extended in recurrent cases.
• Dose adjustment is necessary for patients with renal or hepatic impairment.
• Common side effects include diarrhea, nausea, and abdominal pain, which may require dose reduction.
• Colchicine works by inhibiting neutrophil migration and activity, reducing inflammation in the pericardium, and has been shown to decrease recurrence rates when used alongside standard anti-inflammatory therapy.
• It should be avoided in patients with severe renal or hepatic disease and those taking strong CYP3A4 inhibitors or P-glycoprotein inhibitors.

Evidence-Based Recommendations

• The European Society of Cardiology (ESC) guidelines recommend colchicine as first-line therapy for acute pericarditis as an adjunct to aspirin/NSAIDs therapy, with a recommended dose of 0.5 mg twice or once daily for patients under 70 kg or intolerant to higher doses 1.
• The guidelines also recommend against the use of corticosteroids as first-line therapy for acute pericarditis, due to the risk of favoring the chronic evolution of the disease and promoting drug dependence 1.

Clinical Implications

• Colchicine should be used with caution in patients with a history of gastrointestinal intolerance or renal/hepatic impairment.
• Patients should be monitored for signs of toxicity, including diarrhea, nausea, and abdominal pain, and the dose should be adjusted accordingly.
• The use of colchicine in combination with aspirin/NSAIDs therapy has been shown to be effective in reducing recurrence rates and improving outcomes in patients with pericardial effusion 1.

From the Research

Colchicine Dosage for Pericardial Effusion

• The dosage of colchicine for pericardial effusion varies across studies, with reported dosages including 1 mg/day 2 and 2 mg/day for the first month, followed by 1 mg/day for a further 5 months 3.
• In the treatment of acute and recurrent pericarditis, colchicine is often used concomitantly with non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line approach, particularly in severely symptomatic cases 4.
• Colchicine should be used in all refractory cases and as initial therapy in all recurrences, with a dosage that may need to be adjusted based on the individual patient's response and tolerance to the medication.

Efficacy and Safety of Colchicine

• Colchicine has been shown to be effective in the treatment of large pericardial effusion when therapy with nonsteroidal anti-inflammatory drugs and/or corticosteroids fails 2, 3.
• The use of colchicine is associated with a good safety profile, although gastrointestinal intolerance is a common side effect that may lead to treatment withdrawal in some cases 5.
• Colchicine has been established as a first-line medication in the treatment of acute and recurrent pericarditis, as well as for the prevention of postpericardiotomy syndrome 5.