What is the recommended dose of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for pericarditis?

From the Guidelines

For pericarditis, high-dose NSAIDs are the first-line treatment, with ibuprofen typically recommended at 600 mg every 8 hours (range 1200-2400 mg daily) and aspirin at 500-1000 mg every 6-8 hours (range 1.5-4 g/day). The treatment duration is usually weeks to months, with a tapering schedule to minimize side effects and prevent recurrences 1.

Key Considerations

• Ibuprofen and aspirin are commonly used NSAIDs for pericarditis, with dosages adjusted based on patient response and tolerance.
• Indomethacin is another option, but its use is often limited by side effects such as headache and dizziness, and the dosage should be started at the lower end of the range (25-50 mg every 8 hours) and titrated upward as needed 1.
• Colchicine can be added to the NSAID regimen for recurrent or resistant cases, with a typical dosage of 0.5 mg twice daily for patients weighing 70 kg or more, and 0.5 mg daily for patients weighing less than 70 kg 1.
• Gastric protection with a proton pump inhibitor like omeprazole 20-40 mg daily is often recommended to prevent gastrointestinal side effects associated with NSAID use.
• Treatment should continue until complete resolution of symptoms and normalization of inflammatory markers (CRP), typically 2-4 weeks total, with gradual tapering of NSAIDs over 1-2 weeks to minimize the risk of recurrence 1.

Special Considerations

• Patients with gastrointestinal, renal, or cardiovascular comorbidities may require alternative treatments or dose adjustments under close monitoring.
• Corticosteroids can be used in cases where NSAIDs are contraindicated or ineffective, but their use should be minimized due to the risk of side effects and recurrences, and tapering should be done slowly and carefully to avoid triggering or worsening an episode of pericarditis 1.

From the Research

NSAID Dose for Pericarditis

• The optimal dose of NSAIDs for pericarditis is not explicitly stated in the provided studies, but it is mentioned that high-dose NSAIDs are used to treat acute idiopathic and pericarditis after cardiac procedures or operations 2.
• The dose of NSAIDs should be tapered once chest pain has resolved and C-reactive protein level has normalized, typically over several weeks 2.
• Aspirin and NSAIDs are the mainstay of therapy for acute and recurrent pericarditis, with the possible adjunct of colchicine, especially for recurrences 3.
• The choice of NSAID should be dictated by comorbid conditions, tolerability, and adverse effects, with aspirin being the drug of choice in patients with coronary artery disease, heart failure, or renal disease 4.

Specific NSAIDs and Their Uses

• Aspirin (ASA) is the drug of choice in patients with coronary artery disease (CAD), heart failure (HF), or renal disease, but should be avoided in patients with asthma and nasal polyps, who are naïve to ASA therapy 4.
• Ibuprofen is an inexpensive and relatively accessible option in patients who do not have concomitant CAD, HF, or renal disease 4.
• Indometacin is not available over-the-counter in the USA, and has a relatively higher incidence of central nervous system (CNS) adverse effects 4.
• Ketorolac is an intravenous option; however, clinicians must be mindful of the maximum dose that can be administered 4.

Treatment Duration and Monitoring

• Treatment with NSAIDs and colchicine should be continued for several weeks, with monitoring of C-reactive protein levels and tapering of the dose once chest pain has resolved and C-reactive protein level has normalized 2, 4.
• High-sensitivity C-reactive protein-guided therapy may be used to monitor treatment response and adjust the dose of NSAIDs accordingly 5.