From the Guidelines
NSAIDs are the first-line treatment for pericarditis, with ibuprofen typically recommended at doses of 600-800mg three times daily for 1-2 weeks, followed by a gradual taper over 2-4 weeks, as supported by the 2015 ESC guidelines 1. The choice of NSAID should be based on the patient's history, concomitant diseases, and physician expertise. Aspirin (750-1000mg three times daily) is preferred for patients who are already on antiplatelet therapy or have coronary artery disease. Colchicine is often added to NSAIDs (0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg) for 3-6 months to improve outcomes and prevent recurrence, as recommended by the 2015 ESC guidelines 1. Some key points to consider when using NSAIDs for pericarditis include:
- Monitoring for NSAID side effects, including gastrointestinal bleeding, renal dysfunction, and cardiovascular complications
- Using a proton pump inhibitor like omeprazole 20mg daily to protect the stomach
- Tapering NSAIDs gradually over 2-4 weeks to minimize the risk of recurrence
- Considering colchicine therapy for longer durations (> 6 months) in some cases, according to clinical response, as suggested by the 2015 ESC guidelines 1
- Restricting physical activity until resolution of symptoms and normalization of CRP, especially for athletes, as recommended by the 2015 ESC guidelines 1 and the American Heart Association 1.
From the Research
NSAlD for Pericarditis
- Non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for acute and recurrent pericarditis, especially for viral and idiopathic cases 2.
- Aspirin and NSAIDs are often used as the first line of treatment, with colchicine as a possible adjunct, especially for recurrences 2, 3.
- The treatment should be individualized, with the goal of providing full daily control of symptoms and achieving remission and C-reactive protein normalization, followed by tapering 2.
- NSAIDs are effective in reducing the frequency of pericarditis recurrences, with a mean frequency per month of 0.69 (± 0.40) with aspirin/NSAIDs and colchicine 4.
- However, some patients may not respond to NSAIDs and may require second-line treatment, such as corticosteroids or immunosuppressive agents 4, 5.
Comparison of Treatment Options
- A study compared the efficacy of colchicine monotherapy to NSAID monotherapy or combination therapy for the prevention of recurrent pericarditis in patients with heart failure with reduced ejection fraction and/or coronary artery disease, and found no significant difference in the primary outcome between groups 6.
- Another study found that corticosteroids at low doses did not act as an independent risk factor for recurrences and may be considered a successful and safe treatment for acute and recurrent idiopathic pericarditis 5.
Treatment Considerations
- The choice of treatment should take into account the patient's underlying medical conditions, such as systemic autoimmune diseases, postpericardiotomy syndrome, and pregnancy 2.
- The treatment should be tailored to the individual patient's needs, with the goal of achieving remission and preventing recurrences 2, 3.
- The use of corticosteroids and immunosuppressive agents should be considered in patients who do not respond to NSAIDs or have recurrent pericarditis 4, 5.