From the Guidelines
Colchicine is recommended for both acute and recurrent pericarditis, with a dose of 0.5 mg twice daily (or 0.5 mg once daily for patients <70 kg or with renal impairment) for 3 months in acute pericarditis and 6 months in recurrent pericarditis, alongside NSAIDs like ibuprofen or aspirin. The use of colchicine in pericarditis is supported by the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1.
Key Points
- Colchicine works by inhibiting microtubule assembly and leukocyte function, thereby reducing inflammation in the pericardium.
- It decreases recurrence rates by approximately 50% when added to conventional therapy.
- Common side effects include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain, which occur in about 10-15% of patients.
- Dose reduction may help manage these side effects.
- Colchicine should be avoided in patients with severe renal or hepatic impairment and used cautiously with certain medications like statins and macrolide antibiotics due to potential interactions.
- Blood counts and liver function should be monitored periodically during treatment.
Recommendations
- For acute pericarditis, colchicine should be given at a dose of 0.5-0.6 mg twice daily (or 0.5 mg once daily for patients <70 kg or with renal impairment) for 3 months, alongside NSAIDs like ibuprofen or aspirin.
- For recurrent pericarditis, the same dosing is recommended but for a longer duration of 6 months.
- Colchicine should be used as an adjunct to aspirin/NSAIDs therapy, without a loading dose and using weight-adjusted doses, to improve the response to medical therapy, improve remission rates, and prevent recurrences 1.
Monitoring and Precautions
- CRP should be considered to guide the treatment duration and assess the response to therapy 1.
- Exercise restriction should be considered for non-athletes with recurrent pericarditis until symptom resolution and CRP normalization, taking into account the previous history and clinical conditions 1.
- Athletes are recommended to return to competitive sports only after symptoms have resolved and diagnostic tests (i.e. CRP, ECG, and echocardiogram) have been normalized 1.
From the Research
Colchicine for Pericarditis
- Colchicine has been suggested to be beneficial in preventing recurrent pericarditis 2
- Empiric anti-inflammatory therapy for acute and recurrent pericarditis is warranted for viral and idiopathic cases, with colchicine as a possible adjunct to aspirin and non-steroidal anti-inflammatory drugs (NSAID) 3
- Colchicine reduces episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up, with a number needed to treat (NNT) of 4 2
- Colchicine also reduces recurrence in people with acute pericarditis, with moderate quality evidence 2
Efficacy and Safety
- Colchicine led to a greater chance of symptom relief at 72 hours, with low quality evidence 2
- Adverse effects of colchicine were mainly gastrointestinal, including abdominal pain and diarrhoea, with no statistically significant difference between the treatment groups 2
- Colchicine was generally well tolerated with a low incidence of adverse events 4
- There was moderate quality evidence that treatment with colchicine led to more people stopping treatment due to adverse events 2
Clinical Use
- Colchicine may be an effective substitute in steroid-dependent recurrent pericarditis, avoiding the frequent and severe side effects of corticosteroid therapy 5
- Colchicine, as an adjunct to aspirin or NSAIDs, is effective in the prevention of recurrent pericarditis and in the management of acute symptoms 4
- Colchicine plus NSAIDs significantly reduced recurrence and treatment failure in patients with acute episode of idiopathic pericarditis, with no differences in adverse events between colchicine and placebo 6