Initial treatment of acute pericarditis in adults
NSAIDs: nonsteroidal anti-inflammatory drugs.
* NSAIDs are the preferred anti-inflammatory for nearly all patients with acute idiopathic or viral pericarditis. Glucocorticoids should be used for initial treatment of acute pericarditis only in patients with contraindications to NSAIDs, or for specific indications (ie, systemic inflammatory diseases, pregnancy, renal failure), and should be used at the lowest effective dose. Refer to the UpToDate topic on treatment of acute pericarditis for glucocorticoid dosing information.
¶ Response to treatment includes improvement/resolution of symptoms within one to two weeks of initiation of therapy and normalization of C-reactive protein level (if measured).
Δ Refer to UpToDate content on recurrent/refractory pericarditis for therapeutic approach to patients who are not showing clinical improvement.
Drug therapy in acute and recurrent pericarditis for adult patients
|
Drug |
Anti-inflammatory dose |
Duration of therapy* (anti-inflammatory dose) |
Tapering* |
|
For initial combination treatment of most patients: |
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|
Aspirin¶ |
650 to 1000 mg orally three times daily |
One to two weeks |
Weekly decrease once patient is symptom-free and CRP has normalized |
|
OR |
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|
Ibuprofen¶ |
600 to 800 mg orally three times dailyΔ |
One to two weeks |
Weekly decrease once patient is symptom-free and CRP has normalized |
|
OR |
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|
Indomethacin¶ |
25 to 50 mg orally three times daily |
One to two weeks |
Weekly decrease once patient is symptom-free and CRP has normalized |
|
PLUS |
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|
Colchicineפ |
0.5 to 0.6 mg orally two times daily |
Three months (acute) Six months or longer (recurrent) |
Usually not tapered¥ |
|
For initial combination therapy of patients following myocardial infarction: |
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|
Aspirin¶ |
650 to 1000 mg orally three times daily |
One to two weeks |
Weekly decrease once patient is symptom-free and CRP has normalized |
|
PLUS |
|||
|
Colchicineפ |
0.5 to 0.6 mg orally two times daily |
Three months (acute) Six months or longer (recurrent) |
Usually not tapered¥ |
|
For refractory cases or patients with a contraindication to NSAID therapy: |
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|
Prednisone |
0.2 to 0.5 mg/kg/day |
Two weeks (acute) Two to four weeks (recurrent) |
Gradual tapering over three months; refer to UpToDate topic review of treatment of acute pericarditis, section on glucocorticoids |
|
PLUS |
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|
Colchicineפ |
0.5 to 0.6 mg orally two times daily |
Three months |
Usually not tapered¥ |
CRP: C-reactive protein; NSAID: nonsteroidal anti-inflammatory drug.
* Duration and tapering of therapy (except colchicine) should be tailored according to resolution of symptoms and normalization of markers of inflammation; refer to topic reviews for approach.
¶ Proton pump inhibitor (eg, omeprazole) gastrointestinal protection may be indicated.
Δ Some patients may require ibuprofen every six hours (four times daily), in which case the dose should not exceed 600 mg every six hours.
◊ 0.5 mg colchicine is not available in the US. It is widely available elsewhere.
§ Colchicine dose should be reduced to 0.5 to 0.6 mg once daily in patients <70 kg.
¥ The duration of colchicine therapy for recurrent or refractory pericarditis is at least six months.
Data from:
Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med 2004; 351:2195.
Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial disease: The task force on the diagnosis and management of pericardial disease of the European Society of Cardiology. European Heart Journal 2004; 25:587.
Imazio M, Brucato A, Trinchero R, et al. Individualized therapy for pericarditis. Expert Rev Cardiovasc Ther 2009; 7:965.
REF. UpToDate 2019.08.20
