Pericarditis

Author: Chris Bond, MD
Updated: 1/6/2015

Pericarditis

Diagnosis

2 of 4 Criteria Required

  1. Classic chest pain history – Sharp, pleuritic, and positional (improved by sitting up and leaning forward) and pain radiating to trapezius ridge
  2. Pericardial friction rub
  3. Pericardial effusion on echocardiogram or ED bedside ultrasound
  4. Characteristic ECG changes

3-Part Treatment

  1. NSAID or Aspirin
  2. Taper dose over 3-4 weeks

  3. No definite correct medication or dosing regimen has been established.

  4. Colchicine

  5. If >70 kg, 0.6 mg orally twice daily for 3 months
  6. If <70 kg, 0.6 mg orally daily for 3 months
  7. If diarrhea intractable, decrease dose to once daily for >70 kg or stop for <70 kg

  8. Note: Some countries have 0.5 mg tabs only

  9. Proton pump inhibitor once daily for 3 months

Note: Steroids should be avoided in all cases except refractory cases and neoplastic/autoimmune causes. Steroids are an independent risk for increased recurrence of pericarditis. Expert consultation strongly recommended if prescribing.

Contraindications to Colchicine

  • Tuberculous, purulent or neoplastic pericarditis
  • Severe liver disease or aminotransferase levels ≥1.5x upper limits of normal
  • Serum creatinine >2.5 mg/dL (>221 umol/L)
  • Skeletal myopathy or CK > upper limits of normal
  • Blood dyscrasia
  • Inflammatory bowel disease
  • Life expectancy ≤18 months
  • Pregnancy or lactation
  • Women of childbearing potential not using contraception
  • Hypersensitivity to colchicine or other contraindication to its use

Cost of Colchicine per Pill

  • Canada/ Europe: ~ $0.50-1.00
  • USA: Up to $5 per pill

References

  • Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2013;369(16):1522-8. [PubMed]
  • Imazio M, Bobbio M, Cecchi E, et al. Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial. Arch Intern Med. 2005;165(17):1987-91. [PubMed]
  • Imazio M, Cecchi E, Demichelis B, et al. Indicators of poor prognosis of acute pericarditis. Circulation. 2007;115(21):2739-44. [PubMed]