Version May 2024
| Drug | Antiinflammatory dose | Duration of initial or maintenance dose* | Tapering regimen¶ |
| First-line therapy for most patients:Δ | |||
| Aspirin◊ | 650 to 1000 mg orally 3 times daily | 1 to 2 weeks | Decrease dose by about 250 mg per week |
| or | |||
| Ibuprofen◊ | 600 to 800 mg orally 3 times daily§ | 1 to 2 weeks | Decrease dose by 200 mg per week |
| or | |||
| Indomethacin◊ | 25 to 50 mg orally 3 times daily | 1 to 2 weeks | Decrease dose by 25 mg per week |
| plus | |||
| Colchicine¥‡ | 0.5 to 0.6 mg orally 2 times daily | 3 months (acute) 6 months or more (recurrent) | Usually not tapered |
| Second-line therapy (for refractory cases or patients with a contraindication to NSAID therapy): | |||
| Prednisone | 0.2 to 0.5 mg/kg daily | 2 to 4 weeks (acute or recurrent†) | Gradual tapering over 2 to 3 months; refer to UpToDate topic review of treatment of acute pericarditis, section on glucocorticoids |
| plus | |||
| Colchicine¥‡ | 0.5 to 0.6 mg orally 2 times daily | 3 months or more (acute) 6 months or more (recurrent) Colchicine is generally continued for 4 weeks or more after discontinuation of glucocorticoid | Usually not tapered |
| Third-line therapy: Second-line therapy plus NSAID dosed as for first-line therapy | |||
| Fourth-line therapy: One of the following agents (or pericardiectomy) | |||
| Rilonacept | Loading dose of 320 mg delivered as 2 SC doses of 160 mg on the same day at 2 different sites | 160 mg SC weekly for several months | Slow taper over 3 months or more |
| Anakinra | 1 to 2 mg/kg SC daily (maximum dose 100 mg daily) | Several months | Slow taper over 3 months or more |
| Azathioprine | 1 mg/kg orally daily increasing to 2 to 3 mg/kg daily (maximum dose 150 mg daily) | Several months | Not tapered |
| IVIG | 400 to 500 mg/kg IV daily | 5 days (may repeat after 1 month) | Not tapered |
NSAID: nonsteroidal antiinflammatory drug (includes ibuprofen, indomethacin, and aspirin); SC: subcutaneous injection; IVIG: intravenous immunoglobulin; IV: intravenous; CRP: C-reactive protein.
* This column describes the typical duration of full-dose therapy for symptom control. Except for colchicine, the duration of full-dose therapy and subsequent tapering should be tailored according to resolution of symptoms and normalization of markers of inflammation; refer to topic reviews for approach.
¶ Tapering is begun once symptoms have resolved for at least 24 hours and CRP level has normalized. Tapering is continued only if the patient remains asymptomatic with normal CRP levels. Some clinicians taper more slowly than shown in the table by reducing the total daily dose (rather than each individual dose) by the taper dose amount indicated.
Δ For patients treated with aspirin as an antiplatlet agent (including patients with peri-infarction pericarditis), NSAIDs (such as ibuprofen and indomethacin) are avoided. Glucocorticoid therapy is also avoided in patients with peri-infarction pericarditis. Refer to UpToDate content on pericardial complications of myocardial infarction.
◊ Proton pump inhibitor (eg, omeprazole) gastrointestinal protection may be indicated.
§ Some patients may require ibuprofen every 6 hours (4 times daily), in which case the dose should not exceed 600 mg every 6 hours.
¥ 0.5 mg colchicine is not available in the United States. It is widely available elsewhere.
‡ Colchicine dose should be reduced to 0.5 to 0.6 mg once daily in patients <70 kg. Refer to UpToDate content on colchicine dosing for other indications for dosage reduction.
† Patients with acute pericarditis are generally treated with prednisone for a duration at the lower end of this range, while patients with recurrent pericarditis are generally treated for a duration at the upper end of this range.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
