Treatment of pericarditis

• High-dose NSAID (eg, ibuprofen 600–800 mg tid) or ASA (eg, 650–1000 mg tid) × 7–14 d then taper over wks; ASA preferred over NSAID in acute MI; consider PPI to ↓ risk of GIB
• Add colchicine 0.6 mg bid (qd if ≤70 kg) × 3 mo; 50% ↓ risk of refractory or recurrent pericarditis (NEJM 2013;369:1522). Amio, dilt, verap & atorva ↓ P-gp & ↑ risk of colchicine tox.
• Avoid steroids except for systemic autoimmune disorder, uremia, preg., NSAIDs contra- indicated. Appear to ↑ rate of pericarditis recurrence; risk lower w/ low-dose wt-based (ie, prednisone 0.2–0.5 mg/kg) with slow taper (Circ 2008;118:667 & 2011;123:1092).
• Avoid anticoagulants (although no convincing data that ↑ risk of hemorrhage/tamponade)
• Infectious effusion → pericardial drainage (preferably surgically) + systemic antibiotics
• Restrict activity until sx resolve/hsCRP ↓; athletes must also wait ~1–3 mos w/ nl TTE/ECG
• Acute idiopathic pericarditis self-limited in 70–90% of cases
• Recurrent pericarditis (Circ 2007;115:2739) risk factors: subacute, lg effusion/tamponade, T >38°C, no NSAID response after 7 d. Rx: colchicine 0.6 mg bid × 6 mo (Lancet 2014;383: 2232). IL-1 antagonists: anakinra (JAMA 2016;316:1906) or rilonacept (NEJM 2021;384:31).
• Recurrent effusions: consider pericardial window (percutaneous vs. surgical)