What is the right dose of NSAIDs in treating recurrent pericarditis?
Today we saw a patient with a complicated history of recurrent pericarditis - he's been treated/partially treated with ibuprofen, colchicine, and two steroid tapers, and now he returns with similar albeit less intense chest pain. He's currently taking ibuprofen once daily as well as colchicine.
We decided to increase his ibuprofen, continue his colchicine, and check in in a month to make a further plan pending his symptoms. I wasn't sure about the right dose of NSAIDs in a scenario like this one, though, so I searched the literature.
I found a good JACC review which I'm attaching here that had this helpful graphic:
Figure 3. Treatment for Acute and Recurrent Pericarditis and Their Complications
And another review from pharmacists about treating pericarditis, also attached and also with one helpful table. Turns out most of what we know about treating pericarditis with NSAIDs, though, is based on clinical experience and not randomized trials.
Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of Acute and Recurrent Pericarditis. Journal of the American College of Cardiology. 2020;75(1):76-92. doi:https://doi.org/10.1016/j.jacc.2019.11.021
Schwier N, Tran N. Non-Steroidal Anti-Inflammatory Drugs and Aspirin Therapy for the Treatment of Acute and Recurrent Idiopathic Pericarditis. Pharmaceuticals. 2016;9(2):17. doi:https://doi.org/10.3390/ph9020017
