Pericarditis Treatment Guidelines

First-Line Therapy

The European Society of Cardiology recommends aspirin or NSAIDs combined with colchicine as the first-line treatment for acute pericarditis, with corticosteroids reserved only for cases where NSAIDs fail or are contraindicated 1, 2, 3
Both medications should be started together as initial therapy to maximize symptom control and prevent recurrences 2, 3
Aspirin is preferred when the patient already requires antiplatelet therapy for other indications 1
The American Heart Association suggests that always provide gastroprotection (proton pump inhibitor) with any NSAID 1, 2

The European Society of Cardiology recommends aspirin: 750-1000 mg every 8 hours for 1-2 weeks, then taper by 250-500 mg every 1-2 weeks 1, 2
Ibuprofen: 600 mg every 8 hours for 1-2 weeks, then taper by 200-400 mg every 1-2 weeks 1, 2
Colchicine dosing is weight-adjusted: patients <70 kg: 0.5 mg once daily, patients ≥70 kg: 0.5 mg twice daily 1, 2, 4
The treatment duration for colchicine is 3 months 1, 2, 4

The European Society of Cardiology recommends continuing NSAIDs until complete symptom resolution AND CRP normalization, typically 1-2 weeks for uncomplicated cases 1, 2, 3
Use CRP levels to guide treatment length and assess response 3, 4
Restrict physical activity beyond ordinary sedentary life until symptoms resolve and CRP normalizes 1, 2

The European Society of Cardiology suggests that corticosteroids should only be used when NSAIDs are contraindicated or have failed because they increase the risk of chronic disease evolution and drug dependence 1, 2
Low to moderate doses of prednisone: 0.2-0.5 mg/kg/day (NOT high doses of 1.0 mg/kg/day) should be used 1, 5
Always combine corticosteroids with colchicine 1

Never start corticosteroids as first-line therapy unless NSAIDs are absolutely contraindicated 1, 2
Never stop treatment before CRP normalizes - premature discontinuation causes recurrences 5
Never use NSAIDs for asymptomatic post-surgical effusions without systemic inflammation 4