Heart Failure Reviews

, Volume 18, Issue 3, pp 355–360 | Cite as

Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis

  • Massimo Imazio
  • Yehuda Adler


Empiric anti-inflammatory therapy for acute and recurrent pericarditis is warranted for viral and idiopathic cases that represent most cases of pericarditis in developed countries. For specific uncomplicated etiologies, such as systemic autoimmune diseases and postpericardiotomy syndromes, the same drugs are also indicated. Aspirin and non-steroidal anti-inflammatory drugs (NSAID) are mainstay of therapy with the possible adjunct of colchicine, especially for recurrences. Corticosteroids are a second choice for difficult cases requiring multi-drug therapies and specific medical conditions (i.e., specific cases with systemic autoimmune diseases, postpericardiotomy syndrome, and pregnancy). Medical therapy of pericarditis should be individualized as much as possible providing the attack dose every 8 h to ensure full daily control of symptoms and till remission and C-reactive protein normalization, and then tapering should be considered. The present paper will review current evidence for the treatment of acute and recurrent pericarditis with aspirin, NSAID, corticosteroids, and colchicine.


Pericarditis Therapy Aspirin Non-steroidal anti-inflammatory drugs Corticosteroids Colchicine 


Conflict of interest

All authors declare that they have no competing interests.


  1. 1.
    Little WC, Freeman GL (2006) Pericardial disease. Circulation 113:1622–1632PubMedCrossRefGoogle Scholar
  2. 2.
    Imazio M, Spodick DH, Brucato A et al (2010) Controversial issues in the management of pericardial diseases. Circulation 121:916–928PubMedCrossRefGoogle Scholar
  3. 3.
    Imazio M, Trinchero R, Shabetai R (2007) Pathogenesis, management, and prevention of recurrent pericarditis. J Cardiovasc Med (Hagerstown) 8(6):404–410CrossRefGoogle Scholar
  4. 4.
    Imazio M, Brucato A, Trinchero R, Adler Y (2009) Diagnosis and management of pericardial diseases. Nat Rev Cardiol 6:743–751PubMedCrossRefGoogle Scholar
  5. 5.
    Maisch B, Seferovic PM, Ristic AD et al (2004) Task force on the diagnosis and management of pericardial diseases of the european society of cardiology. Guidelines on the diagnosis and management of pericardial diseases. Eur Heart J 25:587–610PubMedCrossRefGoogle Scholar
  6. 6.
    Imazio M, Spodick DH, Brucato A et al (2010) Diagnostic issues in the clinical management of pericarditis. Int J Clin Pract 64:1384–1392PubMedCrossRefGoogle Scholar
  7. 7.
    Maisch B, Ristic AD (2002) The classification od pericardial disease in the age of modern medicine. Curr Cardiol Rep 4:13–21PubMedCrossRefGoogle Scholar
  8. 8.
    Levy PY, Fournier PE, Charrel R, Metras D, Habib G, Raoult D (2006) Molecular analysis of pericardial fluid: a 7-year experience. Eur Heart J 16:1942–1946CrossRefGoogle Scholar
  9. 9.
    Seferović PM, Ristić AD, Maksimović R, Tatić V, Ostojić M, Kanjuh V (2003) Diagnostic value of pericardial biopsy: improvement with extensive sampling enabled by pericardioscopy. Circulation 107:978–983PubMedCrossRefGoogle Scholar
  10. 10.
    Lorbar M, Spodick DH (2007) ‘Idiopathic’ pericarditis—the clinician’s challenge [nothing is idiopathic]. Int J Clin Pract 61:138–142PubMedCrossRefGoogle Scholar
  11. 11.
    Imazio M, Brucato A, Derosa FG et al (2009) Aetiological diagnosis in acute and recurrent pericarditis: when and how. J Cardiovasc Med (Hagerstown) 10:217–230CrossRefGoogle Scholar
  12. 12.
    Ntsekhe M, Mayosi BM (2009) Cardiac manifestations of HIV infection: an African perspective. Nat Clin Pract Cardiovasc Med 6:120–127PubMedCrossRefGoogle Scholar
  13. 13.
    Imazio M, Brucato A, Mayosi BM et al (2010) Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med (Hagerstown) 11:712–722Google Scholar
  14. 14.
    Mayosi BM, Burgess LJ, Doubell AF (2005) Tuberculous pericarditis. Circulation 112:3608–3616PubMedCrossRefGoogle Scholar
  15. 15.
    Pankuweit S, Ristić AD, Seferović PM, Maisch B (2005) Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs 5:103–112PubMedCrossRefGoogle Scholar
  16. 16.
    Maisch B, Ristic A, Pankuweit S (2010) Evaluation and management of pericardial effusion in patients with neoplastic disease. Prog Cardiovasc Dis 53:157–163PubMedCrossRefGoogle Scholar
  17. 17.
    Lestuzzi C (2010) Neoplastic pericardial disease: old and current strategies for diagnosis and management. World J Cardiol 2:270–279PubMedCrossRefGoogle Scholar
  18. 18.
    Imazio M, Brucato A, Maestroni S et al (2011) Prevalence of C-reactive protein elevation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis. Circulation 123:1092–1097PubMedCrossRefGoogle Scholar
  19. 19.
    Imazio M, Brucato A, Trinchero R et al (2009) Individualized therapy for pericarditis. Expert Rev Cardiovasc Ther 7:965–975PubMedCrossRefGoogle Scholar
  20. 20.
    Imazio M, Brucato A, Cumetti D et al (2008) Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation 118:667–671PubMedCrossRefGoogle Scholar
  21. 21.
    Maisch B, Ristic A, Pankuweit S (2002) Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone. The way to avoid side effects of systemic corticosteroid therapy. Eur Heart J 23:1503–1508PubMedCrossRefGoogle Scholar
  22. 22.
    Frasiolas JA, Cahoon WD (2010) Intrapericardial triamcinolone administration for autoreactive pericarditis. Ann Pharmacother 44:1641–1646PubMedCrossRefGoogle Scholar
  23. 23.
    Shabetai R (2005) Recurrent pericarditis. Recent advances and remaining questions. Circulation 112:1921–1923PubMedCrossRefGoogle Scholar
  24. 24.
    Imazio M, Brucato A, Trinchero R et al (2009) Colchicine for pericarditis: hype or hope? Eur Heart J 30:532–539PubMedCrossRefGoogle Scholar
  25. 25.
    Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R (2005) Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation 112(13):2012–2016PubMedCrossRefGoogle Scholar
  26. 26.
    Imazio M, Bobbio M, Cecchi E et al (2005) Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial. Arch Intern Med 165:1987–1991PubMedCrossRefGoogle Scholar
  27. 27.
    Imazio M, Brucato A, Cemin R, Ferrua S, Belli R, Maestroni S, Trinchero R, Spodick DH (2011) CORP (COlchicine for Recurrent Pericarditis) investigators. Colchicine for recurrent pericarditis (CORP): a randomized trial. Ann Intern Med 155(7):409–414PubMedGoogle Scholar
  28. 28.
    Terkeltaub RA (2009) Colchicine update: 2008. Semin Arthritis Rheum 38:411–419PubMedCrossRefGoogle Scholar
  29. 29.
    Cocco G, Chu DC, Pandolfi S (2010) Colchicine in clinical medicine. A guide for internists. Eur J Intern Med 21:503–508PubMedCrossRefGoogle Scholar
  30. 30.
    Imazio M, Cecchi E, Ierna S (2007) ICAP investigators. Investigation on Colchicine for Acute Pericarditis: a multicenter randomized placebo-controlled trial evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of pericarditis; study design amd rationale. J Cardiovasc Med (Hagerstown) 8(8):613–617CrossRefGoogle Scholar
  31. 31.
    Caforio AL, Brucato A, Doria A et al (2010) Anti-heart and anti-intercalated disk autoantibodies: evidence for autoimmunity in idiopathic recurrent acute pericarditis. Heart 96:779–784PubMedCrossRefGoogle Scholar
  32. 32.
    Vianello F, Cinetto F, Cavraro M, Battisti A, Castelli M, Imbergamo S, Marcolongo R (2011) Azathioprine in isolated recurrent pericarditis: a single centre experience. Int J Cardiol 147:477–478PubMedCrossRefGoogle Scholar
  33. 33.
    Maisch B, Hufnagel G, Kölsch S, Funck R, Richter A, Rupp H, Herzum M, Pankuweit S (2004) Treatment of inflammatory dilated cardiomyopathy and (peri)myocarditis with immunosuppression and i.v. immunoglobulins. Herz 29:624–636PubMedCrossRefGoogle Scholar
  34. 34.
    Dinarello CA (2011) Interleukin-1 in the pathogenesis and treatment of inflammatory diseases. Blood 117:3720–3732PubMedCrossRefGoogle Scholar
  35. 35.
    Rigante D, Cantarini L, Imazio M, Lucherini OM, Sacco E, Galeazzi M, Brizi MG, Brucato A (2011) Autoinflammatory diseases and cardiovascular manifestations. Ann Med 43:341–346PubMedCrossRefGoogle Scholar
  36. 36.
    Imazio M, Brucato A, Rampello S et al (2010) Management of pericardial diseases during pregnancy. J Cardiovasc Med (Hagerstown) 11:557–562CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Cardiology DepartmentMaria Vittoria HospitalTorinoItaly
  2. 2.Cardiac Rehabilitation InstituteChaim Sheba Medical CenterTel-HashomerIsrael
  3. 3.Sackler Faculty of MedicineTel AvivIsrael

Personalised recommendations