Non-pharmacologic

Acute and early convalescent periods:

Avoidance of vigorous physical activity is highly
recommended
Acute idiopathic pericarditis:
Bed rest
MOA of Anti-inflammatory Drugs
Aspirin
Non-selective cyclooxygenase (COX) inhibitor
It irreversibly acetylates and inhibit COX
It also bocks the synthesis of thromboxane A2
Indomethacin
It is a potent non-selective COX inhibitor

Ibuprofen
Reversible inhibitor of COX
MOA of Anti-inflammatory Drugs
Colchicine
Colchicine produces its anti-inflammatory effects by binding to
the intracellular protein tubulin, thereby preventing its
polymerization into microtubules and leading to the inhibition of
leukocyte migration and phagocytosis
It also inhibits the formation of leukotriene B4
Glucocorticoids (Prednisone)
Broad spectrum inhibitor
It down-regulates the expression of the genes encoding for COX-
2, phospholipase A2, proinflammatory cytokines (IL-1 and TNF)
and iNOS
It up-regulates the gene encoding for lipocortin 1 (lipocotin 1
inhibits the release of Arachidonic Acid from membrane
phospholipids
Pharmacologic Treatment
In the absence of significant pericardial effusion,
treatment that is directed primarily at relieving the
patient's symptoms can be successful in 85% or so of
cases on an outpatient basis
NSAIDS:
Indomethacin: 25 - 50 mg, TID
Ibuprofen: 300 - 800 mg, TID or QID
Aspirin: 325 - 650 mg, TID
Glucocorticoids: may be useful for resistant
situations
Prednisone: 20 - 60 mg/day
Pharmacologic Treatment
Anti-inflammatory drugs should be continued at
a constant high dose until the patient is afebrile
and asymptomatic for 5 to 7 days, followed by a
gradual taper during the next several weeks
Note:
the use of warfarin or heparin should be
avoided to minimize the risk of
hemopericardium, but anticoagulation may be
required in atrial fibrillation or in the presence of
a coexistent prosthetic valve
Pharmacologic Treatment
Acute Viral and Idiopathic Pericarditis:
no specific therapy
Hyperimmune globulin: beneficial in
cytomegalovirus, adenovirus and parvovirus
pericarditis
Interferon: useful for coxsackie B pericarditis
Bed rest and aspirin (24 mg/d)*
* If ineffective:
Ibuprofen: 300 - 800 mg, QID
Colchicine: 0.6 mg, BID
Pharmacologic Treatment
Glucocorticoids: prednisone, 4080 mg daily
It suppress the clinical manifestations of the acute illness and
may be useful in patients in whom purulent bacterial
pericarditis has been excluded and in patients with pericarditis
secondary to connective tissue disorders and renal failure

Note:
After the patient has been asymptomatic and afebrile for about
a week, the dose of the NSAID may be tapered gradually
Colchicine may prevent recurrences, but when recurrences are
multiple, frequent, disabling, continue beyond 2 years, and are
not controlled by pulses of high doses of glucocorticoids,
pericardiectomy may be carried out in an attempt to
terminate the illness
Pharmacologic Treatment
For patients with a 1st episode of viral or
idiopathic pericarditis:
Colchicine: 0.6 - 1.2 mg/day for 3 to 12 months
It reduces the recurrence rate from about 32% to
about 11%
It is also effective in patients with familial
Mediterranean fever
Pharmacologic Treatment
Viral and idiopathic pericarditis: self-
limited, but a quarter of patients may have
recurrent pericarditis
Treatment:
prolonged treatment with NSAIDS (e.g., ibuprofen,
300 - 600 mg, TID) plus colchicine (0.6 mg BID,
declining to once daily after a year)
Pharmacologic Treatment
For patients who are intolerant of colchicine and
have recurrent episodes despite high-dose
nonsteroidal anti-inflammatory drugs (e.g.,
indomethacin, 50mg, TID, or ibuprofen, 800 mg
QID):
oral steroids (prednisone, 60 mg with a 2- to 4-week
taper)
Pericardiectomy
Patients with recurrent pericarditis are at increased
risk for progression to constrictive pericarditis
Pharmacologic Treatment
Acute bacterial pericarditis:
Intravenous antibiotics
SurgicalTreatment
Pericardiectomy: for recurrent pericarditis
Drainage of pericardial fluid: for acute
bacterial pericarditis and for massive pericardial
effusion