Drug Treatments

Any obvious underlying cause for acute pericarditis should be treated (eg. pneumonia, tuberculosis, uraemia, etc.).

NSAIDS are the mainstay of treatment for pericarditis (e.g. aspirin, ibuprofen, indomethacin, etc.). Aspirin is used preferentially if pericarditis is a complication of acute myocardial infarction.

Adding colchicine to NSAIDS should be strongly considered as it has been shown to reduce symptoms, decrease the rate of recurrent pericarditis, and the low dose regimen (0.5-1.2mg daily) is generally well tolerated [14].

It has been recommended that NASIDS can be stopped after resolution of symptoms but colchicine should be continued for 3 months.

Patients who fail to respond to initial treatment within 1-2 weeks should be admitted to hospital for further assessment.

Steroids are not indicated for acute pericarditis in the early phase as they are associated with an increased risk of relapsing pericarditis. Steroids should only be considered as first line treatment when the underlying cause is thought to be immune-mediated, due to a connective tissue disorder, or in uraemic pericarditis [9].

Learning bite

First line drug treatment for uncomplicated acute idiopathic pericarditis is NSAIDs and colchicine.

Emerging Treatment


Rilonacept is a subcutaneously injected interleukin-1 alpha and beta cytokine trap approved by the US Food and Drug Administration for use in adults to treat recurrent pericarditis and to reduce risk of recurrence in adults and children aged 12 years and older. Among patients with recurrent pericarditis and systemic inflammation in the RHAPSODY trial, rilonacept led to rapid resolution of recurrent pericarditis episodes and to a significantly lower risk of pericarditis recurrence compared with placebo [17] It is not currently approved in Europe for this indication.