Constrictive Pericarditis Medication

Updated: Jan 01, 2020
  • Author: William M Edwards, Jr, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Medication

Medication Summary

No medications are required when the diagnosis of constrictive pericarditis is definitive, because the patient is usually referred for surgical management. To help maintain a euvolemic state, diuretics and afterload-reducing medications should be used cautiously; decreasing preload or afterload can cause greater compression of the heart and sudden cardiac decompensation, especially when general anesthetic agents are administered just before the pericardiectomy is performed.

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Anti-Inflammatory Agents

Class Summary

Other medical therapy is dependent on the etiology of the constrictive pericarditis such as nonsteroidal anti-inflammatory agents (NSAIDs) in early constriction with an inflammatory component. Relatively recently a variant, "transient constrictive pericarditis," has been named because of its reversible pattern after spontaneous recovery or medical therapy (ie, NSAIDs or colchicine, steroids, or other immune-modulating agents in refractory cases). [15, 44]

Aspirin (Acetylsalicylic acid, ASA, Bayer Advanced Aspirin)

Aspirin is a mainstay of treatment for acute pericarditis. The European Society of Cardiology recommends a dosing regimen of 750-1000 mg every 8 hours for 1-2 weeks. [41] Consider tapering by decreasing the doses by 250-500 mg every 1-2 weeks.

Ibuprofen (Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB)

Ibuprofen is also a mainstay of treatment for acute pericarditis. The European Society of Cardiology recommends a dosing regimen of 600 mg every 8 hours for 1-2 weeks. [41] Consider tapering by decreasing the doses by 200-400 mg every 1-2 weeks.

Colchicine (Colcrys, Gloperba, Mitigare)

The European Society of Cardiology recommends cochicine as an adjunct first-line drug added to conventional anti-inflammatory therapies (eg, aspirin, ibuprofen) in individuals with a first or recurrent episode of pericarditis for improvement in therapeutic response, increase in remission rates, and reduction in recurrences/ [41]

The dosing regimen is 0.5 mg once (< 70 mg) or 0.5 mg twice daily (≥70 kg) for 3 months. Although tapering is not mandatory, consider tapering by alternating 0.5 mg every other day (< 70 kg) or 0.5 mg once (≥70 kg)  in the last weeks. [41] Provide gastroprotection for patients administered colchine.

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Diuretics, Loop

Class Summary

Diuretics may improve pulmonary and systemic congestion. They should be used cautiously because any drop in intravascular volume may cause a corresponding drop in cardiac output. Any loop diuretics may be used to treat volume overload. Always start at the minimal dose necessary.

Furosemide (Lasix)

Furosemide increases excretion of water by interfering with the chloride-binding co-transport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. If a switch is made from IV to oral administration, an equivalent oral dose should be used. Doses vary depending on the patient's clinical condition and renal function.

Torsemide (Demadex)

Torsemide increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. It increases excretion of water, sodium, chloride, magnesium, and calcium. If a switch is made from IV to oral administration, an equivalent oral dose should be used. Doses vary depending on the patient's clinical condition and renal function.

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