Pericardial Effusion Medication

Updated: Sep 25, 2016
  • Author: William J Strimel, DO, FACP; Chief Editor: Richard A Lange, MD, MBA  more...
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Medication

Medication Summary

Most acute idiopathic or viral pericarditis occurrences are self-limited and respond to treatment with an NSAID. The corticosteroid prednisone may be administered for severe inflammatory pericardial effusions or when NSAID treatment has failed.

Research indicates that the anti-inflammatory drug colchicine, when used in combination with conventional therapy, is more effective at reducing the symptoms and recurrence of pericarditis than is conventional therapy alone. [28]

Autoimmune pericardial effusions may respond to treatment with anti-inflammatory medications. In general, selection of an agent depends on the severity of the patient's symptoms and the tolerability and adverse effect profiles of the medications.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

These agents are used mostly for patients with active, nonhemorrhagic pericarditis with or without pericardial effusion. NSAIDS have analgesic, anti-inflammatory, and antipyretic activities.

The mechanism of action in pericarditis is not known, but NSAIDS may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Indomethacin (Indocin)

Indomethacin is the drug of choice in this class, although other NSAIDs (ie, ibuprofen, naproxen, aspirin) possess some efficacy. It is used as initial therapy for mild to moderately severe inflammatory pericardial effusions.

Ibuprofen (Advil, Motrin, Addaprin, Ultraprin)

Ibuprofen is a propionic acid derivative that reduces the formation of inflammatory mediators by enzyme inhibition.

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Naproxen is a propionic acid derivative that reduces the formation of inflammatory mediators by enzyme inhibition.

Diclofenac sodium (Cataflam, Voltaren SR, Zipsor)

Diclofenac possesses properties similar to those of the propionic acid derivatives and reduces the formation of inflammatory mediators by enzyme inhibition. The tablets are immediate-release formulations.

Ketoprofen

Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

Aspirin (Bayer Aspirin, Ascriptin, Bufferin, Ecotrin)

Aspirin inhibits prostaglandin synthesis, preventing the formation of platelet-aggregating thromboxane A2.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli.

Prednisone

Prednisone is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed. Other agents may be used if the adverse effect profile warrants; dosages should be determined by prednisone equivalents.

Methylprednisolone (Solu-Medrol, Depo-Medrol, A-Methapred)

Methylprednisolone is available in IV/IM and oral form. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.

Prednisolone (Pediapred, Prelone, Orapred, Millipred)

Prednisolone is available in IV/IM and oral form. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.

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Anti-inflammatory Agents

Class Summary

These agents inhibit key factors involved in inflammatory reactions.

Colchicine

Colchicine is an alkaloid extract that inhibits microtubule formation and has unique anti-inflammatory properties. The drug concentrates well in leukocytes and reduces neutrophilic chemotaxis and motility. Colchicine reduces the release of lactic acid and proinflammatory enzymes. It inhibits the release of histamine-containing granules from mast cells, which may be important in the pathogenesis of elastic tissue changes found in anetoderma.

The use of colchicine in autoimmune disease is primarily empiric, and the mechanism of action in the reduction of inflammation is not clear. Colchicine is not truly an immunomodulating agent.

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