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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.^[30]

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.

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)

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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)

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

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

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

Diclofenac sodium (Cataflam, Voltaren SR, Zipsor)

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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

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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)

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

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

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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)

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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)

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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.

Class Summary

These agents inhibit key factors involved in inflammatory reactions.

Colchicine

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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.

Questions

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Media Gallery

This image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film.
Echocardiogram (parasternal, long axis) of a patient with a moderate pericardial effusion.
This image is from a patient with malignant pericardial effusion. The effusion is seen as an echo-free region to the right of the left ventricle (LV).
This electrocardiogram (ECG) is from a patient with malignant pericardial effusion. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.
Subcostal view of an echocardiogram that shows a moderate to large amount of pericardial effusion.
This echocardiogram shows a large amount of pericardial effusion (identified by the white arrows).

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Author

William J Strimel, DO, FACP Cardiologist, Lehigh Valley Heart Specialists

William J Strimel, DO, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bilal Ayub, MD Chief Cardiology Fellow, Division of Cardiology, Department of Internal Medicine, Lehigh Valley Health Network

Bilal Ayub, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Echocardiography, National Lipid Association, American Society of Nuclear Cardiology

Disclosure: Nothing to disclose.

Tahmeed Contractor, MD Fellow, Division of Cardiology, Department of Internal Medicine, Lehigh Valley Health Network

Tahmeed Contractor, MD is a member of the following medical societies: American College of Cardiology, Indian Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Terrence X O'Brien, MD, MS, FACC Professor of Medicine/Cardiology, Director, Clinical Cardiovascular Research, Medical University of South Carolina College of Medicine; Director, Echocardiography Laboratory, Veterans Affairs Medical Center of Charleston

Terrence X O'Brien, MD, MS, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Ramin Assadi, MD, Senior Fellow, Department of Cardiology, Loma Linda University School of Medicine

Ramin Assadi, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Abraham G Kocheril, MD, FACC, FACP, FHRS Professor of Medicine, University of Illinois College of Medicine

Abraham G Kocheril, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Cardiac Electrophysiology Society, Central Society for Clinical Research, Heart Failure Society of America, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Justin D Pearlman, MD, PhD, ME, MA Director of Advanced Cardiovascular Imaging, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center

Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America

Disclosure: Nothing to disclose.

Ali A Sovari, MD, FACP, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois College of Medicine; Staff Physician and Hospitalist, St John Regional Medical Center, Cogent Healthcare, Inc

Ali A Sovari, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Physiological Society, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Pericardial Effusion Medication

Medication Summary

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

Indomethacin (Indocin)

Indomethacin (Indocin)

Ibuprofen (Advil, Motrin, Addaprin, Ultraprin)

Ibuprofen (Advil, Motrin, Addaprin, Ultraprin)

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Diclofenac sodium (Cataflam, Voltaren SR, Zipsor)

Diclofenac sodium (Cataflam, Voltaren SR, Zipsor)

Ketoprofen

Ketoprofen

Aspirin (Bayer Aspirin, Ascriptin, Bufferin, Ecotrin)

Aspirin (Bayer Aspirin, Ascriptin, Bufferin, Ecotrin)

Corticosteroids

Class Summary

Prednisone

Prednisone

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

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

Prednisolone (Pediapred, Prelone, Orapred, Millipred)

Prednisolone (Pediapred, Prelone, Orapred, Millipred)

Anti-inflammatory Agents

Class Summary

Colchicine

Colchicine

Pericardial Effusion Medication

Medication Summary

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Class Summary

Indomethacin (Indocin)

Ibuprofen (Advil, Motrin, Addaprin, Ultraprin)

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Diclofenac sodium (Cataflam, Voltaren SR, Zipsor)

Ketoprofen

Aspirin (Bayer Aspirin, Ascriptin, Bufferin, Ecotrin)

Corticosteroids

Class Summary

Prednisone

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

Prednisolone (Pediapred, Prelone, Orapred, Millipred)

Anti-inflammatory Agents

Class Summary

Colchicine

References

Tables

Contributor Information and Disclosures

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