Pericarditis is a heart condition that causes inflammation in the pericardium, the thin, fluid-filled sac surrounding your heart. Managing this condition involves medication, lifestyle changes, and, in serious cases, surgery.
Pericarditis Medications
NSAIDs and colchicine
The standard treatment for pericarditis is a combination of NSAIDs and colchicine. Over-the-counter NSAIDs like ibuprofen and aspirin help ease swelling and inflammation. Your doctor may also prescribe other pain relievers. When used alone or in combination with NSAIDs, colchicine lessens symptoms and makes it less likely that your symptoms will come back.
Studies show this drug combination works well to treat pericarditis. But it can cause side effects. You could have stomach problems and weakness. These medications may also hinder other drugs you may be taking. You should also avoid colchicine if you have liver or kidney disease. Share your health history with your doctor so they’ll know if colchicine is safe for you to take.
Corticosteroids
If NSAIDs and colchicine don’t soothe your symptoms or you can’t take one of these medications, your doctor may prescribe a corticosteroid such as prednisone. This is a powerful drug that combats inflammation. With steroids, some studies show there’s a higher chance of your symptoms coming back or lasting longer than usual. You could also have side effects like weight gain and muscle loss.
Immunosuppressants
You may take these drugs if your symptoms come back, or recur, after treatment for your first acute pericarditis episode. This is also known as recurrent pericarditis. Your doctor could keep your immune system in check by prescribing:
- IV immunoglobulin (IVIG)
- Azathioprine
IL-1 blockers
Interleukin-1 (IL-1) inhibitors treat recurrent pericarditis. They work by blocking inflammation of the pericardium and can also lower your odds of the symptoms returning. The IL-1 inhibitor anakinra (Kineret) is used for treating pericarditis. Rilonacept (Arcalyst) is approved to treat recurrent pericarditis. These are used for at least 6 months, but often for more than a year. After that, your doctor will slowly taper your dose if you're taking anakinra, a process that can also take a year or more. If you're taking rilonacept, your doctor may end your treatment without a tapering off period.
Possible side effects include upper respiratory and urinary tract infections and high levels of fat (lipid) in your blood.
While they work well to treat pericarditis, IL-1 inhibitors are expensive. Medicare does not cover them, but private insurance may cover all or part of the costs if you qualify. Financial assistance programs offered by the drug manufacturers are also available to help pay for the costs of these medications.
Other medications
Here are some other medications you could take to treat pericarditis symptoms:
- Antibiotics. You’ll take these if a bacterial infection caused your pericarditis.
- Drugs for stomach and digestive symptoms. You may need to take these if large doses of ibuprofen have caused stomach or digestive problems.
- Water pills. If constrictive pericarditis has caused a buildup of extra fluid, a diuretic, also called a water pill, can help rid your body of it.
- Cancer drugs. Cancer sometimes causes pericarditis, and treating it can lessen your symptoms.
Pericarditis Surgeries and Procedures
Pericarditis can cause a buildup of fluid around your heart, and you’ll need to get rid of it. There are two procedures to treat this complication:
- Pericardiocentesis. A doctor inserts a needle or catheter into your pericardium and drains extra fluid.
- Pericardiectomy. During this surgery, a doctor removes your pericardium. You may need this type of surgery if you have constrictive pericarditis. This is a serious form of the condition that causes your pericardium to get thick or stiff. It can block your heart from beating as it should. Most people feel better after surgery, but you may have lingering chest pain caused by leftover inflammation.
New Pericarditis Treatment Approaches
Doctors typically decide whether to start or stop or taper a treatment plan for pericarditis based on your symptoms and blood tests. But if you’re taking several anti-inflammatory medications, certain signs that usually point to inflammation may not show up as expected.
New research suggests that a special type of heart imaging called cardiac MRI (CMR) can better help to guide treatment decisions. Doctors can see how much inflammation shows up on the CMR scan before they decide to start taking you off of medication.
Pericarditis Lifestyle Changes
If you have mild pericarditis, you could feel better simply by resting and taking over-the-counter pain medications. If you’re feeling pain, it can help to sit upright or lean forward instead of lying down. You’ll need to avoid sports and other vigorous activities while you get better. They can set off symptoms. Your doctor will tell you how long your recovery should be.
Pericarditis Recovery and Outlook
After starting medication, you should start to feel better within a week. But you may need to keep taking it for a couple of weeks.
If you have recurrent pericarditis, you may need to take medication for much longer, even for years, even though you feel well. They’ll taper it off if they see changes.
Most people who get treatment for an episode of pericarditis get fully better. Those who don’t can end up with long-term symptoms.
Recovery from pericarditis can take time, and there may be times that you feel frustrated. As you recover, it’s important to let your health care team know how you’re feeling and how your symptoms change. This will help them adjust your treatment so that you’ll feel better as soon as possible with less likelihood of symptoms coming back.
Show Sources
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SOURCES:
American College of Cardiology: “The Paradigm Shift in the Management of Recurrent Pericarditis.”
American Heart Association: “Symptoms and Diagnosis of Pericarditis."
NHS: “Pericarditis.”
Mayo Clinic: “Pericarditis.”
Cleveland Clinic: “Pericarditis,” ”Constrictive Pericarditis.”
FDA: “FDA Approves First Treatment for Disease That Causes Recurrent Inflammation In Sac Surrounding Heart.”
MedlinePlus: “Anakinra.”
American Family Physician: “Acute pericarditis: diagnosis and management.”
European Heart Journal -- Cardiovascular Pharmacotherapy: "Interleukin-1 blockade for the treatment of pericarditis."
BMJ: "THU0570 Anakinra as a successful treatment of idiopathic recurrent pericarditis: taper or not to taper? case series at the university of southern California."
Heart International: "The role of rilonacept in recurrent pericarditis."
