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Colchicine -- taking the pain
out of your heart!
By Dr Lisa Nissen
Lisa Nissen is Associate Professor (QUM),
at the School of Pharmacy, University of
Queensland and Deputy-Director, Centre
for Safe and Effective Prescribing (CSEP).
Pericarditis is a condition where the
sac-like covering around the heart
(pericardium) becomes in amed. It
can be caused by both infectious and
non-infectious stimulus. Pericarditis most
commonly a ects men aged 20--50 years
and usually follows respiratory infections.
In children, it is generally associated with
infection from adenovirus or coxsackie
virus. It is estimated to be present in
approximately 5% of patients presenting
to hospital emergency departments
with chest pain in the absence of a
Although pericarditis is generally a
complication of viral infections, it may
also be caused by bacterial and fungal
infections. In addition, pericarditis can
be associated with diseases such as
autoimmune disorders, cancer, HIV/
AIDS, hypothyroidism, kidney failure,
rheumatic fever and tuberculosis.
Other physical trauma may also lead
to pericarditis including myocardial
infarction, surgery or trauma to the chest,
oesophagus or heart. However, the cause
of pericarditis often remains unknown.
The symptoms of pericarditis include
swelling of the ankles, feet and legs
(occasionally), anxiety, di culty breathing
when lying down and chest pain, pain
radiating to the neck, shoulder, back or
abdomen, pleuritis, dry cough, fatigue
and fever. It is essential to treat the
in ammation and uid build-up in the
pericardium as it may lead to poor heart
function and complications including
arrhythmias, cardiac tamponade,
constrictive pericarditis, which may
develop into heart failure. This is a
particular concern where recurrent
The primary treatment of pericarditis is
to identify the cause of the condition and
treat it with antibiotics. However, other
treatments include analgesics for pain
and anti-in ammatory agents including
NSAIDs, corticosteroids (e.g. prednisone)
Colchicine is most commonly known as
an acute and preventive treatment for
gout. It is an e ective anti-in ammatory
and operates by binding to the
tubulin molecule thereby inhibiting
its polymerisation into microtubules.
Speci cally, its anti-in ammatory e ect
has been attributed to its disruption of
microtubules in neutrophils, thereby
inhibiting their migration toward the
chemotactic factors. Furthermore,
colchicine may also alter the distribution
of adhesion molecules on the surface of
both neutrophils and endothelial cells,
leading to a signi cant inhibition of
interaction between white blood cells
(WBC) and endothelial cells interfering
with their transmigration.
The results of a number of randomised
controlled clinical trials (double-blind
and open-label) have shown the
bene t of colchicine in the treatment
of pericarditis for acute, secondary and
recurrent pericarditis (e.g. neoplastic
disease, tuberculosis). Patients took a
dosage regimen of 1--2 mg on the rst
day, followed by a maintenance dose of
0.5--1 mg/day. Those in the intervention
groups had less recurrences of pericarditis
and although gastrointestinal intolerance
was the most frequent side-e ect (<10%)
seen in the colchicine group there were
no serious adverse e ects reported.
From the evidence available it appears
that colchicine is safe and e cacious for
the primary and secondary prevention
of pericarditis and may provide an
alternative to other therapies.
• Imazio M. Evaluation and management
of pericarditis. Expert Rev Cardiovasc
Ther. 2011 Sep;9(9):1221--33.
• Rahman A, Liu D. Pericarditis - clinical
features and management. Aust Fam
Physician. 2011 Oct;40(10):791--6.
• Gianni F, Solbiati M; Gruppo di
Autoformazione Metodologica (GrAM).
Colchicine is safe and e ective for
secondary prevention of recurrent
pericarditis. Intern Emerg Med. 2012
Apr;7(2):181-2. Epub 2012 Mar 20.
• Imazio M, Brucato A, Forno D,
Ferro S, Belli R, Trinchero R, Adler Y.
E cacy and safety of colchicine for
pericarditis prevention. Systematic
review and meta-analysis. Heart. 2012
Jul;98(14):1078--82. Epub 2012 Mar 22.
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