Colchicine has been effectively used in the treatment of several inflammatory conditions, such as gouty attacks,
serositis related to
familial Mediterranean fever, Behçet syndrome and more recently, in acute and recurrent
pericarditis.
Colchicine concentrates in white blood cells, particularly polymorphonuclear cells, inhibiting
tubulin polymerization, thus interfering with migration and phagocytosis, and reducing the inflammatory cycle. Although the exact number of responders is unknown, the
drug has been successfully used for the treatment and prevention of recurrences and to taper
corticosteroids in patients with recurrent
pericarditis in several retrospective studies and an open-label, randomized trial, where the recurrence rate was halved in the treatment arm. Less evidence supports the use of the
drug for the treatment of acute
pericarditis, where
colchicine remains optional and requires further multicenter confirmatory studies. At present,
colchicine has been recommended by the 2004 European guidelines on the management of pericardial diseases for acute (class IIa) and recurrent
pericarditis (class I), but its use is still unlabeled and informed consent is required for prescription. A careful monitoring of possible
contraindications, drug interactions and side effects is necessary. The aim of this paper is to review the evidence that supports the use of the
drug in acute and recurrent
pericarditis, as well as dosing and precautions for clinical use.