Dawaa Reference

acute

Acute Pericarditis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64)

Verified against2 documents
  • 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64)
  • Acute Pericarditis - disease-level clinical article (acute-pericarditis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Chest pain is central and severe, worse with a deep breath, and eases when sitting forward [chest pain]
  • Pain can radiate to the trapezius ridges when the phrenic nerve is irritated
  • Breathlessness may dominate the picture when myocarditis is present alongside it [breathlessness]
  • A flu-like illness with fever or upper respiratory symptoms often comes before a viral cause [fever]
  • Symptoms can appear days to weeks after prior cardiac surgery or chest trauma
  • Recurrence runs at an estimated 15% to 30% of cases [relapse]
  • The pericardium can thicken and, rarely, go on to constrict the heart months or even years after the attack

Signs — what you find (10)

  • A left parasternal friction rub with a scratchy triphasic quality is heard on auscultation [friction rub]
  • The friction rub is heard at some point in roughly 35% to 85% of cases, with wide variation reported [friction rub]
  • A triphasic friction rub, when heard, is highly specific for the diagnosis [friction rub]
  • A missing friction rub does not exclude pericarditis when the clinical picture still points that way [friction rub]
  • A friction rub can come and go, so listening repeatedly in different positions is needed [friction rub]
  • In uremic pericarditis, pleuritic pain is less common and ECG changes are often absent [chest pain]
  • Red flag: an effusion that is large or forms fast compresses the chambers from outside, restricts diastolic filling, and tips into cardiac tamponade
  • Red flag: tamponade presents as obstructive shock, and it is an emergency needing treatment at once [shock]
  • Meeting the criteria with raised cardiac biomarkers makes it myopericarditis; add a wall motion abnormality or systolic dysfunction and it is perimyocarditis
  • Red flag: an ejection fraction under 50%, heart failure, shock, sustained ventricular tachycardia or advanced heart block make it complicated myocarditis [heart block · shock · tachycardia]

Tests (12)

  • All suspected cases should get an ECG, echocardiogram, chest x-ray, and troponin and inflammatory markers
  • Stage I ECG changes show widespread concave ST elevation with reciprocal depression in lead aVR
  • PR-segment elevation in lead aVR helps tell pericarditis apart from a heart attack on ECG
  • Widespread T-wave inversion marks stage III of the ECG evolution
  • Meeting 2 or more of the listed criteria makes the diagnosis definitive rather than probable
  • A pericardial effusion drops mitral inflow velocity by 30% on inspiration on echo
  • Cardiac MRI is recommended when the diagnosis is unclear or myocarditis is suspected
  • Emergency pericardiocentesis is needed for cardiac tamponade
  • A pericardial fluid glucose-to-serum ratio under 0.3 with neutrophil predominance points away from TB or malignancy
  • Confirmed TB pericarditis is treated for at least 6 months
  • Pericardiectomy is considered if symptoms have not improved after 4 to 8 weeks of TB therapy
  • The fluid names the cause: thick and cloudy is usually bacterial, caseous strongly suggests tuberculosis, and blood-stained points to malignancy, tuberculosis, or recent cardiac surgery

If not this — what else fits (7)

  • Stable angina or an acute coronary syndrome can present with similar chest pain
  • Subendocardial ischemia from aortic stenosis or hypertrophic cardiomyopathy is a differential
  • Aortic dissection is an important differential to exclude
  • Pulmonary embolism causing pleurisy is on the differential list
  • Costochondritis, oesophageal spasm, and peptic ulcer disease are also differentials
  • Referred pain from another organ, such as acute cholecystitis, should be considered
  • Bone-related pain and angina are also listed among the differentials for this chest pain

SourceStatPearls "Pericarditis" - disease-level clinical article

Presentation findings are traced to the source above.

1

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

600 mg orally every 8 hours (1800 mg/day) for 1 to 2 weeks, guided by symptoms and CRP, then tapered (decrease dose by 200-400 mg every 1-2 weeks). x 1 to 2 weeks, then tapered

Paediatric dose

The guideline is written for adults. Pericarditis in a child is a paediatric cardiology problem, not a primary-care dosing decision.

Choice

Alternatives. The cited guideline names aspirin and NSAIDs together as the mainstay; ibuprofen is the cheaper and the one most reached for outside a post-infarct patient.

Dose source

2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64)

Why

The guideline names aspirin or an NSAID as the mainstay of therapy for acute pericarditis, and gives ibuprofen at 1200-2400 mg/day with treatment duration guided by symptoms and CRP.

Cautions
  • Confirm the diagnosis before treating: pleuritic chest pain relieved by sitting forward, a friction rub, widespread ST elevation or PR depression on ECG, or a pericardial effusion. Chest pain is not pericarditis until the alternatives are excluded.
  • GASTROPROTECTION is part of the recommendation, not optional - the guideline states it should be provided with aspirin or an NSAID at these doses.
  • Taper rather than stop abruptly; the guideline recommends tapering be considered.
  • Rest matters and is the guideline's first non-drug recommendation: restrict activity beyond ordinary sedentary life until symptoms resolve and CRP normalises.
  • Refer the same day if there is fever above 38C, a large effusion, tamponade, trauma, immunosuppression, anticoagulation, or a failure to respond after a week - these mark a poor prognosis.
  • Rising troponin means myopericarditis, which is a different problem and needs cardiology.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP
2

ACETYLSALICYLIC ACID

1st line

Formoral.solid

Adult dose and duration

750-1000 mg every 8 hours for 1 to 2 weeks, then tapered. Preferred over an NSAID when the patient already needs aspirin, for example after a myocardial infarction x 1 to 2 weeks, symptom and CRP guided

Paediatric dose

NOT for children. Aspirin in a child carries the risk of Reye's syndrome, and paediatric pericarditis is a cardiology problem in any case.

Dose source

2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64)

Why

The guideline names aspirin alongside NSAIDs as the mainstay of therapy. It is the anti-inflammatory of choice where antiplatelet treatment is wanted anyway, since an NSAID would otherwise be added on top of it.

Cautions
  • Sold in Egypt as acetylsalicylic acid - aspirin is the common name, not the register name.
  • This is anti-inflammatory dosing, several times the antiplatelet dose - do not confuse it with 75-150 mg once daily.
  • GASTROPROTECTION is part of the recommendation at this dose.
  • Confirm the diagnosis before treating: pleuritic chest pain relieved by sitting forward, a friction rub, widespread ST elevation or PR depression on ECG, or a pericardial effusion. Chest pain is not pericarditis until the alternatives are excluded.
  • Taper rather than stop abruptly.
  • Acetylsalicylic acid is not for children - there is a risk of Reye's syndrome.
Egyptian brands
Egyptian brandManufacturerIndicative price
ASPOCID 300 MG 200 TABS.CID80.00 EGP (0.40/unit)
AGGREX 75MG 60 TABS.RAMEDA33.00 EGP (0.55/unit)
ASPOCID 75MG 20 TAB.CID22.00 EGP (1.10/unit)
ECOPRIN 325MG 10 ENTERIC COATED TAB.SIGMA5.00 EGP
RIVO 75 MG 30 CHEW. TABS.ARAB DRUG COMPANY (ADCO)21.00 EGP
ASPRICARLO 81MG 30 CHEWABLE TABS.EUROPEAN EGYPTIAN PHARM. IND.45.00 EGP
ASPIRIN PROTECT 100 MG 30 GASTRO-RESISTANT TABS.MEMPHIS > BAYER BITTERFELD GMBH-GERMANY78.00 EGP
JUSPRIN 81 MG 60 E.C.TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > JULPHAR81.00 EGP
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Pericarditis - disease-level clinical article (acute-pericarditis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - The admission criteria for poor prognostic markers are fever >38°C, subacute/recurrent presentation, large effusion, cardiac tamponade, or failure to respond within 1 week.
4

COLCHICINE

add-on - not a substitute

Strength0.5 mg

Formoral.solid

Adult dose and duration

0.5 mg ONCE daily if under 70 kg, or 0.5 mg TWICE daily if 70 kg or over, for 3 months. After a recurrence the guideline's trials used 6 months x 3 months (6 months after a recurrence)

Paediatric dose

The guideline is written for adults and does not dose children for this indication.

Dose source

2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64)

Why

The guideline recommends colchicine as first-line therapy in addition to aspirin or an NSAID, at low weight-adjusted doses. It is what reduces recurrence, which is the main problem in this condition - so it is an add-on to the anti-inflammatory, never a replacement for it.

Cautions
  • GIVE IT WITH THE ANTI-INFLAMMATORY, NOT INSTEAD OF IT. It is what cuts the recurrence rate, and recurrence is the main problem in pericarditis.
  • The dose is weight-split at 70 kg: 0.5 mg once daily under 70 kg, 0.5 mg twice daily at 70 kg and over. It is NOT the gout regimen.
  • Egypt's commonest colchicine tablet is 1 mg, so the 0.5 mg dose usually means half a tablet; 500 microgram and 0.6 mg tablets are also registered.
  • The colchicine product label does not carry pericarditis - it covers gout and familial Mediterranean fever. This dose is from the ESC guideline, not the licence.
  • Reduce or avoid in significant renal or hepatic impairment, and it interacts dangerously with clarithromycin and with statins. Colchicine 500 microgram tablets SmPC (https://www.medicines.org.uk/emc/product/100968), s4.5: "Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a P-gp inhibitor ... or a strong CYP3A4 inhibitor (e.g. ritonavir, atazanavir, indinavir, clarithromycin, telithromycin, itraconazole or ketoconazole)"; and "The risk of myopathy and rhabdomyolysis is increased by a combination of colchicine with statins, fibrates, ciclosporin or digoxin."
  • Diarrhoea is the usual reason it is stopped; it is dose-related.
  • Confirm the diagnosis before treating: pleuritic chest pain relieved by sitting forward, a friction rub, widespread ST elevation or PR depression on ECG, or a pericardial effusion. Chest pain is not pericarditis until the alternatives are excluded.
Egyptian brands
Egyptian brandManufacturerIndicative price
COLCHICINE 500 MCG 100 TABS.EL NASR190.00 EGP (1.90/unit)
COLMEDITEN 0.5 MG 100 TABS.KAHIRA190.00 EGP (1.90/unit)
GOURYST 0.5 MG 100 TABS.PHAROPHARMA190.00 EGP (1.90/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.