Review Article
Background: Myopericarditis, defined by concurrent myocardial and pericardial inflammation, has emerged as a frequent pandemic syndrome. Colchicine is an anti-inflammatory alkaloid recognized as a cornerstone in pericardial disease. Recent data support its expanding role across post-pandemic inflammatory cardiovascular states.
Methods: We reviewed literature from 2019–2025, including randomized controlled trials, meta-analyses, guideline statements, and registries, was synthesized to provide an integrative review.
Results: Colchicine exerts pleiotropic anti-inflammatory effects through inhibition of microtubule polymerization and NLRP3 inflammasome activation, reducing interleukin 1β, interleukin 6, and C reactive protein expression. Clinical studies in pericarditis and myopericarditis demonstrate accelerated symptom resolution and reduced recurrences by 25–50%. In the setting of acute COVID 19 illness, meta-analyses identified decreased oxygen requirement (RR 0.07, 95% CI 0.02–0.27) and mortality reduction (RR 0.35, 95% CI 0.15–0.79) without major safety issues. In reports of myopericarditis arising during the COVID-19 pandemic, colchicine has been associated with a reduction in symptoms and prevention of recurrence. Parallel cardiovascular outcome trials (LoDoCo2, COLCOT) show 23–31% reduction in major adverse cardiovascular events, leading to FDA endorsement (2023) of low dose colchicine for secondary prevention in atherosclerotic cardiovascular disease (ASCVD).
Conclusions: Colchicine represents a mechanistically coherent, evidence supported, clinically indicated oral anti-inflammatory for pandemic acute and subacute myopericarditis. Given its favorable safety profile, mechanistic overlap of post viral and iatrogenic pericardial, myocardial, and atherosclerotic inflammation, and now regulatory endorsement, continued and extended use is justified in patients with pandemic associated myopericarditis and who are at high risk of atherosclerotic events.
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