Which drugs can cause pericarditis? A comprehensive guide

October 14, 2025 •

5 min read

While the incidence remains rare, multiple medications have been implicated in drug-induced pericarditis. These medication-related cases account for a small but significant portion of pericardial inflammation and should always be considered when a patient presents with symptoms, particularly after excluding common infectious or idiopathic causes.

Quick Summary

A review of medications linked to pericarditis, exploring drug classes like immunotherapies, chemotherapy agents, and certain antibiotics. It details the immune-mediated and toxic mechanisms, plus the symptoms, diagnosis, and prognosis of drug-induced pericarditis.

Key Points

Immune Checkpoint Inhibitors: These cancer treatments, like ipilimumab and nivolumab, are known to cause cardiac toxicity, including pericarditis, by triggering immune-mediated inflammation.
Drug-Induced Lupus: Certain drugs, such as procainamide and hydralazine, can induce a lupus-like syndrome, which often involves pericardial inflammation.
Chemotherapy and Cardiotoxicity: Cancer drugs like anthracyclines (e.g., doxorubicin) can directly damage heart tissue and lead to pericarditis.
Vaccine Association: A rare, but known, association exists between some mRNA COVID-19 vaccines and pericarditis, especially in young men, though the risk is much lower than from the virus itself.
Importance of Medication History: A detailed medication history is crucial for diagnosis, as discontinuing the offending drug is the primary treatment for drug-induced pericarditis.
Good Prognosis with Treatment: When recognized and treated appropriately, the prognosis for drug-induced pericarditis is generally good, with most patients making a full recovery.

What is Drug-Induced Pericarditis?

Drug-induced pericarditis is an inflammatory condition affecting the pericardium, the sac-like membrane surrounding the heart, that is triggered by medication. The exact incidence is rare and may not always be immediately recognized, as symptoms can mimic more common causes like viral infections. A patient's complete medical and medication history is therefore crucial for accurate diagnosis. The pathophysiology behind drug-induced cases varies, including immune-mediated reactions, lupus-like syndromes, and direct cardiotoxicity. When identified early, discontinuing the offending agent is the primary treatment and often leads to a good prognosis.

Medications associated with pericarditis

Many different drugs have been reported to cause pericarditis, spanning various therapeutic categories. These associations range from well-documented syndromes to rarer, individually reported cases.

Immunomodulatory Agents

This is a growing class of medications linked to cardiac inflammation, often due to their mechanism of action involving the immune system. The two most prominent classes are monoclonal antibodies that target specific proteins to modulate the immune response.

Immune Checkpoint Inhibitors (ICIs): Used in cancer treatment, ICIs like ipilimumab, nivolumab, and pembrolizumab can cause serious cardiac toxicity, including pericarditis and myocarditis, by unleashing the immune system to attack healthy tissue.
Anti-TNF drugs: Used for inflammatory conditions like rheumatoid arthritis, anti-tumor necrosis factor (anti-TNF) agents such as adalimumab and infliximab have also been linked to pericarditis.
Other Immunomodulators: Drugs such as mesalazine, sulfasalazine, and methotrexate, used for inflammatory bowel disease and other autoimmune conditions, are also associated with pericardial inflammation.

Drugs causing Lupus-like Syndrome

Certain drugs can trigger a systemic lupus erythematosus (SLE) -like reaction, which often includes inflammation of the serous membranes, such as the pericardium.

Procainamide: This antiarrhythmic agent is a classic, high-risk medication for inducing a lupus-like syndrome.
Hydralazine: An antihypertensive medication with a strong association with drug-induced lupus.
Isoniazid: An antibiotic primarily used to treat tuberculosis that is also linked to this syndrome.
Phenytoin: This anti-seizure medication has been reported to cause drug-induced lupus with myopericarditis in rare cases.

Chemotherapy Agents

Several drugs used in cancer treatment can have direct toxic effects on heart tissue.

Anthracyclines: Cytotoxic agents such as doxorubicin and idarubicin can cause direct cardiac toxicity, leading to acute pericarditis or myopericarditis.
Cyclophosphamide: An alkylating agent known to cause cardiotoxicity.

Other Implicated Drugs

Vaccines: In the post-COVID-19 era, a rare association between mRNA COVID-19 vaccines and pericarditis has been recognized, primarily in male adolescents and young adults. The risk is significantly lower than developing cardiac issues from COVID-19 infection itself. Other vaccines, such as smallpox and influenza, have also been associated.
Anticoagulants: Medications like warfarin and heparin can cause hemorrhagic pericarditis by causing bleeding into the pericardial sac.
Antipsychotics: Clozapine has been consistently linked to reports of myocarditis and pericarditis.
Miscellaneous: Other drugs reported in association include methysergide, minoxidil, and certain antibiotics like minocycline and penicillin.

How Drugs Trigger Pericarditis

The mechanisms by which medications cause pericarditis are diverse and often involve the immune system or direct cellular toxicity.

Immune-mediated mechanisms: Many drugs provoke an immune response that mistakenly targets the pericardium. This can manifest as a hypersensitivity reaction, where the body overreacts to the drug, or an autoimmune reaction, where the drug triggers the production of autoantibodies, leading to inflammation.
Drug-Induced Lupus: As mentioned, certain medications induce a syndrome that mimics SLE, characterized by autoantibodies (like anti-histone antibodies) and inflammation of serous membranes, including the pericardium.
Direct Cardiac Toxicity: Some chemotherapy agents directly damage heart muscle cells, which can trigger an inflammatory response in the surrounding pericardium.
Pharmacologic Effects: Certain agents, like anticoagulants, can lead to pericardial inflammation via indirect effects, such as causing bleeding in the pericardial sac.

Diagnosing and Treating Drug-Induced Pericarditis

Diagnosing drug-induced pericarditis involves a comprehensive approach, including a detailed medication history, physical examination, and various diagnostic tests. It is crucial to exclude other potential causes, particularly viral infections, which are far more common.

The diagnostic process includes:

Medical History: A thorough review of all current and recently discontinued medications is vital. Clinicians should specifically ask about agents known to cause cardiac side effects.
Physical Examination: Listening for a pericardial friction rub, a hallmark sign of pericarditis, is a key part of the physical exam.
Diagnostic Tests: These may include an electrocardiogram (ECG) to detect characteristic changes, an echocardiogram to check for pericardial effusion, and blood tests to check for elevated inflammatory markers and cardiac enzymes. In cases of suspected drug-induced lupus, specific antibody tests may be performed.

The most important step in treatment is the timely discontinuation of the suspected causative drug. For many cases, especially if caught early, this may be the only intervention needed. Additional treatment may involve:

Symptomatic relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin may be used to manage pain and inflammation.
Anti-inflammatory therapy: In some cases, especially if recurrent, colchicine may be added to reduce inflammation.
Corticosteroids: These are typically reserved for more severe or refractory cases, or when a specific autoimmune cause is confirmed, as their use is associated with a higher risk of recurrence.

Comparison of drugs and mechanisms


Drug Class	Examples	Commonly Associated Mechanism
Immune Checkpoint Inhibitors (ICIs)	Ipilimumab, Nivolumab, Pembrolizumab	Autoimmune/immune-mediated reaction targeting heart tissue
Drugs Causing Lupus-like Syndrome	Procainamide, Hydralazine, Isoniazid	Triggering of autoantibody production (anti-histone)
Chemotherapy Agents (Anthracyclines)	Doxorubicin, Idarubicin	Direct cardiotoxicity causing damage to cardiomyocytes
Anticoagulants	Warfarin, Heparin	Causing hemorrhagic pericarditis (bleeding)
Anti-TNF Drugs	Adalimumab, Infliximab	Immune-mediated inflammation
Vaccines (mRNA)	Pfizer-BioNTech, Moderna	Rare, immune-mediated reaction post-vaccination

Conclusion

While viral and idiopathic causes account for the majority of pericarditis cases, it is important for clinicians to be aware of the rare but significant association with medication use. Drugs spanning multiple classes, from immune modulators and chemotherapeutics to certain antibiotics and vaccines, have been implicated through various mechanisms including immune-mediated reactions, drug-induced lupus, and direct cardiotoxicity. The cornerstone of treatment for drug-induced pericarditis is the prompt identification and discontinuation of the offending medication, which generally leads to a favorable prognosis and complete recovery. This highlights the importance of a detailed medication history in every patient with suspected pericardial inflammation to ensure appropriate management and prevent potential long-term complications like constrictive pericarditis.

For more information on the management of acute and recurrent pericarditis, visit the American Heart Association's journals: https://www.ahajournals.org/doi/10.1161/circulationaha.111.066365.

Frequently Asked Questions

No, the incidence of drug-induced pericarditis is considered rare. While many medications are potentially implicated, it is a diagnosis of exclusion, and other causes like viral infections are much more common.

Common symptoms include sharp, stabbing chest pain that may worsen with breathing or lying down and improve by sitting up and leaning forward. Other symptoms can include fever, fatigue, and shortness of breath.

Diagnosis involves reviewing the patient's full medical and medication history, a physical exam (listening for a pericardial friction rub), and tests such as an ECG, echocardiogram, and bloodwork to check for inflammation and rule out other conditions.

Yes, certain cancer treatments, particularly immune checkpoint inhibitors and some chemotherapeutics like anthracyclines, can lead to pericardial inflammation due to immune-mediated reactions or direct cardiotoxicity.

The primary treatment is to discontinue the medication suspected of causing the inflammation. Supportive care with NSAIDs or colchicine may be used to manage symptoms, but steroid use is generally avoided due to a higher risk of recurrence.

Yes, anticoagulants like warfarin and heparin can potentially lead to hemorrhagic pericarditis by causing bleeding into the pericardial sac. This is a rare, but known, complication.

The prognosis is generally good, especially with early detection and cessation of the causative drug. Most patients make a full recovery, although complications like constrictive pericarditis can occur in severe cases if left untreated.