Can you split Prednisone dose for GCA?

I don’t have experience with a split dose for GCA, but this is a great group and hopefully someone else will chime in.

From my experience, a split dose is less common and it’s not mentioned as frequently in the literature or proposed first, but can be done for PMR if you’re having side effects. That’s what happened to my dad, but it turned out a split dose was worse for him, go figure. I didn’t find any data on GCA specifically.

Were you able to ask the doctor about your concerns and why they didn’t want to split the dose? If it’s a safety or an “evidence shows” reason, that would make sense, but I’m wondering if it’s just not something the doctor is used to which led them to give a flat out “no.” My dad and I both have significant medication sensitivities and need to adjust doses and tapering/titrating schedules often, but just for this. But we’ve found some physicians are simply not flexible. If it’s a gray area, hasn’t been proven ineffective or unsafe, and makes you and your husband more comfortable, I don’t see why it would be a problem.

Hopefully someone else will chime in, and wishing you all the best.

Hi @isabelle7, While you wait for others with experience with Giant Cell Arteritis (GCA), there is another discussion that might be helpful on splitting the prednisone dosage.
--- Divided dose or all at once?: https://connect.mayoclinic.org/discussion/divided-dose-or-all-at-once/

I did find some information from 2020 that discusses the question under topic 5 on page 14.

"This evidence, albeit low quality, raises concerns that alternate-day dosing may be associated with a higher relapse risk. Splitting the dose over the day does not seem to confer benefit and potentially carries risks of disturbance of diurnal rhythms, including sleep [96, 97]. In summary, in GCA there appears to be no reason to alter the standard guidance in other medical conditions to prescribe glucocorticoids as a single daily dose in the morning [12, 91]."
--- British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis:
https://pmrgcascotland.com/wp-content/uploads/2022/08/BSR-2020-Recommendations-for-the-management-of-GCA.pdf
Can you ask your local pharmacist about splitting the dose to see if they may have any suggestions?

Thank you @johnbishop - I appreciate the feedback and will check those links. His doctor has been very adamant that he not split the dose. However, when he had just PMR (just diagnosed with GCA last week following positive temporal arterial biopsy.) It's been a hard road with doctors not believing that he had GCA, even though he had all the listed symptoms other than blindness and he'd had PMR since May 2023. He'd been treated with Prednisone, dosing in the morning and at night per his same doctor that is insisting on one-time per day dosing. I wonder if he should have been on one dose the whole time since he developed PMR. He ended up in the ER for the weekend. They're doing 3 days of methylprednisone IV infusions (1,200 mg each) and after 2 he's pain free and sleeping. He has his last today then goes to 80 mg in the morning. We are praying the severe nighttime headaches don't return. That is what sent him to the ER when the doctor told us not to use any more Tylenol. It's been a ride.

I have GCA. I split my prednisone dose after the first week, with my Doctor saying either daily or splitting is okay so long as the prescribed dosage is taken daily.

I began at 40 mg and have now tapered down to 10 mg daily plus Actemra once weekly.

Thank you for your response. I have asked the doctor and she is adamant that he must take the Prednisone dose one time per day for GCA. It's very frustrating. She has put him on Actemra starting now. We just picked it up. How has it been for you? My husband has a cough so I'm worried about giving him the shot until it clears up. She knows he has a cough and still prescribed it. Have you experienced having a virus while being on the shots?

Splitting the Prednisone dose seems to be one of the more contentious issues with PMR. Your Dr seems to be taking the hard line on following standard guidelines because your husband has the more serious GCA disease and it could be a liability issue for them if something goes wrong. If you read up on how long Prednisone is active over the 24 hr period, there is a period where its effectiveness drops right off after 12 to 16 hrs which leaves you with pain in the middle of the night. So the argument that an evening dose is going to interfere with sleep is invalid because pain is already doing that ! The real reason it's not a great idea is that apparently there is evidence that you are more likely to suffer long term Adrenal insufficiency. This is also an invalid argument in your case because at 80mg AI is a likelihood anyway. Then there's the diurnal rhythm argument, well our bodies do have a slight uptick in cortisol in the evening and all you are doing with a smaller evening dose than the morning one, is mimicking your body's natural rhythm. Finally, does an evening dose make it harder to reduce when you get to single digits, in my case yes, but is it worth that risk to get a peaceful night..you decide.

Interesting development today. I called the doctor’s office and told a nurse that what the doctor has asked us to do - let him develop a headache, go get labs while I call the doctor or if it happens outside of business hours to go to the ER - is just not working. And that her treatment plan was not sustainable. This nurse took the time to really listen. I explained he’s on 80 mg and that his doc (rheumatologist) said he must take it all at once. I explained that we have gone around and around about this issue and she just won’t budge.

The nurse took the initiative and spoke with the Chief of Rheumatology who said 80 mg is too high a dose to take all at once and that we should split the dose. She said she is fine with us splitting it any way that works to eliminate the headaches.

Wow! I think I will take the advise of a Chief of Rheumatology over our current doctor who initially told me she thought I was wrong and that she didn’t think he had GCA. I had to fight to get the biopsy which came back positive. Then he ends up being resistant to treatment, hospitalize and with 1200 mg IV infusions of methylprednisolone.

It’s been a ride. He first had PMR diagnosed back in May.

Well done for standing your ground and being an effective advocate for your husband. Theres a time for sticking to Doctors advice and a time to dig your heels in..if something doesnt feel right its time for a second opinion. This forum is great for helping us to navigate this fine line.

Thank you for that.

How is the Actemra working for you? Did it help to reduce prednisone? My husband is asking if you had any side effects from the Actemra. Also, he’s on 80 mg right now of the prednisone and we are contemplating having him take 60 mg in the morning and 20 mg in the evening. That’s my recommendation. He would prefer to do 50 mg in the morning and 30 mg in the evening. Yesterday he took 80 mg in the morning before they told us we could split it. He took an additional 20 mg in the evening and did great. He woke up headache free. And in much better spirits. The Chief of Rheumatology said 40/40 or to play with it and find what works so long as it’s 80 mg per 24 hour period.