Can you split Prednisone dose for GCA?

Posted by isabelle7 @isabelle7, Feb 26 8:20am

My husband has giant cell arteritis and PMR. Is Dr. insists he cannot split his 80 mg dose for GCA and must take it all at once. His experience with PMR was dosing in the morning and in the evening, which worked. Dosing only one time a day did not work for him, he was getting repeated headaches at night, and ended up in the ER. They gave him three days of 1200 mg steroid IV infusions and right now his pain is gone. And he is able to sleep. However, tomorrow he begins one time a day dosing again at 80 mg and we are hoping the headaches do not return. Has anyone split a dose for GCA and had positive results? And was the doctor OK with it?

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@isabelle7

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.

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The day after the last two injections of Actemra i have experienced blood pressure readings quite a bit lower than normal and unusual fatigue. Back to normal the following day.

Split dosage:
I would follow the recommendation of the Chief of Rheumatology.

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@isabelle7

I agree. We might have to try to get a new rheumatologist.

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I had to get a new Rheumatologist. My first one kept treating my GCA as PMR. She was a scientist, not a doctor.
Make sure your new Rheumatologist is a DOCTOR.

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@moldy

When I was on Prednisone for my GCA, I split my daily dosage anyway I wanted with no ill effects because I thought I was supposed to. Three 10mg tablets a day I assumed meant one every 8 hours, so that is what I did. I didn't realize that I COULD take it all at one time. After being off Prednisone for 6 months and being put back on it for 6 months prior to switching to Actemra, I just took the entre daily amount at one time. Felt no difference between the two ways.
Actemra worked fine for me for the 90 injectins I took (on each week). No side effects, and it cleared up my GCA to the point I was able to stop taking it after 90 weeks. There has been a slight expected "back slide" after stopping. I now have periods of tiredness during the day similar to the feeling I had prior to taking it. But, my doctors haven't pinpointed the reason. Many things can cause this including poor sleep habits, depression, medical, or other medications. I think I should have continued the Actemra, but at a lower dose. My clotting platelets were creeping lower with the Actemra and I have a touch of thrombocytopenia so that was an added incentive to cease the Actemra. Once off the Actemra, my platelets went back up.

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Thank you for sharing your experience with Prednisone dosing and your experience with Actemra. It is very helpful to people like us who are new to this. Also thanks for sharing the effect the Actemra had on your clotting platelets and that once off it, they went back up. One more thing we can watch for as he is on the Actemra. And the thought you should have possibly eased off it rather than a sudden stop. Something to ask the docs about. Thanks again.

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@bws

The day after the last two injections of Actemra i have experienced blood pressure readings quite a bit lower than normal and unusual fatigue. Back to normal the following day.

Split dosage:
I would follow the recommendation of the Chief of Rheumatology.

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Thank you for sharing your experience on Actemra and your thoughts on the split dose.

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I did drop a little on the Acterma, a couple months of alternate weeks instead of weekly, but that was to see if my infection would rise back up as opposed to withdrawal. As far as Prednsone, taper off as low as you can reasonable go for as long as you can. My first rheumatologist had me stop that abruptly at around 10mg. Had withdrawal like you see dope addicts in movies. Dry heaves, severe vomiting. I had to go back on 20mg and taper off again at MY speed down to about 1/2 mg every other day.

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@moldy

I did drop a little on the Acterma, a couple months of alternate weeks instead of weekly, but that was to see if my infection would rise back up as opposed to withdrawal. As far as Prednsone, taper off as low as you can reasonable go for as long as you can. My first rheumatologist had me stop that abruptly at around 10mg. Had withdrawal like you see dope addicts in movies. Dry heaves, severe vomiting. I had to go back on 20mg and taper off again at MY speed down to about 1/2 mg every other day.

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I'm so sorry your doctor misled you and had to quit abruptly. Everything you read says you taper slowly and never stop abruptly. That must have been miserable. I've heard you can abruptly stop Actemra with no side effects, unlike Prednisone.

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Yes, the Actemra is quite forgiving. No noticeable side effects while on it either. It IS rough on teeth and bones, he'll probably be advised to add calcium to his diet.
On Prednisone I had high sugar, I swelled up and looked like a "cabbage patch" doll (and I don't like cabbage patch dolls : ).

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@moldy

Yes, the Actemra is quite forgiving. No noticeable side effects while on it either. It IS rough on teeth and bones, he'll probably be advised to add calcium to his diet.
On Prednisone I had high sugar, I swelled up and looked like a "cabbage patch" doll (and I don't like cabbage patch dolls : ).

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Thanks for the info on Actemra. I didn't know that about teeth and bones. I had read that was a possible issue with Prednasone. I've asked my husband's rheumatologist about adding calcium and Vit D since I've read over and over that it's suggested and she said no. I will ask again and ask her to explain why. We are going to get a baseline bone density test done in the next couple of weeks. Any idea why she'd say no?

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@isabelle7

Thanks for the info on Actemra. I didn't know that about teeth and bones. I had read that was a possible issue with Prednasone. I've asked my husband's rheumatologist about adding calcium and Vit D since I've read over and over that it's suggested and she said no. I will ask again and ask her to explain why. We are going to get a baseline bone density test done in the next couple of weeks. Any idea why she'd say no?

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Hmm. I’m not sure why she’d say no, unless maybe she meant it wasn’t an absolute must? I don’t see how that could be harmful unless you take too much calcium. Vitamin D would be hard to over-do.

My father is taking Fosomax to prevent bone loss and he was already prescribed a multivitamin that includes calcium and vitamin D because he’s mostly on tube feeding.

I’d be interested to see what they say.

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@isabelle7

Thanks for the info on Actemra. I didn't know that about teeth and bones. I had read that was a possible issue with Prednasone. I've asked my husband's rheumatologist about adding calcium and Vit D since I've read over and over that it's suggested and she said no. I will ask again and ask her to explain why. We are going to get a baseline bone density test done in the next couple of weeks. Any idea why she'd say no?

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My Doctor warned me that taking Calcium supplements alone can be a problem. It isnt well absorbed by the body and can leave deposits in blood vessels and kidneys. Better to get it from your diet. Not as much of a problem if taken in combination with vit D3 and K2, not sure why ?

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