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Can you split Prednisone dose for GCA?
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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It's good to hear that the 20 mg dose of prednisone made you feel better. Hopefully taking the full 60 mg dose will take care of all of your problems. I can honestly say that since I started treatment for PMR and GCA I haven't had any symptoms or pain from either disease.
I'm like you in that I took Tylenol for several months to treat my problems, and it helped some, but it seemed to wear off fairly quickly and didn't relieve all my pain. The prednisone and Actemra are much more effective.
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1 ReactionI have been treated for PMR and GCA for 2 years I'm afraid. I'm 79 years old and I am unable to get actemra, long story. I don't separate my dosage but I take it at 4:00 in the morning. This is because it takes several hours to be fully active in your system and that's about the same time that your natural cortisol would be at its highest level. I can do this because I have no problem falling back asleep. In the whole time it it's only been maybe once that I had trouble getting back to sleep.
I do this based on the work of a British doctor who tells his patients to take it at 2:00 a.m. . But 2:00 a.m. doesn't make sense to me because the highest level naturally is six or seven a.m.
I have been on longer than I would have expected but I've had several setbacks. I had COVID and then I had surgery and both of those things sent my symptoms skyrocketing. Overall though I have felt very well throughout my journey. My doctor is impressed with my blood work. I have a supplement and dietary routine that I stick to religiously. I get a great deal of exercise, momostlyy walking my dogs.
I don't think splitting the dose makes a lot of sense because that's not how your body works in terms of cortisol.
@alonna I was similar to you when I was taking prednisone to treat GCA. I would take it around 4 am, partly because it fit my schedule, and I had read that the body releases inflammatory substances like cytokines at that time. The single dose worked ok for me. I started taking Actemra 6 weeks after being diagnosed. I'm still taking Actemra, but I finished prednisone about 6 months ago.
I think for some people a dose of prednisone doesn't last 24 hours, and they are the ones that benefit from splitting a dose.
@alonna
"I don't think splitting the dose makes a lot of sense because that's not how your body works in terms of cortisol."
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I understand what you are saying. I mostly agree with you. However, it isn't possible to duplicate how our bodies work in terms of cortisol. By taking prednisone we stop the production of cortisol and how the HPA axis works. No matter how we take prednisone, we don't even come close to how the body works.
@alonna First I want to talk about prednisone. Per Dr Google this is what he says -
"Prednisone typically begins working within 1-2 hours after oral administration, with peak effects occurring around 1-2 hours after ingestion. The duration of action for a single dose is approximately 12-36 hours, which allows for once-daily dosing in most cases."
So you are right, 2am dosing seems off. Based on Dr Google's information, I would delay the 4am to say 5am to see if that works better for you based on your daily routine. You only need enough oral prednisone to be pain free, have you tried to lower your dosage at all? With CGA you will not be able to come off the prednisone unless or until you are able to get on a biologic for the GCA, so taking the least amount of prednisone is critical. (Next msg will speak to a biologic for your GCA)
I recently started injections for my GCA and am still on prednisone. I wake around 6am, take my thyroid meds on an empty stomach. Take my 10mg prednisone an hour later, eat breakfast within 30 mins and then take doxycycline (an antibiotic I take - long story) immediately after breakfast. I also take three calcium pills, evenly spaced during the day, another doxy with dinner and then my blood pressure med at bedtime. I actually set my phone alarm to remind me to take my calcium pills daily.
@alonna I was Dx with PMR in 2020, been sick for a year prior to Dx. Was Dx with asymptomatic GCA Vasculitis in Nov 2025. I live in Texas, and am a few years older than you. My doctor wanted to put me on Actemra immediately, I did extensive research and discovered that starting in 2026 Actemra would no longer be covered by Medicare drug programs. Tyenne is the accepted biosimilar drug for Actemra and is a fraction of the price. Tyenne was going to be covered by Medicare drug plans starting in 2026. I decided to wait until Jan 2026 to start the home-based injections. I have only had 7 of the weekly treatments. I should be able to begin tapering my prednisone in the next several weeks.
Please do your research to determine if you are able to go onto Tyenne where you live, it is much cheaper than Actemra and thus is available to more patients. Tyenane actually has the very same active drug as Actemra, the only differences are the compounding ingredients, like water, preservatives, etc.
Let me know if you have any questions I can help with. Try not to be afraid, fear does not help solve problems. Knowledge is Power!
Hi! I am new to this phase. My hospital lab shows my IL-6 at a ‘high’ 2.8. I tested because I might have GCA and would like to have Actemra prescribed for my “possible RA/PMR” issues. (I’m the one with uncontrolled pain and bone destruction after taking a shingles shot.)
My question to y’all is what blood markers did you have that determined your GCA? Also, this lab’s parameters are way lower than those written about in say Google. I don’t know if 2.8 is in the mild or horrible range. I appreciate your thoughts.
@susanlf And I just realized I forgot to add the hospital lab’s range is < 2.
@susanlf My GCA was diagnosed with CRP (9.19) and ESR (54), along with several common symptoms. My IL-6 has never been tested. From what I can tell online, your IL-6 is normal (less than 5).