My BP is extremely low and I also break my tablets and take every two hours to keep from getting the highs and lows of a higher dose less often. I do have an occasional mild twitch, but don't know that I can blame that on mestinon. May I ask how you were diagnosed with Sjogren's ? I had positive SSA/RO antibodies, but have not officially been diagnosed with anything. The lab results say that these are an indicator of a connective tissue disease such as Sjogren's or lupus.

Also, what is PN? I have been diagnosed with Lems, but have been trying to unravel the assortment of additional symptoms I have that have not yet been addressed.
Thanks for any answers and hope that mestinon works well for you. It helped me survive until I got my Lems diagnosis.