I take 60 mg every 4 hr and the time release 180 at night. I mistakenly took a double dose one time of the 60 mg and did not have any ill-effect. In fact, I have never had a bad side-effect from mestinon.

I have MG. I think I have some autonomic dysfunction as well - dizziness, balance problems, tinnitis, profuse sweating, body temperature increases/fevers, abdominal cramps and diarrhea. If I miss my mestinon dose, the diarrhea starts.

Good luck
kathie