pdsmith, I can feel mestinon working after about 20 min. It may reach full effect after an hour. It isn't the type of drug that takes weeks to 'kick in'. It doesn't help everyone, but for those it helps, it really is a good drug. Your comment about bowel and twitching are typical side effects. I take 30mg every 2 hours as needed. If I don't need it to relieve symptoms, I don't take it. Talk to your neuro about how to best take it for your situation. I hope it can help you and I hope you feel better soon.