Hi Bob - welcome!

When I first started taking Mestinon, I felt like I was drunk...and/or hung over. So, with my neuro support, I started taking a 1/2 tab (30 mg) every 4 hours. After quite a while, I went to a half tab every three hours, until finally I got the courage to try the whole tab...and it was fine. Been on 60 mg every 4 hours ever since. I have never been on timespan at night - not because there is anything wrong with it...I just don't need it.

And oh yes...in the beginning I had lots of twitches too. Drove me crazy! But that rarely happens now.

Always be sure to have something on your stomach when you take Mestinon (whatever the dose!) Mestinon does have nausea as a side effect - but having food on your stomach helps A LOT.

I hope you find the right adjustment by working with your neuro (yes they are all notoriously difficult to work with).

Are you by any chance taking prednisone as well? Pred and Mestinon is more powerful than Mestinon alone.