Renee, you will learn pretty soon that I sound like a "broken record" -- but, with you taking THAT much Mestinon -- are you drinking enough? I just take 60 mg at a time -- every 2 to 4 hours (depending on the day and my symptoms) -- but, it makes me NEED a LOT of fluid. Mestinon makes your kidneys and saliva and other secretions go into OVERDRIVE -- so, if you aren't replacing these fluids, then you may be experiencing some fatigue from dehydration. I would give that a try -- and just see if you can tell any difference.