Mestinon takes about 20-25 minutes to get into your system, works for 2-2 1/2 hours and then is gone.

When I was taking 120 mg every 4 hours I had about 1 1/2 hours when I felt horrible. With my neuro's help, I changed to 60 every 2 hours and I have sustained help without the ups and downs. It might be worth discussing - maybe doing 30 mg every 2 hours instead of 60 every 4. The total dosage would be the same, but it might work more evenly.