You might want to talk to your doctor about changing the "timing" of your dosages. My understanding is that most people with MG can tolerate a certain dosage level of Mestinon, but it can wear off more quickly with different people (same thing goes for days when you do more activity).

If I'm not mistaken, your body won't let you take "too much" Mestinon - as you've noticed, when you do, you start to feel bad. However, there can definitely be the opposite - you can take "too little", and that can end up making things worse.

Think of it kind of like insulin for a diabetic - they are constantly having to monitor their blood sugar, and whenever their numbers get bad, they have to give themselves an injection - it doesn't really matter when the last one was, their body chemistry is off, and they need to get everything back to normal.

The same thing applies to people with MG - if we don't have enough "juice", we have to boost our system. If we don't, our bodies will become even more tired, which will require more of our precious energy. It then becomes a vicious cycle. It is so much better for our bodies to maintain a relatively level amount of acetylcholine so that our muscles can operate at peak efficiency.

I know that some people don't want to take any more medicine than is absolutely necessary, but in the case of MG, it is absolutely vital that we constantly replenish our body's ability to process acetylcholine, and at the present time the only way to do that is to take medication.

I'm one of those "Mestinon trial = MG diagnosis" folks. I know that if I don't take my meds on time, I pay for it later. As I said, talk to your doctor and see what he/she says about the possibility of taking a small dose more often - you'll probably find a dosage and a schedule that works for you!