I agree with the other responses, too much. Try taking just one pill when it's time, and if you notice weakness still add a half or even a quarter. I've had Mg for almost two years, and it took me about a year to understand my bodies needs. Now I take my mestinon as needed, which is usually about 1/2 a pill an hour. I had gotten down to around 8 quarters a day (two pills total). But if I take a whole pill all at once it's too much too fast, I let my MG tell me how much to take. I'm also on 180mg timespan tablets 2x a day, so i don't crash as hard in between doses of the quick release. It helps give me a little leeway on when and how much quick release I need. Hope this helps and finds you strong and healthy.
Jessica