There are things that can affect dosage and dont think neuros necessarily know them all and we are individuals. For me it took more than a year to learn all the various things that affect mestinon and me. As I enter winter and my muscles do better just from the constant cold I would need to cut back. That first winter was very hard on mestinon generic as I did not know this. I had some bad reactions that include some of what you are saying. AT this point I think at one time or another I have had all of what you are experiencing. I started on 60mg every 6 hours. I dont take near that now. The gastro intestinal is so strong I cant tho my breathing could use it and legs. I have to take small doses more frequently.

That first winter the generic drug company changed the pill too! That caused even more problems. There was the thing with the tablets disintegrating and I believe that added a coating tho they never admitted such. I filled a complaint with them and the FDA and had to get off it going to non generic which to me in winter seemed stronger than the generic. STill does. The pill looked different. Same size and markings but it was now harder and kinda shiny so to me that seemed like an attempt to coat the pill to make it better but for me it meant a big bad reaction forcing me to totally stop while my neuro got the approval and ordered nongeneric.

I KNOW my body responds differently to mestinon when my vitamin D-hyperparthyroid mess is going on stronger and that progressed and got worse that first winter and has never gotten back to where it was prior to that till maybe now that I have a neuro that gets this issue as he has it himself so he is taking it very seriously. I will see now if my body goes back to a better place of tolerance as I take these vit D mega prescitption pills from my neuro.

I hope your neuro is understanding enough to check this all out with you. YOu know your body best.

Annie59