When I first started on Mestinon (60mg 3x), I had an immediate increase in my energy. It helped with my chewing and speaking issues, and I also had more strength in my arms. It also seemed to help with the droopiness in my eye, but never touched the blurriness or double vision.

Rogerm- I'm on Mestinon 3x a day too. My doctor didn't specifically instruct me to take it with a meal, but the issues with my chewing I was experiencing, I would time it about 30 minutes prior to eating each meal. It was the only way I could even think about eating, otherwise I didn't have the strength to bite through a piece of wet spaghetti. Thankfully, the IVIg treatment I'm on seems to be helping even more than the Mestinon, so I've been able to be a bit more lax about when I take the meds.