when you go on prednisone they do reduce your mestinon/pyridostigmine dosage usually. I used to take 90mg every 4 hours, and then a mestinon slow release at night but they cut the slow release completely and I now take 60mg, 3x a day. They wanted to reduce it to 30 3x a day but I didn't feel it was enough so my doctor agreed. I am on 60mg of prednisone and now 150mg azathioprine too. Good luck, keep in mind that if you feel anything never hesitate to contact your neuro. Thats what they are there for.