I LOVE Mestinon. The 60mg at first sent me to hospital er.

Mestinon has a 4 hour range of staying in the blood stream. So I am now on 30-60 mg every 3 hours. The 30 mg is what I call the daily stabilizer.

I take the pill, wait 30mins and then I can take other daily pills (helps swallowing muscles) walk the dog as muscles now have "the energy source" to function.

In other words, my window of function is 30 mins after a pill -I can go for about 1 1/2 hours, then the next 30 mins I am crashing but have to wait for the 3rd hour before another pill.

If I go to the docs, conferences etc. due to the extra stress and demand of energy, I will start the day with 30 mg, then a 60, then a 30, a 60mg at end of day with a 30 before bedtime.

On low key regular days I simply take 30mg every 3 hours. Extra stress, activity, heat, cold etc can cause a bodily need for more Mestinon.

Just be very careful as an increase will cause cramping, diarrhea, runny nose, but mostly MORE weakness if the activity/stress level is not demanding a NEED for more Mestinon.

The lower dosage taken more frequently has been my safety net and I do not get any side affects this way and by taking the pill on the third hour I avoid a melt down for most days.

Go to Myasthenia Gravis chat room as there is more info on Mestinon there.

Hope this helps.

Also, you can tell if you have taken too much as the mucus(mouth, nose) will increase or you will start to feel cramping. If this is the case for me I will get up and do extra activity to increase body's need to help alleviate excess of mestinon in body - like walking around block etc until I feel symptoms of too much have subsided.

Sometimes if I have taken a 30mg and my breathing is still not improved I will increase by 15 mg and that will usually stabilize breathing.

My suggestion is go slowly, watch how your body responds, how much you need for different activities. CLose monitoring is needed. But, its my life saver.