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At most I was only able to take 15mg every three hours five times a day but eating with it even a total of 1500 calories a day put on 20lb in months. I currently take generic liquid Mestinon 6mg (a half ml of 60mg/5ml) liquid.The last time I took it a couple years ago I could only take 2mg at a time, an equivalent of one thirtieth of a tablet as any more caused side effects. I stopped taking because of cost but this time I was able to get the insurance to lower the cost from $830 for eight ounces to $20 a month with the correct information. The Mestinon caused esophagitis, gastritis and duodenitis, severe flatulence, and the fact I am so sensitive that I cannot take more than a thirtieth to a tenth of a tablet euivalent that were documented so the insurance now pays. I am unable to take immune suppressants as I had tuberculosis exposure as a nurse treated for a year that contraindicates immune suppressants and the risk/benefit of IVIG or plasmapheresis related to my symptom severity rules that out also. While your provider and you need to look at other therapies including thymectomy even without thymoma as recommended in a New England Journal of Medicine article several years ago, you may find as I did that what is considered normal Mestinon dosing is too much for you too. If you cannot get your insurance to pay try the Patient Assistance Fund of the MGA.