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I’ve had MG now for around 8 years. I have an excellent Neurologist now who specializes in MG. I’m 73 years young presently and over the years my doctor has adjusted my Mestinon as required. I think you might ask your doctor to try the generic version Pyridostigmine Bromide 180mg XR. The XR (extended release) should reduce or eliminate your jitters. I take one of these, every 8 hours, and it keeps me on an even keel. I take them, as well as a bi-monthly infusion of Soliris which I can only afford because I am on Medicare. I feel my MG is now well under control and am able to enjoy my retirement even though I have MG. I think the XR medication might be worth a try for you.