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My neurologist (Canada) said the usual drug protocol upon generalized MG diagnosis is to treat for a year with low dose prednisone AND a longer term less invasive med like mestinon. I had elevated liver enzymes on mestinon which was replaced by mycophenylate. I was weaned off prednisone by 1 year & continued on mycophenylate alone. Mycophenylate is an immune suppressant, mestinon is not. Best to start with the less invasive treatment first.