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I take Pyridostigmine 180mg ER once in the mornings. I do have eyelid twitching and other random twitches during the next two or three hours after I take it. I also sometimes have trouble moving my tongue during that time which makes it difficult to speak clearly. This is annoying, but the benefits of taking the medicine far outweigh this side effect in my case. As I’m reading everyone’s experience with cramping, I feel very grateful I do not currently experience that.