Hello, I was originally started on generic Mestinon, Pyridostigmine Bromide 60 mg, 4 times daily, and IVIG (Gamunex) every 4 weeks. I had all the expected side effects with the Mestinon, the GI upsets, and runny nose. I found that mint calms the stomach, Imodium (Loperamide 2mg.) calmed the GI tract, and Guaifenescin helped with phlegm. I asked about time-release Mestinon and was brushed off, I kept asking about it and am now on it, 180 mg tablets. For me, it has been much better! Depending upon my symptoms, I'll take a half tablet twice a day when I'm feeling good, and gradually increase it to 3 tablets per day at my worst. The tablets give an immediate release of one third of the dose, then settle down to a slow release of the rest over the next 6 to 8 hours. Fewer side effects, and only in the beginning. I can't tell you how much more I prefer the extended release version over the fast acting tablets. They are about $30USD for me for a 3 month supply and worth every penny.
Sorry to have gone on, I'll just add that I'm also on Mycophenalate, and Vyvgart. I cannot take Prednisone as I am diabetic. Don't lose hope, once your Doctors get your meds dialed in, you can feel normal again. I'm getting back to that point, you will too! Stay healthy, Bob