Mestinon Dosage/Direction for Use

When using Mestinon it is important to remember that the full effect appears gradually, usually within 15-30 minutes.
Use in Adult: 1-3 dragees (60-180 mg) 2-4 times daily, or higher doses if required.
The total daily dose is usually in the range of 5-20 dragees (300-1200 mg) but doses higher than these may be needed by some patients.
Use in Children: Children under 6 years old should receive an initial dose of 30 mg of Mestinon. Children 6-12 years old should receive 60 mg. Dosage should increase gradually, in increments of 15-30 mg daily, until maximum improvement is obtained. Total daily requirements are usually in the range of 30-360 mg.
Patients with swallowing difficulties can take tablets broken into pieces instead of the whole tablets or dragees. In myasthenia gravis, one dose is effective for approximately four hours during the day whilst at night (owning to reduced physical activity), a longer duration of effect of around 6 hours can be expected. It is recommended that times of administration  be chosen so that the maximum effect coincides with the most strenuous physical exertion, e.g. when getting up and at mealtimes.
Special Dosage Instructions: The required dose must be carefully titrated when used in paediatrics. In case of neonatal myasthenia, generally one treatment with neostigmine (Prostigmin) is preferred. However, if this appears unsuitable due to excessively cholinergic side effects, then Mestinon can be administered. In these cases, the following serves as a rough guideline: 5-10 mg by mouth in tablet form, 30-60 minutes before food. Treatment over the eight week if life is required only in extremely rare cases of congenital and familial infantile myasthenia. Pyridostigmine is mainly eliminated unchanged via the kidneys. Lower doses may therefore be indicated in patients presenting with kidney disease. The dose should be adjusted in line with the desired effect.