My current dosage is 30 mg, but I was as high as 90 mg early on. My understanding is the max dosage is 120 mg, but you should talk to your neuro before you go higher.

You are right, it is as needed, and stays in your system about 4 hours. You may find that as your prednisone dosages go higher, your need might not be as much. I don't take it before bed or during the night since my doctor said to take it during waking hours

Remember to that we tend to more when we felt good.keep a journal of meds, symptoms ,activities etc.it'll help you and dr. After 5 yrs I still track on a small calendar since I tend to forget or downplay issues. Glad today is better ,also mestinon can cause tremors shakes.

from the UK medical drug site https://www.medicines.org.uk/emc/medicine/865

Myasthenia gravis

Adults

Doses of 30 to 120mg are given at intervals throughout the day when maximum strength is needed (for example, on rising and before mealtimes). The usual duration of action of a dose is 3 to 4 hours in the daytime but a longer effect (6 hours) is often obtained with a dose taken on retiring for bed.

The total daily dose is usually in the range of 5 - 20 tablets but doses higher than these may be needed by some patients.

https://www.medicines.org.uk/emc/medicine/865

I sometimes tried 120 per dose, but that was too much -- 90 worked better (1.5 pills) every 3 hours when I needed to be active and much less when I chilled. The "as needed" is messy for a prescription, so my neuro prescribed it at the maximum she thought I should take in a day. I never needed that much so had a few on hand as my prescriptions ran out. I was pretty paranoid I might run out of them and they were very much what kept me functioning until prednisone worked. I always took some before meals so I could chew decently.
Good Luck

I find that I have to stay on top of taking mine every 6 hrs. If I miss a dose, I will be worse off later.

If you need to take a little more, just nibble off a little chunk from a pill -- you can take up to 1/2 of a 60 mg mestinon pill on top of your normal dose. If I take 2 pills (120 mg) at once I get the heebie jeebies! Always take on a full stomach. ~Joe

I take 180mg of mestinon sustained release (timespan) once as soon as I wake up and once about 10pm every night. I also have 60mg that I take throught the day as needed. (usually between 2pm and 6pm if necessary) Over all, Ive found that the 180mg timespan works wonders for me.
However, I don't take Prednisone or any other form of steroids. They never had and benefits for me.

I am going to try and take the Mestinon every 6 hours w/o fail. I think I may have been too hit and miss. This Friday, I will up my Prednisone to 30 mg a day and see how that goes. I have stayed on 20 mg for 2 weeks and I think I need a bit more.

Again thanks everyone for your replies. You don't know how much I appreciate it.

I am currently on 30 mg of prednisone and have 60 mg tablets for mestinon. I was told I can take up to 6 pills of mestinon per day.

I was hospitalized recently, and they would give me 120 mg (2 tabs) of mestinon per dose. I continued this dosage after I was released, but went back to one at a time because I felt like taking two at a time didn't really make a difference.

It does stay in your system for about 3-4 hours. For me, I try to time my mestinon so that I take it about 30 min to an hour before I need to eat/talk for long periods of time, especially if I'm feeling weaker that day.

Mestinon is definitely something that you have to play around with because each person's body is different. I've been taking it for around 10 years now, and have found that I can take it once a day (on a really good day), and up to 6 per day. Hope this helps!

My doctor has also said sometimes when you take too much mestinon, it can actually make you weaker. Definitely discuss the dosage with your doctor to double check since everyone reacts to medicines differently.

Good to know Jess. He said I could take up to 4 tabs a day, so I am not going to go past that. I stayed on schedule today and I can see some difference, so I need to be diligent.

Out of curiosity -- is the doctor who says 4 per day a neurologist who specializes in MG? My first neuro told me that and I ended up in the hospital because I needed about twice that to breath decently early on. My next neuro was actually experienced with MG and gave me the explanation of "as needed' and a maximum dose at a time (120) and a maximum dose per day, and also what to watch for if I took too much. That was much better for me than the doctor who didn't understand MG and said take one every 6 hours. He just didn't know MG and MG meds and told me that and got me the appointment with the expert.

I am "supposedly" going to a neurologist who specializes in MG, but I am not that crazy about him. At first I was never actually diagnosed with MG, but due to some of the symptoms I had, sort of came to that conclusion. I had a brief few days of double vision, but it went away. All I really had was the progressive weakness and my eyelids would feel heavy at times, seem to be okay now. He started me on Mestinon 3x a day and then I went back after about 2-3 weeks and he started the Prednisone. I was scheduled to have an antiMUSK test, but it never got approved from my insurance company, so he decided to go with Plan B which was the Prednisone/Mestinion. I did have some other blood tests (came back negative) and 2 EMG/NCVs which the first was low abnormal and the second one showed signs of MG.

For the time being, I am hoping the Prednisone works with or without the Mestinon, but I know I can't go off the Mestinon now. Like I said in the previous post, the 4 tablets taken at 6 hour intervals seemed to help me more than 3. I have not had any untoward side effects from either medication so far.

Just keep in mind that Mestinon is a symptomatic treatment. Adjusting the dose based on the degree of symptoms you are experiencing seems logical. However, I have personally found that taking it an every 5-6 hours schedule produces better results for me.

5-6 hours seems to work the best for me as well. I think I might have been waiting to long and then had to play catch up and that wasn't working very well. When I increase my Prednisone tomorrow to 30 mg, see if that makes any difference as well, but I will remain on the same dosage of Mestinon. Hopefully that will be enough for me.

Easier to set alarm on phone to take meds than suffer later if I forget!