Although all of us who take mestinon use it for activity, some of us have more breathing and swallowing problems than others. For those of us with that kind of difficulty, a nighttime dose is helpful in allowing bedtime without gastroesophageal reflux. It also helps to have supper early in the evening if there are problems. Although nighttime activities may be minimal, breathing is essential and reflux can lead to aspiration. If you have been gagging or coughing at bedtime, then a dose shortly before bed may be very helpful and prevent potentially dangerous problems, including aspiration pneumonia.

Although this may never be a problem for you, it is more common than many neurologists recognize and being aware of potential complications may help avoid them. The first time I hopped instead of pushing myself out of my chair at dinnertime (first dose of 30 mg), I was so excited, I said to my hubby, "Did you see that?"

There is more information about Mestinon in the Links Group which may help with understanding how you want to take your medication.
http://www.dailystrength.org/groups/myasthenia-gravis-links-and-news/discussions/messages/15137981 b.

I was instructed to take my first 60mg as soon as I woke up and I am find taking it with no food. Second is with lunch, third with dinner. I was told I could take a fourth at bedtime if I am very weak in the morning but I'm not, and the bedtime test gave me no better results.

If my meals are delayed (like when we were in Spain and dinner usually starts at 9pm) I keep on my 7am, noon and 6pm dosing or else I am so weak I can hardly eat the late meal.
Flutebell

Yesterday was my first full day of Mestinon. I took the first dose about 7 am. I kept a log as suggested.

I noticed I was able to step in the shower while facing it at 8 am. I usually have to stand sideways and use the bars to hold onto to get in.

At noon I tried leg lifts and could do three. Was not able to step in tub. Took another dose at 12:20. Tried the leg lifts at 1:00. I could do seven. Was able to step in tub twice. At 2:00 went to husband's doctor appointment. Was able to stand from chair without using arms. I asked my husband if he saw that and did it again for good measure!

Took last dose at 5:30. Picked son up from church at 8 pm and was able to stand for over ten minutes and visit with a friend. Then I drove home and still felt okay so I did the dishes.

I am very encouraged and will continue to keep a log to monitor.

Happy for you!

Just repeat, take with food, never on empty stomach. I like some one else had to take Imodium for a while until my stomach got used to the mestinon.
Good luck

Yes, i have noticed I am having that side affect also, even though I try to take it shortly after meals. I hope it will settle as it gets more used to the medicine.