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.
Children 6-12 years: 1 dragee (60 mg); <6 years: Initial Dose: ½ dragee (30 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.
Administration: When using Mestinon, it is important to remember that the full effect appears gradually, usually within 15-30 min.
Patients with swallowing difficulties can take tablets broken into small pieces, instead of dragees.
In myasthenia gravis, 1 dose is effective for approximately 4 hrs during the day, while at night (owing to reduced physical activity), a longer duration of effect of around 6 hrs can be expected.
It is recommended that the times of administration be chosen so the maximum effect coincides with the most strenuous physical exertion eg, when getting up and at meal times.
Special Dosage Instructions: When used in pediatrics, the required dosage must be carefully titrated.
In case of neonatal myasthenia, generally, 1 treatment with neostigmine 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 min before food.
Treatment over the 8th week of life is required only in extremely rare cases of congenital and familial infantile myasthenia.