Mestinon SR® 180 mg Sustained-Release Tablets for Myasthenia Gravis

What Mestinon SR® Is and How It Works

Mestinon SR 180 mg is a sustained-release form of pyridostigmine bromide used to manage symptoms of myasthenia gravis. It helps improve muscle strength by blocking acetylcholinesterase, which increases acetylcholine at the neuromuscular junction. This supports better nerve-to-muscle signaling through the day and night. Many people compare Mestinon SR 180 mg with the immediate-release tablets to reduce dosing frequency. Savings can help when purchasing Mestinon SR without insurance.

YouDrugstore is a licensed Canadian pharmacy headquartered in Manitoba, and prescriptions are reviewed by licensed pharmacists before dispensing. We ship to the US at Canadian prices and carry both brand and generic options when available.

We also work with licensed, vetted international partner pharmacies to source authentic brand medications and a broad range of generics at competitive prices.

Mestinon SR® tablets are taken by mouth. The sustained-release core provides a slower, longer effect than standard 60 mg tablets. Prescribers sometimes use the sustained-release tablet at bedtime to help with morning weakness, or twice daily for extended coverage, depending on response and tolerability. Individual dosing varies and should follow the prescriber’s plan.

Dosage and Usage

• Typical use: sustained-release 180 mg once daily at bedtime or twice daily, individualized to symptoms and response.
• Do not substitute milligram-for-milligram from immediate-release without prescriber guidance; absorption profiles differ.
• Swallow tablets whole with water. Do not crush, split, or chew sustained-release tablets.
• May be taken with or without food; consistent timing day to day can help.
• Missed dose: if a dose is missed and it is not close to the next dose, take when remembered. If near the next dose, skip the missed dose. Do not double up.
• Signs of excessive dosing (cholinergic symptoms) include severe muscle weakness, cramping, sweating, salivation, or slow heartbeat; urgent assessment is required.

• Store at 15–30 °C (59–86 °F) in a dry place, away from moisture and heat.
• Keep tablets in the original, child-resistant container with the pharmacy label.
• For travel, carry your medication in your hand luggage with a copy of your prescription.
• Do not leave tablets in a hot car or near windows; avoid humidity in bathrooms.
• Use a pill organizer for short trips; keep some tablets in the labeled bottle for security checks.

Benefits and Savings

Mestinon SR® offers sustained symptom control, which can reduce the number of daily doses needed compared with immediate-release tablets. The longer action may help cover nocturnal or early-morning weakness. Many patients find steady function through the day with fewer peaks and troughs.

Ordering from YouDrugstore provides access to brand and generic Mestinon SR tablets online at Canadian pricing. Typical customers report 60–80% savings versus common US retail prices. This can be helpful for those buying Mestinon SR without insurance or managing long-term therapy costs.

Looking for extra value? See current offers on our Mestinon SR coupon page.

Side Effects and Safety

• Common: nausea, stomach cramps, diarrhea, increased salivation, increased sweating.
• Other: muscle twitching, miosis (small pupils), tearing, urinary frequency.
• Less common: rash, dizziness, mild bradycardia (slow heartbeat).

Serious risks include severe muscle weakness with breathing difficulty (possible cholinergic crisis), pronounced bradycardia, bronchospasm, or severe diarrhea and vomiting with dehydration. People with urinary or gastrointestinal obstruction should not use pyridostigmine. Use caution in asthma or COPD, peptic ulcer disease, seizure disorders, or heart rhythm problems. Report severe or persistent symptoms promptly.

Onset Time

Sustained-release pyridostigmine begins working gradually. Some symptom relief is often felt within a few hours of a dose. The prolonged effect may last up to 8–12 hours in many patients. A stable daily pattern usually emerges after several days. Dose adjustments are sometimes needed across 1–2 weeks to balance benefit and side effects.

Compare With Alternatives

Immediate-release pyridostigmine (often 60 mg tablets) works faster, usually within 30–60 minutes, but the effect lasts a shorter time. It may require multiple daytime doses. Some patients use a mix of sustained-release for baseline coverage and immediate-release for predictable daytime demands. See Mestinon® for standard tablets.

Neostigmine is another acetylcholinesterase inhibitor with a shorter duration and is less commonly used for chronic outpatient therapy. It may be considered when pyridostigmine is not suitable.

Non–acetylcholinesterase options include corticosteroids and steroid-sparing immunosuppressants, intravenous immunoglobulin (IVIG), or plasma exchange for exacerbations, and thymectomy when indicated. These address immune drivers of myasthenia gravis rather than neurotransmission itself.

Combination Therapy

• Sustained-release plus immediate-release pyridostigmine to fine-tune daytime control.
• With corticosteroids or agents such as azathioprine or mycophenolate when immunosuppression is required.
• With IVIG or plasma exchange for short-term stabilization during exacerbations (specialist-directed).
• Careful titration helps avoid cholinergic symptoms; do not exceed prescribed totals.

Patient Suitability and Cost-Saving Tips

Mestinon SR® may suit adults with generalized myasthenia gravis who need longer coverage or have nocturnal symptoms. It is not appropriate for those with mechanical urinary or intestinal obstruction. Extra caution is needed with severe asthma, bradycardia, hypotension, active peptic ulcer, or certain arrhythmias. Clinicians consider pregnancy and breastfeeding on a case-by-case basis.

To reduce monthly costs, consider a multi-month supply if the prescription allows; this can lower the per-month Mestinon SR price. Set up reorder reminders in your account so you do not run out. Explore brand and generic Mestinon SR 180 mg options when available. Many customers also choose to Myasthenia Gravis resources while comparing Mestinon SR cost. Savings help those purchasing Mestinon SR without insurance, especially for long-term therapy.

Authoritative Sources

FDA prescribing information for pyridostigmine bromide (Mestinon)

Health Canada Drug Product Database: pyridostigmine bromide

DailyMed: pyridostigmine bromide sustained-release labeling

Order Mestinon SR® from YouDrugstore: add to cart, upload your prescription, and we ship with prompt, express shipping.

This material is educational and does not replace advice from your healthcare professional. Always follow your prescriber’s directions and the medication label.