I think it's a good idea to start on a low dose, stay on that does for a while, then slowly increase the dose, wait another while, and then repeat. Sometimes I didn't experience common side effects on increasing the dose (nausea, aches), and sometimes I did. Those side effects went away after a few days to a week, so stick with it if you can.
I actually started on a somewhat higher dose--I started off at 30mg 3x per day. I stayed on that dose for one month, and then went up to 60 mg 3x per day. After another month I was put on an extended release capsule of 180 mg just once per day.
In the end I had unpleasant side effects from Mestinon that weren't listed: chills, breathlessness, and constipation. These made me miserable enough that I stopped taking the pills and was put on something else. I wonder if I might have tolerated the medicine better if I had started off slower as
@wigglethemouse suggested. But even though I had to stop I'm glad I at least tried it.
One big tip: I kept my bottle of pills on a post-it note with little boxes for AM, noon, and PM, and I checked off the boxes as I took each pill. That way, I could easily see whether or not I had taken my pill (I'm pretty forgetful), so that helped me keep on track with the routine. I also put daily alarms on my phone to remind me to take the pills.
