How long should I hold the dose of mestinon when I next get Botox so I don’t negate its effects?

Question

Botox while on Mestonin - I have been getting Botox every 3-6 months for years. I recently was started on Mestonin for an unspecified neuro-muscular disorder. I take 60mg 4x a day. How long should I hold the dose when I next get Botox so I don’t negate its effects?

Anna Chacon, MD, FAAD · Answer

This is a very important question, and I would be cautious about stopping or holding Mestinon (pyridostigmine) on your own.

Mestinon is being used to treat an unspecified neuromuscular disorder, and at 60 mg four times daily, it is likely playing an important role in maintaining your muscle function. The bigger concern is usually worsening of the underlying neuromuscular condition if doses are missed, rather than Mestinon completely negating the cosmetic effects of Botox.

The short answer

For most patients, there is no established evidence-based interval for holding Mestinon before cosmetic Botox injections, and I would not routinely recommend skipping it simply to make Botox last longer.

Why?

Botox works by blocking the release of acetylcholine from nerve endings. Mestinon works by preventing the breakdown of acetylcholine. Although these mechanisms are physiologically opposite, the amount of acetylcholine increased by Mestinon is not usually enough to completely overcome the effect of properly placed botulinum toxin.

In clinical practice, patients taking pyridostigmine can still respond to Botox.

The more important issue: your neuromuscular disorder

Because you were started on Mestinon for a neuromuscular condition that has not yet been fully specified, the main safety question is whether botulinum toxin is appropriate for you at all, and whether the dose should be modified.

Conditions such as myasthenia gravis, Lambert-Eaton syndrome, or other disorders affecting neuromuscular transmission can make patients more sensitive to the muscle-weakening effects of Botox.

If someone were considering holding Mestinon

This decision should be made only in coordination with the physician managing the neuromuscular disorder. Pyridostigmine has a relatively short duration of action (about 3–6 hours), so simply skipping a single dose shortly before Botox has not been proven to improve cosmetic outcomes, and it could potentially lead to:

increased fatigue,
eyelid drooping,
difficulty chewing,
swallowing problems,
or generalized weakness depending on the underlying diagnosis.
What I would do in your situation

Before your next Botox session, I would make sure the injector knows:

the exact diagnosis (if it has been clarified by then),
that you are taking pyridostigmine 60 mg four times daily,
and whether you have any symptoms such as ptosis, double vision, chewing fatigue, or generalized muscle weakness.

In many cases, the safest approach is:

continue Mestinon as prescribed,
use conservative Botox dosing,
avoid treating muscles where even mild weakness would be problematic,
and monitor the response carefully after the procedure.
My overall opinion

I would not recommend holding your Mestinon for a specific number of hours or days in an attempt to prevent it from “negating” your Botox, because there is no well-supported guideline for doing so, and the potential risk of worsening your neuromuscular symptoms may outweigh any theoretical cosmetic benefit.

The fact that you are taking 60 mg four times daily for an active neuromuscular disorder makes this a situation where coordination between your neurologist (or prescribing physician) and your Botox injector is much more important than trying to time or skip doses yourself. In most patients, Botox can still be effective while taking Mestinon, but the treatment should be approached more conservatively and with awareness of the underlying neuromuscular condition.

Mahmood Siddique, DO · Answer

Hello! It's important to speak with your physician about any possible interactions between Botox and mestonin, which is used to treat neuromuscular illnesses like myasthenia gravis. In general, waiting a certain amount of time before getting Botox may be wise, but the precise timing can change depending on your unique situation and medical history.It's advisable to wait for your healthcare provider's advise as they are the most qualified to supply you with specific information regarding this scenario. Consider getting in touch with them to talk about your impending Botox procedure if you haven't already.

How long should I hold the dose of mestinon when I next get Botox so I don’t negate its effects?

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