The cholinesterase inhibitor bromipyridamole is an important symptomatic treatment for myasthenia gravis, and some patients can improve their symptoms after taking it for about three quarters of an hour. However, some patients taking the drug experience significant gastrointestinal symptoms, including abdominal pain, diarrhea, nausea and vomiting, and other symptoms of gastrointestinal cramps. Although the symptoms disappear once the drug is discontinued, a few patients are still afraid to take the drug because of the fear of its side effects. If the patient’s gastrointestinal symptoms are mild, they can be left alone and do not need to be discontinued. If the patient’s symptoms are significantly interfering with life status, strategic management is required. Pyridostigmine can be reduced to half a dose, e.g., if pyridostigmine was 1 capsule three times a day, it can be changed to half a capsule three times a day, and if tolerated by the patient, it can be continued and then increased after 1-2 weeks. If the patient still has significant symptoms after reducing to half a dose, consider adding the anticholinergic drug scopolamine (654-2), atropine or prudensine, and taking it at the same time as pyridostigmine, and gradually stop the anticholinergic drug when the patient tolerates it. If the patient has a severe gastrointestinal reaction and is extremely fearful of rejection, the only option is to “cut the cord” and use immunosuppressants alone, but the patient should be informed that immunosuppressants will take longer to work and patience is needed.