The cholinesterase inhibitor bromipyridamole is an important symptomatic treatment for myasthenia gravis and can improve heavy muscle symptoms when taken by patients. However, some patients taking this drug may experience significant GI symptoms such as abdominal pain, diarrhea, nausea and vomiting and other symptoms of gastrointestinal cramps. The adverse GI reactions disappear when this drug is discontinued. However, a small number of patients may still be afraid to take the drug due to fear of its side effects. If the patient’s GI symptoms are mild, they can be left alone and do not require discontinuation of the drug. If the patient’s symptoms significantly affect their life status, strategic management is needed. For example, if the patient was taking 1 capsule three times a day, he or she should continue to take half a capsule three times a day, and then increase the dosage after 1-2 weeks if the patient can tolerate it. If the patient’s symptoms are still obvious after reducing the dosage to half, consider adding the anticholinergic drug scopolamine (654-2), atropine or prudensine, and taking it at the same time as bromipyridamole, and gradually stop the anticholinergic drug after the patient tolerates it. The Chinese herbal remedy, Jiawei Huo Xiang Zheng Qi Wan or Bao Ji Wan, may also be taken to eliminate GI side effects. If the patient has severe gastrointestinal reactions and is extremely fearful of rejection, only immunosuppressive drugs can be used alone, but the patient should be informed that immunosuppressive drugs take a long time to work and patience is needed.