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Ironically, a side effect of excessive anticholinesterase treatment is excessive weakness or cholinergic crisis due to excessive stimulation of nicotinic receptors in the muscle end-plate region, resulting in a transient phase of uncontrolled muscle fasciculations due to sustained depolarization, followed by the development of receptor desensitization and a flaccid paralysis

The article's argument is that provider-guided escalation, dietary adjustment, and ongoing lab monitoring are what keep that risk manageable, and that over-the-counter access would remove all three of those protections