We used it heavily 10 years ago. It was okay, but it had a rocky history. For a long time it seemed abandoned, then Python 3 happened and we had to patch our own version for a while. Then a new maintainer took over and stuff would just break or APIs rewritten between versions. We ran our own pypi instance to deal with pymssql specifically.

In the later years it became rather good though and with Python 3 many of the issues with character encoding went away.

I use it on Windows (and Linux) but can't get it to work on M1 chips.

iirc it had problems with named instances - only on some newer version of sql server