Acotiamide is a potent, selective and reversible inhibitor of human and canine stomach-derived acetylcholinesterase (AChE). Acotiamide showed no affinity for dopamine D2 or serotonin 5-HT4 receptors but does have activity as a muscarinic antagonist. It acts as a prokinetic drug through acetylcholinesterase inhibition and muscarinic receptor antagonism, and has been used for the treatment of functional dyspepsia (FD) involving gastric motility dysfunction.