Huperzine A is a plant alkaloid derived from Club moss plant, Huperzine serrata, which is a member or the Lycopodium species. Huperzine-A is in phase III clinical trial in the USA (Alzheimer disease) and is available as a dietary supplement. It selectively and reversibly inhibits acetylcholinesterase. Huperzine A is also a NMDA receptor antagonist, which protects the brain against glutamate induced damage, and it increases nerve growth factor levels. Huperzine A is used for Alzheimer's disease, memory and learning enhancement, and age-related memory impairment. It is also used for treating a muscle disease called myasthenia gravis, for increasing alertness and energy, and for protecting against agents that damage the nerves such as nerve gases. It can cause some side effects including nausea, diarrhea, vomiting, sweating, blurred vision, slurred speech, restlessness, loss of appetite, contraction and twitching of muscle fibers, cramping, increased saliva and urine, inability to control urination, high blood pressure, and slowed heart rate. Various medications used for glaucoma, Alzheimer's disease, and other conditions (Cholinergic drugs) interacts with Huperzine A.

Ramosetron (INN) is a serotonin 5-HT3 receptor antagonist for the treatment of nausea, vomiting. And "diarrhea-predominant irritable bowel syndrome in males" (IBS-D). Ramosetron is licensed for use in India, Japan (Iribo) and selected Southeast Asian countries. In animal studies, ramosetron reduced defecation induced by corticotrophin-releasing hormone and had inhibitory effects on colonic nociception. In two randomized controlled studies including 957 patients with IBS-D, ramosetron increased monthly responder rates of patient-reported global assessment of IBS symptom relief compared with placebo. Ramosetron was also as effective as mebeverine in male patients with IBS-D. In a recent randomized controlled trial with 343 male patients with IBS-D, ramosetron has proved effective in improving stool consistency, relieving abdominal pain/discomfort, and improving health-related quality of life. Regarding safety, ramosetron is associated with a lower incidence of constipation compared with other 5-HT3 receptor antagonists and has not been associated with ischemic colitis.

Acotiamide (Acofide(®)), an oral first-in-class prokinetic drug, is under global development by Zeria Pharmaceutical Co. Ltd and Astellas Pharma Inc. for the treatment of patients with functional dyspepsia. The drug modulates upper gastrointestinal motility to alleviate abdominal symptoms resulting from hypomotility and delayed gastric emptying. It exerts its activity in the stomach via muscarinic receptor inhibition, resulting in enhanced acetylcholine release and inhibition of acetylcholinesterase activity. Acofide® is launched in Japan for treating functional dyspepsia.

Fudosteine is a derivative of cysteine developed and approved in Japan for the treatment of such diseases as bronchial asthma, chronic bronchitis, pulmonary emphysema, bronchiectasis, pulmonary tuberculosis, pneumoconiosis, atypical mycobacterial disease and diffuse panbronchiolitis. Fudosteine acts as a mucoactive agent, enabling mucin secretion. Although exact mechanism of action is unknown, it is supposed that fudosteine inhibits MUC5AC expression.

Fidarestat (SNK-860) is an aldose reductase inhibitor codeveloped by Sanwa Kagaku, NK Curex, and Sankyo for the treatment of distal symmetric polyneuropathy (DSP). In a Phase III trial, 279 patients with DSP were randomized to receive fidarestat (1 mg daily) or placebo for 52 weeks. Evaluation of efficacy was based on changes in clinical symptoms (numbness, pain, rigidity, alterations in temperature perception, paresthesia, hypesthesia, and weakness) as well as changes in electrophysiological measurements such as F-wave NCV. Five of six electrophysiological measures assessing function in motor nerves showed statistically significant improvement from baseline within the treatment group; a comparison of the placebo and treatment groups on these measures, however, showed the statistical difference on only two of the six measures. Two electrophysiological measures of sensory function failed to show a statistically significant difference from baseline in the fidarestat group. Statistically significant improvements over placebo were noted on several measures of subjective symptoms (e.g., numbness of upper extremities, decreased tactile sensitivity in lower extremities, paresthesia in the sole), with a greater divergence between the two groups associated with the duration of treatment. The incidence of adverse events was 5.8% in the fidarestat group and 5% in the placebo group and no serious adverse events were noted.

Moxaverine, a derivative of papaverine, is a phosphodiesterase inhibitor. Moxaverine has been studied in phase III of a clinical trial for the treatment of ocular blood flow in patients with age- related macular degeneration and primary open angle glaucoma. In addition, it has been studied in phase II of the clinical trial for the treatment of ischemia. This compound is prohibited by FEI (International Federation of equine).

Metralindole (Inkazan) is a reversible inhibitor of monoamine oxidase A (RIMA) which was used in Russia as an antidepressant. Inkasan (3-methyl-8-methoxy-3H, 1,2,5,6- tetrahydropyrazine /1.2.3-ab/-beta-carboline hydrochloride) has pharmacological properties characteristic of antidepressants. The clinical antidepressant effect of inkasan is combined with stimulating action. The drug is primarily indicated for patients in whom adynamic (anergic) disturbances are predominant in the clinical picture of depression.

Cynarine (Cynarin) is the most noteworthy active ingredient of the artichoke, and is considered a medicinal foodstuff due to its beneficial effect on the organism, derived from its condition as a stimulant of bile secretion (choleretic effect). Cynarine is present in artichoke leaves and has a beneficial effect on the control of gallstones, helps control cholesterol levels and improves gallbladder function. Chlorogenic acid and cynarin have been shown to have activity against oxidative stress in human leukocytes, whereas cynarin has also been shown to have hypocholesterolemic, hepatoprotective, and, more recently, antihuman immunodeficiency virus-1 (anti-HIV-1; 44) activities. Cynarin had marked antioxidant, anticholinergic, reducing ability, radical-scavenging, and metal-binding activities.

Phoxim (Diethyl-O-(alpha-cyanobenzylideneamino)-thiophosphate) is an organophosphorus insecticide used in veterinary medicine for the control of mites, lice and other ectoparasites in cattle, pigs, sheep, and goats. Phoxim is also used for plant protection, in tea production. The insecticidal activity of phoxim is mediated through inhibition of cholinesterase. Phoxim is an insecticide with selective properties: it is toxic to insects but virtually non-toxic to mammals. Although differences in sensitivity to cholinesterase inhibition contribute to this selectivity, metabolism plays a more important role. In both insects and mammals, phoxim is oxidatively desulfurated to the oxo-analog, PO-phoxim, which is a more potent inhibitor of cholinesterases than phoxim itself. In mammals, however, PO-phoxim is an extremely short-lived intermediate and, together with phoxim, is rapidly hydrolyzed to non-toxic products.

Cridanimod (Virexxa) is a small-molecule immunomodulator and interferon inducer, which, in preliminary studies, has been shown to increase progesterone receptor expression in endometrial tissue. Restoration of progesterone receptor expression may re-sensitize endometrial tumor tissue to progestin therapy in previously unresponsive tumors. Cridanimod was originally developed by Polysan and Pharmsynthez and licensed to Xenetic Biosciences. Virexxa is currently being studied in an ongoing Phase 2 multi-national study in conjunction with progestin therapy for the treatment of endometrial cancer in women with the recurrent or persistent disease who have failed progestin monotherapy.