Emraclidine

What it is

Emraclidine acts on M4, one of the muscarinic receptors for acetylcholine that also respond to xanomeline–trospium (opens in a new tab). It does not switch the receptor on directly; it amplifies its response to the body’s own acetylcholine. It is taken once a day, without a gradual increase in dose.¹

How well it works

After a small early trial in 81 people,¹ two six-week trials compared emraclidine with placebo in about 750 adults with a worsening of schizophrenia. Neither found a clear benefit: symptoms improved by between 14.2 and 18.5 points on emraclidine, and by 13.5 and 16.1 points on placebo.² Its maker, AbbVie, has since started a new trial in the United States, which first tests higher doses and then compares the medicine with placebo for six weeks.³

Side effects

In the 2024 trials, headache was the most common side effect, in up to 15 in 100 people against up to 11 in 100 on placebo, followed by dry mouth and indigestion.² In the early trial, blood pressure and heart rate rose slightly and briefly.¹

What we don’t know yet

• Whether higher doses help where the doses tested in 2024 did not.