neostigmine methylsulfate + raceanisodamine hydrochloride

This is a fixed-dose combination of two small molecule drugs, neostigmine methylsulfate and raceanisodamine hydrochloride. Neostigmine methylsulfate is a reversible cholinesterase inhibitor that increases acetylcholine levels at neuromuscular junctions by inhibiting acetylcholinesterase, thereby enhancing both nicotinic and muscarinic receptor stimulation. It is primarily used to reverse non-depolarizing neuromuscular blockade after surgery, treat myasthenia gravis, paralytic ileus, and postoperative urinary retention[2][5][6]. Raceanisodamine hydrochloride (also known as anisodamine) is a naturally occurring atropine derivative with anticholinergic properties; it acts as a muscarinic acetylcholine receptor antagonist and has been used in China for its antispasmodic effects on smooth muscle and to counteract cholinergic side effects[7]. The combination may be intended to balance the pro-cholinergic effects of neostigmine with the antimuscarinic actions of raceanisodamine, reducing adverse muscarinic side effects such as bradycardia or excessive secretions.