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Gastroenterology

Acosky®

Acotiamide HCl Hydrate
100 mg film-coated tabletsPack of 20OralRx only

A prokinetic for the meal-related symptoms of functional dyspepsia — postprandial bloating, epigastric distention and early satiety.

Acosky® 100 mg carton, final artwork
Product overview

A prokinetic for functional dyspepsia

Acosky® contains acotiamide HCl hydrate, a drug for functional gastrointestinal disorders. It acts on gastric motility rather than on acid, addressing the meal-related symptoms of functional dyspepsia.

Enhances gastric motility

Strengthens antral and gastric-body contraction by increasing available acetylcholine.

Improves delayed emptying

Increases postprandial antral motility and improves delayed gastric emptying.

Three times daily, before meals

One 100 mg film-coated tablet, three times a day before meals.

Disease context

Functional dyspepsia

Functional dyspepsia describes persistent upper-abdominal symptoms without an organic cause on investigation. Meal-related symptoms — fullness after eating, early satiety and bloating — are often linked to impaired gastric accommodation and delayed emptying.

Before and during treatment, persistent symptoms warrant consideration of organic disease, including gastric malignancy, and further investigation such as upper GI endoscopy where appropriate.

Key symptoms

As listed in the Acosky® prescribing information:

  • Post-meal fullness
  • Early satiety
  • Epigastric discomfort
  • Bloating
  • Nausea
  • Other approved dyspeptic symptoms
Mechanism of action

How acotiamide restores motility

Acotiamide inhibits acetylcholinesterase (AChE) by a mixed type of inhibition, competitive and non-competitive. Suppressing the breakdown of acetylcholine released from cholinergic nerve terminals enhances ACh-induced contraction and motility of the gastric antrum and body, increasing postprandial antral motility and improving delayed gastric emptying.

1 · Fundus 2 · Antrum AccommodationContractionEmptyingOesophagus At the nerve terminal ACh is releasedAChE normally degrades ACh Acotiamide inhibits AChE → more ACh, stronger motility
Schematic, not to scale. Adapted from the Salventis Acosky® literature and prescribing information.

1 · Gastric accommodation

The fundus relaxes to receive a meal; improved accommodation was reported in the gastric motility study below.

2 · Antral contraction

Increased ACh availability strengthens antral contractions that drive gastric emptying.

Stomach-focused action

Acts on the cholinergic pathway governing gastric motility.

Clinical evidence

Backed by controlled trials

Figures below are taken from the primary publications and a peer-reviewed review of the Phase III programme. Full papers are available to healthcare professionals on request.

Phase III placebo-controlled trial

Randomised, double-blind · functional dyspepsia (Rome III) · acotiamide 100 mg three times daily for 4 weeks
n = 892
Overall treatment efficacy (responders)
Acotiamide (450)
52.2%
Placebo (442)
34.8%
Elimination of all three meal-related symptoms
Acotiamide
15.3%
Placebo
9.0%

Both endpoints were significantly higher with acotiamide than with placebo.

Matsueda K, et al. A placebo-controlled trial of acotiamide for meal-related symptoms of functional dyspepsia. Gut 2012;61(6):821–828.

Gastric motility study

Randomised, double-blind, placebo-controlled · acotiamide 100 mg three times daily for 2 weeks
n = 46 completed
Gastric accommodationSignificantly increased with acotiamide
p = 0.04
Gastric emptyingHalf-emptying time significantly accelerated
p = 0.02
GI symptoms (GSRS)Total score significantly improved
p = 0.0007

p-values are for change from baseline within the acotiamide group; corresponding placebo changes were not significant (p = 0.08, 0.59 and 0.14).

Nakamura K, et al. A double-blind placebo controlled study of acotiamide hydrochloride for efficacy on gastrointestinal motility of patients with functional dyspepsia. J Gastroenterol 2017;52(5):602–610.
Approved indication

Therapeutic indication

Acosky® (acotiamide HCl hydrate) is indicated for the treatment of postprandial bloating, epigastric distention and early satiety in functional dyspepsia.

For the treatment of symptoms associated with functional dyspepsia, as specified in the approved prescribing information.

Dosage & administration

How to prescribe

Adults: one 100 mg tablet three times a day, before meals, taken orally.

  • If symptoms do not improve after 1 month of treatment, consider discontinuation.
  • If symptoms improve continuously, consider discontinuing; avoid long-term use without careful consideration.
Clinical pharmacology

Pharmacokinetic profile

Single oral dose of one 100 mg tablet on an empty stomach in a healthy adult (mean ± SD):

Dose (mg)Tmax (h)Cmax (ng/mL)AUCinf (ng·h/mL)t½ (h)
1002.42 ± 0.9730.82 ± 13.33171.3 ± 59.4313.31 ± 6.91
Repeated dosing and effect of food

With 100 mg three times daily for 9 days, plasma concentrations reached near steady state from the third dose on day 3, with almost no change in pharmacokinetics on repeated administration.

Cmax was highest with pre-meal administration (62.7% higher than fasting); after meals it was 59.6% of the pre-meal value. AUClast was lowest after meals.

Distribution and metabolism

Plasma protein binding 84.21–85.95% (human plasma), with albumin the main binding protein. Metabolised to a de-isopropyl form by CYP2C8, CYP1A1 or CYP3A4, and to a glucuronide conjugate by UGT1A8 or UGT1A9.

Excretion

After an oral [14C] dose, 92.7% of radioactivity was excreted in faeces and 5.3% in urine within 216 hours.

Important safety information

Safety profile

Important safety information

  • Contraindication: known hypersensitivity to acotiamide or to any excipient.
  • If symptoms persist, consider organic disease, including malignancy such as gastric cancer, and further investigation, including upper GI endoscopy as necessary.
  • Acotiamide is an acetylcholinesterase inhibitor and enhances the action of acetylcholine — caution is warranted.
  • Use with caution in elderly patients with renal or hepatic impairment.
  • Pregnancy and lactation: use only if the potential benefit justifies the potential risk.
Adverse reactions
Rash, urticaria, increased white blood cell count, dizziness, diarrhoea, constipation, nausea, vomiting, stomach ache, stomatitis, ALT/AST/γ-GTP increase, increased blood bilirubin, increased blood ALP, increased blood prolactin and increased blood triglycerides.
Drug interactions
  • Anticholinergic drugs (e.g. atropine sulfate, butylscopolamine bromide) may attenuate the action of acotiamide.
  • Cholinergic agents (e.g. acetylcholine chloride, neostigmine) may enhance its effect.
Overdosage
Institute appropriate supportive treatment according to the patient's clinical signs and symptoms.
Storage
Store below 30°C in a dry place. Protect from sunlight, heat and moisture. Keep out of reach of children.
Composition & presentation

Product information

BrandAcosky®
GenericAcotiamide HCl hydrate
Strength100 mg (as acotiamide hydrochloride hydrate) per film-coated tablet
Dosage formFilm-coated tablet, oral
PackBlister pack of 20 tablets
Therapeutic areaGastroenterology
Prescription statusPrescription-only medicine
DRAP registration no.129574
Manufacturing licence no.000789
Marketed bySalventis Pharma SMC (Pvt.) Ltd., Islamabad
StorageBelow 30°C, dry place; protect from sunlight, heat and moisture
Resources

Prescribing information

PDF
Acosky® 100 mg — prescribing informationPackage insert (English and Urdu). PDF, 150 KB.
Open PDF
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For healthcare professionals. All Salventis products are prescription-only medicines, to be sold on the prescription of a registered medical practitioner. Information on this site summarises the approved prescribing information and supplied product literature; it is not a substitute for the full prescribing information, which is available on request from Salventis Pharma. To report a suspected adverse reaction, contact info@salventispharma.com.