The muscarinic M 1 receptor (M 1 R) is highly involved in cognition, and selective M 1 agonists have procognitive properties. Loss of M 1 R has been found in postmortem brain tissue for several neuropsychiatric disorders and may be related to symptoms of cognitive dysfunction. 123 I-iododexetimide is used for imaging muscarinic acetylcholine receptors (mAchRs). Considering its high brain uptake and intense binding in M 1 R-rich brain areas, 123 I-iododexetimide may be an attractive radiopharmaceutical to image M 1 R. To date, the binding affinity and selectivity of 123 I-iododexetimide for the mAchR subtypes has not been characterized, nor has its brain distribution been studied intensively. Therefore, this study aimed to address these topics. Methods: The in vitro affinity and selectivity of 127 I-iododexetimide (cold-labeled iododexetimide), as well as its functional antagonist properties (guanosine 5′-[γ-35 S-thio]triphosphate [GTPγ 35 S] assay), were assessed on recombinant human M 1 R-M 5 R. Distributions of 127 I-iododexetimide and 123 I-iododexetimide in the brain were evaluated using liquid chromatography-mass spectrometry and storage phosphor imaging, respectively, ex vivo in rats, wild-type mice, and M 1 -M 5 knock-out (KO) mice. Inhibition of 127 I-iododexetimide and 123 I-iododexetimide binding in M 1 R-rich brain areas by the M 1 R/ M 4 R agonist xanomeline, or the antipsychotics olanzapine (M 1 R antagonist) and haloperidol (low M 1 R affinity), was assessed in rats ex vivo. Results: In vitro, 127 I-iododexetimide displayed high affinity for M 1 R (pM range), with modest selectivity over other mAchRs. In biodistribution studies on rats, ex vivo 127 I-iododexetimide binding was much higher in M 1 R-rich brain areas, such as the cortex and striatum, than in cerebellum (devoid of M 1 Rs). In M 1 KO mice, but not M 2 -M 5 KO mice, 127 I-iododexetimide binding was strongly reduced in the frontal cortex compared with wild-type mice. Finally, acute administration of both an M 1 R/M 4 R agonist xanomeline and the M 1 R antagonist olanzapine was able to inhibit 123 I-iododexetimide ex vivo, and 123 I-iododexetimide binding in M 1 -rich brain areas in rats, whereas administration of haloperidol had no effect. Conclusion: The current results suggest that 123 I-iododexetimide preferentially binds to M 1 R in vivo and can be displaced by M 1 R ligands. 123 I-iododexetimide may therefore be a useful imaging tool as a way to further evaluate M 1 R changes in neuropsychiatric disorders, as a potential stratifying biomarker, or as a clinical target engagement biomarker to assess M 1 R.