The (hydroxymethyl)diorgano(2-piperidinoethyl)germanes rac-Ph( c-Hex)Ge(CH 2OH)CH 2CH 2NR 2 ( rac- 1a), Ph 2Ge(CH 2OH)CH 2-CH 2NR 2 ( 3a) and ( c-Hex) 2Ge(CH 2OH)CH 2CH 2NR 2 ( 5a) (NR 2 = piperidino) were synthesized starting from Cl 3GeCH 2Cl. The ( R)- and ( S)-enantiomer of 1a were obtained by resolution of rac- 1a using the antipodes of O,O′-di- p-toluoyltartaric acid as resolving agents (resolution by fractional crystallization of diastereomeric salts). The enantiomeric purities of the resolved antipodes of 1a were shown to be at least 98 ( 1H NMR) and 97% ee ( 13C NMR) respectively (NMR studies using a chiral shift reagent). Reaction of rac- 1a, ( R)- 1a, ( S)- 1a, 3a and 5a with methyl iodide gave the corresponding methiodides rac- 2a, ( R)- 2a, ( S)- 2a, 4a and 6a ( 1a → 2a, 3a → 4a, 5a → 6a). The absolute configuration of ( R)- 2a was determined by single-crystal X-ray diffraction. On the basis of the experimentally established absolute configuration of ( R)- 2a, the absolute configurations of all the other aforementioned optically active germanium compounds were assigned by chemical and optical correlations. The enantiomerically pure germanium compounds ( R)- 1a, ( S)- 1a, ( R)- 2a and ( S)- 2a and their achiral derivatives 3a–6a were studied for their affinities for muscarinic M1, M2, M3 and M4 receptors by functional pharmacological experiments (M1, rabbit vas deferens; M2, guinea-pig atria; M3, guinea-pig ileum) and radioligand binding experiments (M1, human NB-OK 1 cells; M2, rat heart, M3, rat pancreas; M4, rat striatum). The receptor affinities obtained in these studies were compared with those of the related silicon analogues, the (hydroxymethyl)diorgano(2-piperidinoethyl)silanes ( R)- and ( S)-Ph( c-Hex)Si(CH 2OH)CH 2CH 2NR 2[( R)- 1b and ( S)- 1b], Ph 2Si(CH 2OH)CH 2CH 2NR 2 ( 3b) and ( c-Hex) 2Si(CH 2OH)CH 2CH 2NR 2 ( 5b) (NR 2 = piperidino) and their corresponding methiodides ( R)- 2b, ( S)- 2b, 4b and 6b ( a → b: Ge → Si: studies on Ge Si bioisosterism). According to these studies, all the germanes and the related silicon analogues behaved as simple competitive antagonists at muscarinic M1–M4 receptors. The p K i values obtained in binding studies at M1–M3 receptors were similar to the corresponding functional affinities (p A 2 values). The receptor affinities of the respective Ge Si analogues were found to be very similar, indicating a strongly pronounced Ge Si bioisosterism. The ( R)-enantiomers (eutomers) of the Ge Si pairs 1 a 1 b and 2 a 2 b exhibited higher affinities (up to 26-fold) for M1–M4 receptors than their corresponding ( S)-antipodes (distomers), the stereoselectivity ratios being higher at M1, M3 and M4 than at M2 receptors. In most cases, the diphenyl ( 3 a 3 b and 4 a 4 b ) and dicyclohexyl ( 5 a 5 b and 6 a 6 b ) compounds displayed lower affinities to M1–M4 receptors than the related ( R)-enantiomers of 1 a 1 b and 2 a 2 b , and the sums of the respective affinity differences were very similar to the experimentally established stereoselectivity ratios [ (R) (S) ]. Thus, the stereoselective interaction of the enantiomers of 1 a 1 b and 2 a 2 b with muscarinic receptors is best explained in terms of opposite and weaker binding of the phenyl and cyclohexyl ring of the ( S)-antipodes. The highest receptor selectivity was observed for compound ( R)- 1b at M1 M2 receptors (25-fold in binding studies).