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Pecavaptan is a small molecule, orally active dual antagonist of the vasopressin V1a and V2 receptors. It was developed by Bayer for the treatment of heart failure. Pecavaptan blocks both vascular V1a and renal V2 receptors, leading to increased urine production (aquaresis) and reduced water retention and edema. This dual antagonism is designed to counteract deleterious effects mediated by arginine vasopressin in heart failure, potentially improving cardiac output and reducing total peripheral resistance compared to selective V2 antagonists. Despite promising preclinical results, clinical development for heart failure was discontinued after phase II trials due to scientific reasons[4][5][7].
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