Rethinking Clinical Research – towards more inclusive, innovative, and sustainable patient-centered clinical trials developed in partnership with patientsEditorial

Christine Kubiak, PharmD, PhD, EMBA

Klin Farmakol Farm. 2026;40(2):76  

Over-the-counter products, SARMs and dietary supplements as hidden causes of male hypogonadism and subfertility: a clinical overview and practical managementReview articles

Marek Broul, Aneta Hujová, Kateřina Langmaierová

Klin Farmakol Farm. 2026;40(2):134-138 | DOI: 10.36290/far.2026.004  

Objective: To summarize clinically relevant exposures to over-the-counter (OTC) products and dietary supplements that may cause secondary hypogonadism and impaired male fertility, and to propose a pragmatic diagnostic and management pathway relevant to Czech clinical practice. Methods: Narrative review with targeted searches of MEDLINE/PubMed, Embase and the Cochrane Library (2000-2025), complemented by regulatory sources (FDA, WADA) and Czech resources on dietary supplement oversight and nutrivigilance. Results: Selective androgen receptor modulators (SARMs) carry the highest risk of suppressing the hypothalamic-pituitary-gonadal axis and remain prohibited...

The role of glucocorticoids in endocrinologyReview articles

Pavel Cee, Jan Drugda, Filip Gabalec

Klin Farmakol Farm. 2026;40(2):129-133 | DOI: 10.36290/far.2026.007  

Glucocorticoids represent a fundamental group of hormones that play a key role in the regulation of metabolism, immune response, and adaptation to stress. Their widespread use in medicine is based on potent anti-inflammatory and immunosuppressive effects; however, long-term therapy is associated with the risk of serious adverse effects. This article focuses on hypercortisolism, both in the form of endogenous Cushing's syndrome and the more frequent exogenous form related to long-term glucocorticoid administration. Clinical manifestations, diagnostic procedures, and current therapeutic options including surgical, pharmacological, and radiotherapeutic...

Specifics of corticosteroid administration in patients with central nervous system diseases with a focus on neurointensive careReview articles

Lucie Sauerová

Klin Farmakol Farm. 2026;40(2):124-128 | DOI: 10.36290/far.2026.008  

Corticosteroids (CST) play a key role in the treatment of oncological, infectious, and autoimmune diseases of the central nervous system (CNS). CST reduces inflammatory processes and is used mainly to reduce brain edema and intracranial pressure, thereby significantly improving the quality of life of patients. They are also administered as substitution therapy in the context of a functional deficit of the pituitary gland or hypo­thalamus. Administration is not indicated universally in all patients. Before use, we should evaluate the risk/benefit, i. e., the severity of the clinical manifestations of the disease and the risk of adverse effects, and...

Proton pump inhibitors: rational prescribing and long-term safety in childrenReview articles

Jana Tomanová, Petra Rozsívalová, Rita Halašová, Josef Malý, Jan Melek

Klin Farmakol Farm. 2026;40(2):116-123 | DOI: 10.36290/far.2026.009  

Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in paediatrics, with their prescription rates having significantly increased in recent years. Although effective for indications such as gastroesophageal reflux disease, peptic ulcers, or eosinophilic esophagitis, concerns remain regarding their safety, dosing, and frequent off-label use, especially in infants and newborns. This article provides a comprehensive overview of the pharmacological properties of PPIs in the pediatric population, focusing on the specifics of pharmacokinetics and pharmacodynamics in different age groups. It considers the influence of CYP2C19 genetic...

Patient and Public Involvement in clinical research: from regulatory requirements to partnerships with patientsMain topic

Hana Blahynková, Lenka Součková, Adriána Papiež

Klin Farmakol Farm. 2026;40(2):112-115 | DOI: 10.36290/far.2026.025  

In recent years, clinical research has increasingly focused on the systematic involvement of patients and the public (Patient and Public Involvement, PPI), with patients no longer viewed merely as study participants but also as active partners contributing to research planning. This approach enhances the relevance of research questions, improves the feasibility of studies, and increases the applicability of their results in clinical practice. The principles of patient involvement are reflected in modern methodological and regulatory frameworks, including the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human...

Environmentální udržitelnost v klinickém výzkumuMain topic

Michaela Beníšková, Jitka Rychlíčková

Klin Farmakol Farm. 2026;40(2):108-111 | DOI: 10.36290/far.2026.021  

Skleníkové plyny zásadně ovlivňují globální klima. Sektor zdravotní péče představuje jeden z významných zdrojů emisí CO₂, v celosvětovém měřítku se řadí na páté místo. Klinický výzkum je jeho nedílnou součástí; přináší inovace, ale i další environmentální zátěž. Snaha minimalizovat uhlíkovou stopu proto prostupuje i do metodologie a designu klinických studií a klinického výzkumu jako celku. Prvky jako digitalizace a decentralizace klinických studií mohou přispět ke snižování environmentální zátěže. Stále jde ale spíše o předpoklad podložený omezenými daty. K dosažení udržitelnějších metodik je třeba cílenější kvantifikace a identifikace klíčových...

Inclusivity in clinical trials: barriers and their potentional solutionsMain topic

Hana Kocourková, Jitka Rychlíčková

Klin Farmakol Farm. 2026;40(2):102-107 | DOI: 10.36290/far.2026.022  

Inclusivity in clinical research is an important prerequisite for obtaining relevant results applicable to routine clinical practice. Clinical research should therefore include partici­pants who accurately represent the target population across a range of characteristics. However, certain patient groups remain under-represented in clinical trials. The so called under-served populations often include older adults, ethnic minorities, patients with multiple comorbidities, and socioeconomically disadvantaged individuals. Their limited participation may be due to methodological and organizational barriers inherent in the study design. This review article...

Innovative clinical trial designsMain topic

Adriána Papiež, Lenka Součková, Jitka Rychlíčková

Klin Farmakol Farm. 2026;40(2):97-101 | DOI: 10.36290/far.2026.024  

Innovative clinical trial designs represent an important shift in the methodology of clinical research, reflecting the growing complexity of diseases, the development of personalized medicine, and the emergence of advanced therapy medicinal products. In addition to traditional randomized controlled trials, approaches such as adaptive designs, master protocols or single-arm studies are increasingly being used, enabling more flexible and targeted evaluation of new therapeutic interventions. They may accelerate the identification of effective therapies and improve the efficiency of resource utilization; however, they also introduce methodological and...

Clinical trials: The evolution of the traditional phase-based approach in contemporary clinical researchMain topic

Lenka Součková, Veronika Kunešová, Adriána Papiež, Hana Blahynková

Klin Farmakol Farm. 2026;40(2):92-96 | DOI: 10.36290/far.2026.017  

Clinical trials represent a key component of the development of medicinal products and a fundamental source of evidence for evidence-based medicine. Traditionally, the clinical development of medicines has been described through four sequential phases of clinical trials (I-IV), reflecting the stepwise evaluation of safety, dosing, efficacy, and post-marketing surveillance after a medicinal product is introduced to the market. This model has long served as both a regulatory and educational framework for clinical research. However, in recent decades the clinical development of medicines has undergone significant changes. In practice, sub-phases of clinical...

Luna - a software tool for data transfer from admission note to medication chartOriginal articles

Marek Pecha

Klin Farmakol Farm. 2026;40(2):87-91 | DOI: 10.36290/far.2026.019  

The admission report is a fundamental document that a physician creates when admitting each patient for hospitalization. Manually transcribing data from the admission report into the medication chart (so-called "temperature chart") is time-consuming and represents a potential source of errors. Medication errors are among the most common adverse events in hospital care, and a significant proportion of them occur during the prescribing and refilling of medications, including incomplete or illegible prescriptions. The author presents a software tool called Luna, which automatically transfers key information from the admission report into a medication...

Potentially inappropriate drugs in patients with chronic ischemic heart diseaseOriginal articles

Mária Kolesárová, Martina Dobrovičová, Dalibor Kolesár

Klin Farmakol Farm. 2026;40(2):77-86 | DOI: 10.36290/far.2026.003  

As a result of population aging, the rate of polymorbidity and the associated polypharmacy and polypragmasia are increasing. There is an increased risk of drug interactions, adverse effects, and the likelihood of inappropriate drug use in the elderly population. The aim of this retrospective study was to analyze the medication history of older adult patients with chronic ischemic heart disease (IHD) and to identify potentially inappropriate medications (PIMs). Data were collected over a one-month period from the prescription records of patients who were institutionalized in a social services home. PIMs were identified according to the current Beers...

Slovo editoraEditorial

MUDr. Irena Krčmová, CSc.

Klin Farmakol Farm. 2026;40(1):04  

Komentář k článku: Linezolid a terapeutické monitorování: Nastal čas pro rutinní TDM?Comment

Martin Róbert Grác, Pavel Suk, Jitka Rychlíčková

Klin Farmakol Farm. 2026;40(1):70-71  

Methadone poisoning in a childCase reports

Alice Nogolová, Markéta Ručková, Petra Matalová

Klin Farmakol Farm. 2026;40(1):67-69 | DOI: 10.36290/far.2026.005  

Intoxication and accidental ingestion of toxic substances is a common cause of hospita­lization in children, especially younger ones. Usually, the cause of ingestion is improper storage of toxic substances and their easy accessibility to children. The most common causes of poisoning are the ingestion of medicines, chemicals, drugs, including alcohol, and natural substances. We describe a case of intoxication in a four-year-old boy, who accidentally ingested methadone, used by his stepfather in substitution treatment of opiate addiction, he received treatment with opiate antidote naloxone. Though is this type of intoxication being rare in children,...

Targeted treatment of psoriatic arthritisReview articles

Leona Procházková

Klin Farmakol Farm. 2026;40(1):61-66 | DOI: 10.36290/far.2025.067  

Psoriatic arthritis is a chronic, immune-mediated inflammatory disease from the group of spondyloarthritis. The disease is characterized by joint, enthesis, or axial skeleton involvement in patients with psoriasis. Joint manifestations usually occur after the development of skin psoriasis, although in a smaller subset of patients, this may be the reverse. The phenotype of psoriatic arthritis is highly variable, reflecting a combination of specific musculoskeletal manifestations and various forms and severity of skin psoriasis, as well as the presence of extra-articular manifestations of the disease. The different presentations of the disease, especially...

The microbiome and pharmacotherapy: from mechanisms to consequencesReview articles

Lenka Jourová, Eva Anzenbacherová, Pavel Anzenbacher

Klin Farmakol Farm. 2026;40(1):56-60 | DOI: 10.36290/far.2026.001  

The gut microbiome plays a significant role in the regulation of physiological processes and, in certain cases, may also influence the outcome of pharmacotherapy - from variability in the efficacy of commonly used drugs to the results of modern immunotherapies. Interactions between microbial metabolites, host hepatic enzymes, and the immune system may determine whether a treatment succeeds or fails. Understanding these mechanisms opens the way to novel approaches that can enhance drug efficacy, reduce the risk of adverse effects, and bring personalized medicine closer to clinical practice. This article provides a concise overview of current knowledge...

QT interval, etiopathogenesis of "torsade de pointes", and risk pharmacotherapyReview articles

Přemysl Mladěnka, Josef Kautzner

Klin Farmakol Farm. 2026;40(1):47-55 | DOI: 10.36290/far.2026.002  

The electrocardiographic QT interval reflects the duration of ventricular depolarization and repolarization. Prolongation of the QT interval occurs most commonly due to a slowdown in the late repolarization phase. There are inherited forms of long QT syndrome caused by mutations in genes that encode components of potassium or sodium channels, with a prevalence of about 1 in 2000 inhabitants. Additionally, there are acquired forms of long QT syndrome, which often result from the use of certain medications. These drugs either directly block the potassium channel Kv11.1 (hERG), or disrupt its trafficking. Prolonged QT interval is a key risk factor for...

Interactions between ARTA drugs and orally administered anticoagulantsReview articles

Kryštof Dobečka, Anna Králová

Klin Farmakol Farm. 2026;40(1):41-46 | DOI: 10.36290/far.2025.068  

ARTA drugs, including enzalutamide, apalutamide, darolutamide, and abiraterone, are antiandrogenic agents used in the treatment of prostate cancer. These medications can induce or inhibit biotransformation enzymes and transporters, thereby affecting plasma concentrations and the efficacy of concomitantly administered drugs. This article examines the interactions between ARTA and orally administered anticoagulants such as apixaban, rivaroxaban, edoxaban, dabigatran, and warfarin. It outlines the mechanism of interactions between individual agents and summarizes the current state of knowledge on optimizing pharmacotherapy when combining ARTA with anticoagulants....

Injectable and non-injectable adrenaline applicators - their use in practiceMain topic

Irena Krčmová, Jakub Novosad

Klin Farmakol Farm. 2026;40(1):34-40 | DOI: 10.36290/far.2026.012  

Anaphylaxis is an acute, potentially life-threatening systemic reaction, that affects the skin, respiratory tract, circulation and/or digestive tract simultaneously or sequentially, but occurring within a short period of time (within 1 hour of the onset of the first symptoms). The most severe form of anaphylaxis is anaphylactic shock. From a pathophysiological point of view, it can be an immunological reaction, mediated by IgE antibodies or other immunological mechanisms and the subsequent massive release of biologically active mediators from mast cells and basophils. Mast cells/basophils can also be degranulated non-immunologically by direct receptor...

Biological treatment of asthma at the end of the first quarter of the 21^st centuryMain topic

Jakub Novosad, Irena Krčmová

Klin Farmakol Farm. 2026;40(1):25-33 | DOI: 10.36290/far.2026.010  

Bronchial asthma affects more than 339 million people worldwide, with traditional treatment achieving ultimate success in only about 50-60 % of patients. Since the turn of the 21^st century, we have been facing a revolution in asthmatology, consisting in the introduction of precision medicine focused on identifying pathogenetically causal molecular endotypes of the disease (type 2-high and type 2-low) using biomarkers (eosinophils, FeNO, IgE) and the introduction of targeted biological treatment with monoclonal antibodies: omalizumab (anti-IgE), mepolizumab, depemokimab (anti-IL-5), benralizumab (anti-IL-5R), dupilumab (anti-IL-4R) and tezepelumab...

Allergen immunotherapy for respiratory allergiesMain topic

Jiří Nevrlka

Klin Farmakol Farm. 2026;40(1):19-24 | DOI: 10.36290/far.2026.011  

Specific allergen immunotherapy is the only causal and disease‑modifying treatment modality for respiratory allergies. It represents a personalized approach that may induce long‑term immunotolerance to causal allergens. It can thus reduce or even completely eliminate symptoms of allergic rhinitis and, in some patients, allergic asthma, decrease the need for pharmacotherapy, improve patients' quality of life and, last but not least, protect them against progression of the allergic disease. This review summarizes the mechanisms of action and clinical efficacy of allergen immunothe­rapy in diseases related to inhalant allergens and discusses...

Allergic rhinitis - allergist's point of viewMain topic

Ester Seberová

Klin Farmakol Farm. 2026;40(1):13-18 | DOI: 10.36290/far.2026.013  

Allergic rhinitis is a chronic immunoglobulin E-mediated nasal illness that affects quality of life and productivity of patients and can lead to serious complications such as asthma. The complex therapy includes conventional pharmacotherapy (intranasal corticosteroids, oral and intranasal antihistamines, leukotriene antagonists, intranasal and oral vasoconstrictors, and nasal rinses), and in some cases also allergen immunotherapy. Good cooperation of patients, physitians of different specialities and pharmacists is necessary for improving standards of care. Modern informatic technologies can be helpful in this field.

The significant role of gliflozins in the treatment of type 2 diabetes mellitusOriginal articles

Mária Kolesárová, Michaela Bučková, Dana Marcinčáková, Zuzana Mačeková, Peter Takáč

Klin Farmakol Farm. 2026;40(1):5-12 | DOI: 10.36290/far.2025.072  

Type 2 diabetes mellitus (DM2) is a chronic progressive syndrome leading to damage to most tissues in the body. The aim of this retrospective study was to analyze the resulting effect of combined pharmacotherapy of DM2 after adding gliflozins to pharmacotherapy. The study included 30 patients with combined pharmacotherapy for DM2, with an average age of 65 ± 8.71 years. The parameters monitored were blood glucose, glycated hemoglobin (HbA1c), body mass index (BMI), blood pressure (BP), LDL-cholesterol, HDL-cholesterol, and triacylglycerides (TAG). Patients enrolled in the study were indicated for sodium-glucose cotransporter 2 inhibitors (SGLT2i),...

Selection of an appropriate urinary spasmolytic in a geriatric patientCase reports

Lada Feřtová, Barbora Brezinová, Jaroslava Červeňová

Klin Farmakol Farm. 2025;39(4):245-248 | DOI: 10.36290/far.2025.064  

The selection of an appropriate medication for a geriatric patient is a complex process that requires careful consideration of several factors, such as the presence of all medications in the patient's pharmacological history, age-related changes in pharmacokinetics and pharmacodynamics, the patient's functional status, and comorbidities. Special attention should also be given to the medication regimen itself (including dosage forms), ensuring maximum support for patient adherence to pharmacotherapy. This case study discusses an individualized approach to urinary spasmolytic selection in a multimorbid geriatric patient. This article provides comparison...

Dapagliflozin in the treatment of IgA nephropathy in a paediatric patientCase reports

Markéta Ručková, Petra Matalová

Klin Farmakol Farm. 2025;39(4):241-244 | DOI: 10.36290/far.2025.043  

IgA nephropathy is the most common primary chronic glomerulonephritis in children and adults. It manifests itself as haematuria and proteinuria. Given that approximately half of patients develop kidney failure after 20 years, the prognosis is serious. In recent years, new treatment options have emerged for adults, including SGLT2 inhibitors, endothelin receptor antagonists, and targeted-release budesonide. These drugs are not yet approved for use in children with IgA nephropathy, but SGLT2 inhibitors are approved for children with diabetes mellitus type 2 (T2DM) over the age of 10. We describe the case of a boy with IgA nephropathy and an inadequate...

Vasoactive drugs in the treatment of erectile dysfunction: current conceptsReview articles

Markéta Rafajová

Klin Farmakol Farm. 2025;39(4):236-240 | DOI: 10.36290/far.2025.051  

Erectile dysfunction is a widespread health problem that significantly affects the quality of life of men. Pharmacotherapy is a key pillar of erectile dysfunction treatment, with vasoactive drugs, particularly phosphodiesterase type 5 inhibitors and prostaglandin E1, playing a crucial role in therapeutic approaches. This review article focuses on current concepts in the use of vasoactive drugs in the treatment of erectile dysfunction, including indications, mechanism of action, dosage, adverse effects and pharmacological interactions.

A brief overview of pharmacotherapy in palliative medicine - part twoReview articles

Miroslav Žiaran

Klin Farmakol Farm. 2025;39(4):229-235 | DOI: 10.36290/far.2025.070  

The second part of the overview of pharmacotherapy in palliative medicine focuses on the treatment of additional symptoms that significantly impair patients' quality of life - dyspnea, nausea and vomiting, constipation, diarrhea, hiccup, and cachexia. The article provides an overview of the etiopathogenesis of these conditions, non-pharmacological interventions, and in particular pharmacological approaches, highlighting their efficacy, safety, and practical application in clinical practice. Emphasis is placed on the need for an individualized approach, appropriate titration of medications, and multidisciplinary collaboration. The text is again intended...

Pharmacotherapie of neuropathic painReview articles

Dana Vondráčková

Klin Farmakol Farm. 2025;39(4):223-228 | DOI: 10.36290/far.2025.066  

Neuropathic pain is one of the most severe and difficult pain to treat with significant impact on health-related quality of life. The international associations IASP and EFIC have issued recommendations for the pharmacotherapy of this pain, which are based on recommendations in most countries. The three basic lines of choice as defined by the Clinical Standard for Pharmacotherapy of Neuropathic Pain include antidepressants, gabapentinoids, anticonvulsants, and weak or strong opioids. In addition, local treatment (capsaicin, lidocaine, botox) is recommended. For individual neuropathic pain syndromes, the recommendations slightly differ. The main differences...

Linezolid and therapeutic drug monitoring: Is it time for routine TDM?Main topic

Irena Murínová

Klin Farmakol Farm. 2025;39(4):218-222 | DOI: 10.36290/far.2025.075  

Therapeutic drug monitoring (TDM) has traditionally been used primarily for antibiotics with a narrow therapeutic index, such as aminoglycosides and vancomycin, or for drugs with complex pharmacokinetics, such as voriconazole. For most other antibiotics, its use has been limited to specific cases. However, in the context of the growing prevalence of multidrug-resistant pathogens and the limited development of new antibiotics, there is an increasing need to reconsider this approach. TDM is now seen not only as a tool for improving safety but also as a key strategy for optimizing efficacy, limiting the development of resistance, and thereby extending...