Induction of CYP3A4 by metamizole confirmed by TDM: a case study with quetiapineMain topic

Ivana Tašková

Klin Farmakol Farm. 2025;39(4):213-217 | DOI: 10.36290/far.2025.071  

Metamizole is an analgesic and antipyretic with a long history of clinical use, although some of its pharmacological properties, including its safety profile, remain incompletely understood. Recent studies indicate that metamizole is a moderate inducer of cytochrome P450 enzymes (CYP), particularly CYP3A4 and CYP2B6, which may result in altered plasma concentrations of concurrently administered drugs that are substrates of these enzymes. This article presents a case report of a patient whose regular administration of meta­mizole led to a marked decrease (approximately 75%) in quetiapine plasma concentration, consistent with the moderate induction of...

TDM as a tool for pharmacogenetic patient profiling: a case report of phenoconversionMain topic

Ivana Tašková, Nicole Šafářová

Klin Farmakol Farm. 2025;39(4):206-212 | DOI: 10.36290/far.2025.073  

Pharmacogenetics and therapeutic drug monitoring (TDM) are essential tools of personalised medicine in psychiatry. While pharmacogenetic testing enables the prediction of genetically determined enzyme activity, TDM provides a direct view of actual plasma drug concentrations and individual pharmacokinetics. These two methods are complementary; TDM can be utilised not only for dose optimisation but also to estimate the patient's metabolic phenotype or detect phenoconversion - a situation where the observed metabolic profile does not align with the genotype-predicted enzymatic activity. This case report details a patient with obsessive-compulsive disorder...

The importance of therapeutic monitoring of theophyllineMain topic

Kristina Pechandová

Klin Farmakol Farm. 2025;39(4):199-205 | DOI: 10.36290/far.2025.069  

Theophylline, a worldwide known and long-used bronchodilators in the treatment of lung diseases, has a narrow therapeutic range. The considerable interindividual variability in its pharmacokinetic parameters, the weak correlation between dose and plasma concentration, and the close relationship between plasma concentration and clinical effect make it a suitable candidate for therapeutic drug monitoring. Theophylline is mainly used in the treatment of pulmonary diseases, but its expected bronchodilator effect is only exerted when higher plasma levels are reached. During treatment, their regular determination is necessary to optimize therapy. High levels...

Retrospective evaluation of remdesivir effectiveness in the treatment of COVID-19 disease during the second wave of the pandemicOriginal articles

Lucia Žigová, Orsolya Hrubá, Andrea Gažová

Klin Farmakol Farm. 2025;39(4):194-198 | DOI: 10.36290/far.2025.049  

The COVID-19 pandemic has posed unforeseen challenges to healthcare systems and prompted intensive research into novel therapeutic strategies. Remdesivir, a nucleoside analogue with an approved indication for the treatment of COVID-19, has been included in numerous clinical trials aimed at evaluating its efficacy. While some of these studies suggested a potential clinical benefit, others failed to demonstrate a clear effect on mortality reduction or shortening of hospital stay. The aim of this retrospective study was to evaluate whether the administration of remdesivir during the second pandemic wave influenced clinical outcomes in hospitalized patients...

Úvodní slovo k tématu číslaEditorial

Ivana Tašková

Klin Farmakol Farm. 2025;39(4):192-193  

Pharmacokinetic interactions of clozapine and olanzapine: case studies of drug modifications due to CYP1A2 inhibitionCase reports

Kateřina Skopalová

Klin Farmakol Farm. 2025;39(3):181-184 | DOI: 10.36290/far.2025.063  

MARTA antipsychotics are essential drugs in the treatment of psychiatric disorders; however, their efficacy and safety can be affected by drug interactions. This article focuses on interactions between antipsychotics and antibiotics, particularly through the inhibition of cytochrome P450 1A2 (CYP 1A2), which may lead to drug level changes beyond the therapeutic range. Two selected case reports from clinical practice in an inpatient psychiatric hospital illustrate the consequences of these interactions and possible solutions. Special emphasis is placed on the drug interaction between clozapine and ciprofloxacin and the necessity of therapeutic drug...

Efficacy and safety of fezolinetant in the treatment of moderate to severe vasomotor symptoms in women for whom hormone therapy is considered inappropriateReview articles

Marek Lapka

Klin Farmakol Farm. 2025;39(3):174-180 | DOI: 10.36290/far.2025.062  

The phase 3b DAYLIGHT study evaluated fezolinetant, a neurokinin-3 receptor anta­gonist, in women with moderate-to-severe vasomotor symptoms (VMS) unsuitable for hormone replacement therapy (HRT). A total of 453 women aged 40-65 years were randomized to fezolinetant 45 mg once daily or placebo for 24 weeks. Fezolinetant significantly reduced the frequency and severity of VMS, improved sleep quality and menopause-related quality of life, with effects evident from week 1 and sustained throughout treatment. The safety profile was favorable and comparable to placebo, with slightly more fatigue and mild, transient liver enzyme elevations. Fezolinetant represents...

Nitazenes and other opioid receptor superagonistsReview articles

Jitka Rychlíčková, Ema Kunová

Klin Farmakol Farm. 2025;39(3):171-173 | DOI: 10.36290/far.2025.061  

Nitazenes and spirochlorphine are synthetic opioids that have been of interest in recent years in relation to unintentional overdoses with non-fatal and fatal consequences. These substances are potent agonists, predominantly of µ-opioid receptors, and exhibit a similar potency to fentanyl. The diagnosis of overdose is complicated by the inability to detect them with standard opioid screening tests. The available literature on the treatment of nitazene and spirochlorphine intoxication is limited. The objective of this article is to highlight the existence of these agents, summarise the known information on their pharmacology, and point out possible...

Treatment of multimorbid patients with multiple sclerosisReview articles

Martina Petrášová, Jan Kočica

Klin Farmakol Farm. 2025;39(3):165-170 | DOI: 10.36290/far.2025.060  

The review summarises practical principles for treating polymorbid patients with multi­ple sclerosis. Comorbidities are common and strongly influence diagnosis, prognosis, and the choice of chronic disease-modifying therapy (DMT); radiographic activity in the setting of vascular comorbidities should therefore be interpreted in the context of additional biomarkers. In highly active disease, early high-efficacy therapy (e. g., anti-CD20 antibodies, cladribine, or natalizumab) has a clear role, always coupled with rigorous pharmacovigilance. Overlapping conditions can be managed safely with parallel, comorbidity-targeted treatment (e. g., anti-CGRP for...

Beta-blockers in the treatment of heart failureMain topic

Monika Špinarová, Karel Lábr

Klin Farmakol Farm. 2025;39(3):160-164 | DOI: 10.36290/far.2025.059  

Heart failure is a common disease with a serious prognosis. Treatment is always complex and includes both pharmacological and non-pharmacological processes. Beta-blockers are one of the fundamental drugs in treatment of chronic heart failure with reduced ejection fraction (HFrEF). The recommended drugs include bisoprolol, carvedilol, metoprolol succinate and nebivolol. Beta-blockers should be initiated in clinically stable, euvolaemic, patients at a low dose and gradually uptitrated to the maximum tolerated dose. The only reason for not administering beta-blockers in these patients are contraindications. We do not have enough evidences for recommendation...

Betablockers in the treatment of heart rhythm disordersMain topic

Dominik Broniš, Irena Andršová, Tomáš Novotný

Klin Farmakol Farm. 2025;39(3):155-159 | DOI: 10.36290/far.2025.058  

Beta-blockers represent a fundamental component in the treatment of cardiac arrhythmias due to their ability to suppress the effects of the sympathetic nervous system and stabilize heart rhythm. They are primarily used for heart rate control in atrial fibrillation, and they also reduce the risk of ventricular arrhythmias and sudden cardiac death, particularly in patients with ischemic heart disease or heart failure. Thanks to their long-established efficacy, good tolerability, and favorable impact on survival, beta-blockers maintain a strong position in clinical practice. Advances in personalized medicine and genetic profiling of patients further open...

Beta-blockers in the treatment of arterial hypertensionMain topic

Karel Lábr, Monika Špinarová

Klin Farmakol Farm. 2025;39(3):150-154 | DOI: 10.36290/far.2025.057  

Beta-blockers represent a traditional class of antihypertensive drugs, whose role in the treatment of arterial hypertension has evolved significantly over recent decades. While they are no longer recommended as first-line therapy for uncomplicated hypertension, they remain a key treatment option in certain clinical scenarios - particularly in patients with concomitant ischemic heart disease, a history of myocardial infarction, heart failure, tachyarrhythmias, or increased sympathetic activity in younger individuals. This review aims to summarize the mechanism of action of beta-blockers, evaluate available clinical evidence of their efficacy, compare...

Beta-blockers in the treatment of chronic coronary artery diseaseMain topic

Martin Ambroz, Ondřej Ludka

Klin Farmakol Farm. 2025;39(3):145-149 | DOI: 10.36290/far.2025.056  

Beta-blockers (BB) represent one of the key groups of drugs in the treatment of chronic coronary artery disease. Pharmacological treatment with BB includes symptom-controlling therapy and prognosis-improving therapy in certain groups of patients. The benefit of BB has been demonstrated in patients with reduced left ventricular ejection fraction (LVEF), but there is a lack of clear data from randomised clinical trials in patients with LVEF > 40 %. Recent studies REDUCE-AMI and ABYSS have attempted to assess the effect of BB in this patient group, but the results were quite contradictory. Chronic coronary artery disease is a heterogeneous disease...

Beta-blockers in acute coronary syndrome: current evidence and clinical implicationsMain topic

Anna Chaloupka

Klin Farmakol Farm. 2025;39(3):141-144 | DOI: 10.36290/far.2025.055  

Beta-blockers (BBs) have long been a cornerstone of therapy for acute coronary syndrome (ACS). With the advent of reperfusion strategies and modern pharmacotherapy, however, particularly in patients with preserved left-ventricular ejection fraction (LVEF), the role of beta-blockers has become a matter of expert debate. This review summarizes the properties and the role of betablockers in the treatment of acute coronary syndrome, the current guidelines and key randomized trials, and offers a pragmatic framework for the modern indication and duration of beta-blocker therapy across the ACS spectrum.

Adverse effects of oral anticoagulant therapy in hospitalized patientsOriginal articles

Orsolya Hrubá, Lucia Žigová, Peter Jackuliak, Juraj Payer, Ján Kyselovič, Andrea Gažová

Klin Farmakol Farm. 2025;39(3):134-140 | DOI: 10.36290/far.2025.054  

Aim of the study: To retrospectively evaluate the incidence of adverse effects of oral anticoagulant therapy (warfarin vs. direct oral anticoagulants - DOACs) in hospitalized patients who died during their hospital stay in a selected clinical department, with an emphasis on analyzing INR values, antidote administration, and the nature of clinical complications. Methods: Between 2010 and 2022, a total of 46,521 hospitalizations were recorded at the 5th Department of Internal Medicine, Faculty of Medicine, Comenius University, and University Hospital Bratislava. Among these, 5,380 ended with the patient's death. Out of these, 461 patients were identified...

Betablokátory v kardiologii editorialEditorial

Jiří Vítovec

Klin Farmakol Farm. 2025;39(3):133  

Slovo úvodemEditorial

MUDr. David Suchý, Ph.D.

Klin Farmakol Farm. 2025;39(2):71  

Retatrutide: A novel approach in the treatment of obesity, diabetes mellitus, and MASLD (metabolic dysfunction-associated steatotic liver disease)Review articles

Robert Prosecký, Klaudia Hálová Karoliová

Klin Farmakol Farm. 2025;39(2):122-129 | DOI: 10.36290/far.2025.041  

Obesity and metabolic diseases represent a global challenge requiring innovative therapeutic approaches. Retatrutide (LY3437943) is a new pharmacological option that combines agonistic action on GLP-1, GIP, and glucagon receptors, offering a comprehensive approach to the treatment of obesity, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD). Its mechanism of action includes appetite regulation, delayed gastric emptying, enhanced insulin secretion, and improved energy metabolism. Clinical trials TRIUMPH demonstrate significant weight loss (up to 24.2 % after 48 weeks of treatment) and improvement in...

Conservative treatment od endometriosisReview articles

Martin Trhlík

Klin Farmakol Farm. 2025;39(2):117-121 | DOI: 10.36290/far.2025.040  

Endometriosis is a chronic gynaecological condition affecting up to 10 % of women of reproductive age. Fertility disorders, pain, and organ involvement significantly impact the quality of life and health of those affected. The socioeconomic burden is considerable, with substantial resources allocated to treatment. Management includes both radical surgical approaches and conservative methods, namely the administration of various groups of medicinal products. Analgesics are used to alleviate painful symptoms. Hormonal therapies include progestins alone or in combination with oestrogens, which influence the activity of endometriotic lesions. Another group...

The role of glucocorticoids in rheumatologyReview articles

Tomáš Lederer, Tomáš Soukup

Klin Farmakol Farm. 2025;39(2):111-116 | DOI: 10.36290/far.2025.039  

Glucocorticoids remain an important pillar in the treatment of rheumatologic diseases due to their strong anti-inflammatory and immunosuppressive effects. Their benefit is undeniable, but prolonged use carries significant risks such as accelerated osteoporosis, steroid-induced diabetes mellitus, cardiovascular diseases, and immunosuppression. These risks must be monitored and prevented. By using new approaches, we aim to minimize side effects. Dosage is optimized, and the duration of use is shortened to the necessary minimum. Glucocorticoid therapy is combined with other medications that have a glucocorticoid-sparing effect.

Antidepressants in the treatment of depressive disorder during pregnancy: to treat or not to treat?Review articles

Lenka Sušilová

Klin Farmakol Farm. 2025;39(2):103-110 | DOI: 10.36290/far.2025.038  

Antidepressants, as well as untreated depressive disorder during pregnancy, represent risk factors for the course of pregnancy, fetal development, and neonatal adaptation after birth. This review summarizes currently published data on the impact of untreated depressive disorder and the risks associated with antidepressant treatment on the course of pregnancy, fetal development, and early neonatal adaptation. Available studies do not indicate that most antidepressants have teratogenic potential or clinically significantly increase the risk of pregnancy complications or impaired fetal development. However, exposure to antidepressants may increase the...

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

Miroslav Žiaran

Klin Farmakol Farm. 2025;39(2):96-102 | DOI: 10.36290/far.2025.037  

Palliative medicine is dedicated to enhancing the quality of life in patients with incurable illnesses through comprehensive, interdisciplinary care, in which pharmacotherapy plays a central role. Pharmacological treatment in this context seeks to manage distressing symptoms and alleviate suffering during the final stages of life. This article outlines the principles and specific considerations of pharmacotherapy in palliative care, with emphasis on individualized treatment approaches, patient safety, ethical implications, and multidisciplinary collaboration. Considering the altered physiology commonly seen in advanced illness, the need to tailor pharmacological...

Primum non nocere: How safe is modern therapy for multiple sclerosis?Main topic

Dominika Šťastná, Dana Horáková

Klin Farmakol Farm. 2025;39(2):89-95 | DOI: 10.36290/far.2025.036  

Multiple sclerosis is a chronic autoimmune disease of the central nervous system which, if left untreated, leads to significant neurological disability. The early initiation of high-efficacy disease-modifying therapy has fundamentally improved patient prognosis, effectively suppressing inflammatory activity and slowing disease progression. However, higher efficacy comes with an increased risk of serious adverse events, including infections, autoimmune complications, and potentially malignancies. Infections remain the most frequent adverse event, with the risk particularly pronounced in therapies involving anti-CD20 monoclonal antibodies. This article...

Adverse effects of systemic treatment for psoriasisMain topic

David Suchý, Petra Cetkovská

Klin Farmakol Farm. 2025;39(2):84-88 | DOI: 10.36290/far.2025.035  

Psoriasis is a chronic genetically determined immunologically mediated inflammatory condition associated with systemic comorbidities. Local therapy and phototherapy is usually recommended for mild psoriasis. When this treatment is not effective, not tolerated or contraindicated, as well as in patients with severe disease or significantly decreased quality of life the systemic therapy is prescribed. It is clinically important to consider the potential adverse events risks associated with the long-term use of synthetic oral and biological systemic therapies. The aim of this paper is to summarize profil of adverse events reported in context of psoriasis...

The safety of biological and targeted therapies in rheumatologyMain topic

Marta Olejárová

Klin Farmakol Farm. 2025;39(2):77-83 | DOI: 10.36290/far.2025.034  

Biological and targeted synthetic agents have fundamentally transformed the thera­peutic approach to patients with inflammatory rheumatic diseases, including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and more recently also systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). By targeting key components of the immune response, biologic therapies demonstrate superior efficacy and often a more favorable safety profile compared to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). However, biologic and targeted synthetic therapies are not without risks. The spectrum and nature...

Metformin and vitamin B₁₂ deficiency - own observations from clinical practiceOriginal articles

Dana Weberová, Pavel Weber, Hana Meluzínová

Klin Farmakol Farm. 2025;39(2):72-76 | DOI: 10.36290/far.2025.033  

Introduction: Long-term use of metformin can lead to digestive problems, lactic acidosis, and deterioration of renal function, as well as vitamin B₁₂ deficiency. The aim of our work was to point out the risk of long-term use of metformin, especially in higher doses, in a specific group of patients with type 2 diabetes treated by us. Patients and methodology: In 2024, a total of 2,136 patients with type 2 diabetes (T2DM) were treated in the diabetes outpatient clinic Diastop, l. t. d. (non-state healthcare facility) a long time - 1,111 men and 1,025 women. Of these, 70 % were ≥ 65 years old and 12.6 % were ≥ 80 years old. Their...

Slovo úvodemEditorial

MUDr. Michal Prokeš, PharmDr. Josef Suchopár

Klin Farmakol Farm. 2025;39(1):4  

Psychedelics in the treatment of cluster headachesReview articles

Michal Židó, Tomáš Páleníček, Ivana Štětkářová

Klin Farmakol Farm. 2025;39(1):62-66 | DOI: 10.36290/far.2025.021  

Psychedelics are psychoactive substances that typically cause changes in perception, thinking, emotionality, and cognitive processes immediately after use. Recently, their antidepressant and anxiolytic effects have been intensively investigated. The main advantage of these substances is the rapid onset and long-lasting effect after administration of one or only a few doses. They also have a good safety profile. These substances can also be used to treat chronic neurogenic pain and primary headaches, e.g. cluster headache. Cluster headache is a rare disease, manifested by episodes of intense headaches with vegetative accompaniment, which can significantly...

The use of therapeutic second-generation antipsychotics level monitoring in the individualization of schizophrenia pharmacotherapyReview articles

Anna Králová, Petr Potměšil, Miloslav Kopeček

Klin Farmakol Farm. 2025;39(1):57-61 | DOI: 10.36290/far.2025.020  

Therapy for schizophrenia involves a complex treatment plan consisting of social interventions, psychotherapy, and pharmacotherapy. Second-generation antipsychotics are the cornerstone of the treatment due to their pharmacological profile and lower incidence of side effects. Antipsychotika treatment is long-term and extends beyond the acute phase. Maintenance therapy is crucial to prevent relapse. Determining the plasmatic levels of antipsychotic drugs, known as therapeutic drug monitoring, helps adjust the dose for each patient individually. This process also helps minimize toxicity, monitor adherence, and reduce treatment costs.

Sex-related differences - from pharmacology to clinical research methodologyReview articles

Adriána Papiež, Zora Čechová, Jitka Rychlíčková

Klin Farmakol Farm. 2025;39(1):52-56 | DOI: 10.36290/far.2025.019  

Expert community and even patients are increasingly concerned about whether the results of clinical trials can be applied to patient subgroups that were not originally included in the research. Regarding this, female population is the most frequently discussed. Biological sex significantly influences the pharmacokinetics and pharmacodynamics of drugs, leading to differences in both therapeutic and adverse effects. Despite this, women have been historically under-represented in clinical studies, for example in cardiovascular research. Although female participation has improved in recent years, disparities persist. This article explores the historical...