Medycyna Faktow (J EBM)

A practical guide to the use of P2Y12 inhibitors in acute coronary syndrome

2025-10-27T16:01:09+01:00

P2Y12 receptor inhibitors are a key component of pharmacotherapy for patients with acute coronary syndrome. The European Society of Cardiology?s 2023 guidelines recommend ticagrelor or prasugrel as preferred P2Y12 inhibitors for most acute coronary syndrome patients. Clopidogrel remains a valuable option in special situations, such as when anticoagulation therapy is needed or there is a high risk of bleeding. This article presents the differences between available P2Y12 inhibitors and proposes a practical algorithm for selecting them. The algorithm considers the acute coronary syndrome treatment strategy (percutaneous coronary intervention vs. conservative management), patient age, contraindications, and risk of bleeding complications. This article compiles current clinical data and guideline recommendations in a practical format to facilitate rapid therapeutic decision-making.

Gastroesophageal reflux disease in primary care in the light of current guidelines

2025-10-27T16:01:49+01:00

Gastroesophageal reflux disease is frequent, recurrent disease. Clinical manifestations are various, with typical esophageal or extraesophageal symptoms. Endoscopical diagnosis is necessary in case of alarm symptoms, in elderly patients and before the surgical treatment. Proton pump inhibitors are fundamental in medical treatment.

Why does health start with the gut? The importance of microbiota and the use of probiotics in the context of maintaining mental health and supportive treatment of mental disorders. Part II

2025-10-28T08:41:42+01:00

In recent decades, there has been growing interest in the influence of gut microbiota on human mental and physical health. Understanding the role of microbiota, including interactions between the digestive system and the central nervous system, is of particular importance in the context of lifestyle diseases, including the increasing prevalence of mental disorders. Research results indicate that the composition of gut microbiota may differ significantly between healthy individuals and those suffering from depressive or anxiety disorders. This fact provides the basis for research on the use of probiotics and psychobiotics as a potential support for standard pharmacotherapy. This article discusses the importance of microbiota, not only in terms of physical health, but also mental health, pointing to key mechanisms of the brain-gut axis and discussing the possibilities of using probiotics in the treatment of depression, schizophrenia and bipolar disorder.

Single-pill combination therapy in the treatment of dyslipidemia and in the prevention of cardiovascular events

2025-10-28T09:02:12+01:00

Cardiovascular diseases are main cause of deaths worldwide and in Poland. Dyslipidemia remains main reversable risk factor for cardiovascular diseases. The main elements of the treatment involves high-intensivity statins in maximally tolerated doses, ezetimibe and PCSK-9 inhibitors. Development of single-pill combination therapy including statin and ezetimibe increases compliance and in contrast to separate pills allows for amplification of hypolipemic effect for about 15%. Initiation therapy with single-pill fixed dose combination therapy was already proposed for treatment of patients post-acute coronary syndrome (European Society of Cardiology guidelines, II B). However, in regards to current state of knowledge, the faster and the lower the LDL-cholesterol the better prognosis achieved by the patients. Thus, the initiation of the therapy with single-pill fixed dose combination therapy may be considered in justified cases (especially among patients with high/very-high risk when LDL-cholesterol is higher than 120 mg/dl).

California Rocket Fuel – the combination of mirtazapine and venlafaxine

2025-10-28T09:20:37+01:00

The combination of mirtazapine and venlafaxine, known as the „California rocket fuel”, has been attracting growing interest due to its potential application in the treatment of depression resistant to conventional therapies. This review paper examines the available data on the mechanisms of action and the clinical use of the mirtazapine-venlafaxine combination in medical practice. A key aspect of its action lies in its impact on the monoaminergic system, including increased release of serotonin (5-HT) and norepinephrine (NE) through interactions with presynaptic receptors, which may lead to a rapid improvement in depressive symptoms. This combination may also exert its effects by inhibiting presynaptic alpha-2 autoreceptors, thereby enhancing noradrenergic, serotonergic and dopaminergic transmission. Mirtazapine and venlafaxine demonstrate synergistic action in the treatment of depression. Clinical studies have reported improvements in patients with treatment-resistant depression, and there is a growing suggestion that this combination could also be used as a first-line treatment for depression. However, the safety aspects of this pharmacotherapy must be carefully considered before initiating combination treatment. It should be closely monitored for potential adverse effects to ensure the optimal safety and efficacy of the intervention.

Reasons to use trazodone XR/CR

2025-10-28T09:46:54+01:00

Depression is one of the leading causes of disability worldwide, and standard selective serotonin reuptake inhibitors treatment often does not lead to full improvement, especially regarding insomnia, anhedonia, or sexual dysfunction, and sometimes even worsens these symptoms. Trazodone stands out due to its unique, dose-dependent mechanism of action, combining antagonism of 5-HT_2A/2C receptors, blockade of α₁, H₁, and α₂ receptors, and inhibition of serotonin reuptake, enabling versatile clinical use. At low doses, trazodone has a sedative effect and improves sleep quality, while at higher doses it exhibits strong antidepressant and anxiolytic effects. The availability of controlled-release (CR) and extended-release (XR) formulations allows for convenient dosing and better tolerability, which is important in depression therapy. Trazodone is especially recommended for patients with depression accompanied by insomnia, improving sleep architecture without risk of dependence. Additionally, it benefits patients experiencing sexual dysfunction often caused by selective serotonin reuptake inhibitors by reducing symptom severity. The drug may also be used in patients with depression and metabolic disorders due to a more favorable metabolic profile compared to other antidepressants. All these features make trazodone XR/CR a valuable therapeutic option in treating depression, both as monotherapy and as adjunct therapy.

Nonsteroidal anti-inflammatory drugs in primary care – pain therapy

2025-10-28T09:53:17+01:00

Pain is a subjective experience associated with actual or potential tissue damage. Among the most commonly used pharmaceuticals in pain therapy are nonsteroidal anti-inflammatory drugs (NSAIDs), which belong to the first step of the analgesic ladder. NSAIDs are not a homogeneous group of drugs – one of their distinguishing features is their selectivity in inhibiting COX-2, which is responsible for their anti-inflammatory, analgesic, antipyretic, and antithrombotic effects. This article discusses the mechanism of action, therapeutic indications, and limitations of NSAIDs in pain therapy.

The use of nimesulide in clinical practice

2025-10-28T10:01:54+01:00

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs in pain therapy. It is a group of drugs of first choice, primarily in the treatment of inflammatory receptor pain, which is due to the inhibition of constitutive COX-1 and inducible COX-2 cyclooxygenase. The choice of a particular preparation among the many NSAIDs cannot be random and must take into account not only the main mechanism of action, i.e. inhibition of cyclooxygenase activity, but also non-cyclooxygenase effects and the individually assessed risk of drug-related adverse reaction. The subject of this article is the place of nimesulide, a preferential cyclooxygenase-2 (COX-2) inhibitor, in the treatment of acute and chronic pain. The use of nimesulide in various clinical situations is shown, taking into account its safety profile compared to other NSAIDs.

Fluoroquinolones. Levofloxacin vs. ciprofloxacin. Is the choice obvious?

2025-10-28T10:22:57+01:00

The fluoroquinolone class of antibacterial agents are among the most frequently prescribed drugs, with utility in a broad range of bacterial infections. Although very useful agents, the fluoroquinolones as a class are associated with a number of adverse events, some with considerable clinical significance. In the past 15–20 years, tolerability concerns have led to restrictions on the use of the fluoroquinolones and, in some instances, even to their withdrawal. Adverse events commonly associated with the fluoroquinolones include gastrointestinal and central nervous system toxicity (most frequently headache and dizziness), as well as other adverse events including ECG abnormalities (for example QT interval prolongation), disrupted glucose metabolism, phototoxicity, tendon and joint disorders, hypersensitivity and skin disorders, and hepatic toxicity. These differences may be explained, at least in part, by structural differences. Furthermore, many of the fluoroquinolone-associated adverse effects and toxicities occur more frequently in patients with pre-existing risk factors, or in certain subpopulations. Overall, it appears that levofloxacin is relatively well tolerated, with low rates of clinically important adverse events such as central nervous system toxicity, cardiovascular toxicity and dysglycaemia.

Reasons to use 5% lidocaine patch

2025-10-28T10:35:19+01:00

This article discusses the problem of peripheral localized neuropathic pain. One of the therapeutic choices in this condition is 5% lidocaine patches. Local treatment with lidocaine is characterized by direct action at the site of pain, which minimizes systemic side effects and drug interactions, as well as low absorption into the systemic circulation (1–5% of the dose), which translates into a better safety profile. 5% lidocaine patches are registered for the treatment of postherpetic neuralgia, but clinical and observational studies also indicate their effectiveness in diabetic polyneuropathy, posttraumatic neuropathy or carpal tunnel syndrome.

Expert recommendations, including International Association for the Study of Pain Neuropathic Pain Special Interest Group and European Federation of Neurological Societies, indicate 5% lidocaine patches as a second-line drug in peripheral neuropathic pain, and even first-line in the elderly and with multimorbidity, due to the limited possibility of using systemic drugs in these patient groups.

Why do we need biotin?

2025-10-28T11:13:35+01:00

The present paper delineates the mechanism of action of biotin in the human body and the consequences of biotin deficiency. Indeed, the prevalence of biotin supplements is notable, with approximately 30% of consumers in the USA reporting their use and a significant proportion of medical professionals recommending them. Consequently, a critical examination of this substance is warranted. In order to this end, the indications for implementing biotin supplementation were analysed in the context of research findings and the aetiology of biotin deficiency.

Eszopiclone – benefits map

2025-10-28T11:24:16+01:00

Eszopiclone is a modern non-benzodiazepine GABA-A receptor agonist used for the treatment of insomnia, characterized by a favorable efficacy and safety profile. Compared to traditional hypnotics, it offers a rapid onset of action, prolongation of total sleep time, and improvement in sleep quality, with minimal risk of dependence or adverse effects. One of its key advantages is sustained effectiveness during long-term use without significant tolerance. Eszopiclone has also been shown to improve daytime functioning and overall quality of life in patients with chronic insomnia. This article presents the main therapeutic benefits of eszopiclone, supported by clinical evidence, and discusses its role in current treatment guidelines for sleep disorders.

Tapentadol – a new opioid with a unique, dual mechanism of action and wide possibilities of application

2025-10-28T11:41:55+01:00

Tapentadol is a new drug classified as a strong opioid, a representative of a new class of centrally acting analgesics called MOR-NRI. It is a drug with a unique, dual mechanism of action: it is an agonist of the μ-opioid receptor (MOR) and norepinephrine reuptake inhibitor (NRI). This drug, despite its 50-fold lower affinity for the μ-opioid receptor compared to morphine, has an analgesic effect that is only three times weaker than morphine, which is a consequence of the synergism of its two mechanisms of action. It is believed that the noradrenergic mechanism of action of tapentadol is largely responsible for its effectiveness in relieving various neuropathic pain syndromes, while its action on μ-opioid receptor for analgesic effect of tapentadol in nociceptive pain. Many clinical studies have confirmed good analgesic effect of tapentadol in treatment of acute postoperative pain and many chronic pain syndromes, including pain in the course of osteoarthritis, spinal pain syndrome (with or without a neuropathic component) or neuropathic pain in the course of painful diabetic polyneuropathy. Available studies and everyday clinical practice also confirm the efficacy and safety of tapentadol in the treatment of severe pain in cancer patients.

For whom is triple antihypertensive therapy indicated? Optimizing the management of arterial hypertension – patient profiles

2025-10-28T12:19:41+01:00

Hypertension is one of the most prevalent chronic, non-communicable diseases in the 21st century and represents a significant modifiable risk factor for cardiovascular diseases, including myocardial infarction, stroke, and heart failure. According to estimates from the World Health Organization, hypertension affects over one-third of the adult population globally, with prevalence rates reaching as high as 40–50% among individuals over the age of 60 in developed countries. The 2024 guidelines from the Polish Society of Hypertension (PTNT) and the Polish Cardiac Society (PTK) underlined several recommendations, one of the most significant changes being the shift towards the prompt initiation of triple therapy in patients at high and very high cardiovascular risk, as well as in those for whom dual therapy fails to achieve the desired therapeutic outcomes. Combination therapy involving perindopril, amlodipine, and indapamide is one of the most well-documented and practically utilized treatment regimens for hypertension in Europe. This study aims to comprehensively discuss this treatment scheme from clinical, pharmacological, and organizational perspectives, considering its position within the current PTNT/PTK 2024 guidelines and its importance for improving hypertension control among patients, including the Polish population.

Efficacy and safety of combination therapy: valsartan and sustained-release indapamide

2025-10-28T12:48:42+01:00

According to the 2024 guidelines of the European Society of Cardiology, the treatment of arterial hypertension should be based on combination therapy, preferably in the form of a single-pill combination, which improves both treatment efficacy and patient adherence. The combination of valsartan (an angiotensin II receptor blocker) with sustained-release indapamide (a thiazide-like diuretic) offers complementary antihypertensive mechanisms while maintaining a favourable safety and metabolic profile, and providing additional renal- and cardioprotective effects. These benefits have been confirmed in high-risk populations, including patients with cardiovascular diseases and elderly individuals. The valsartan + sustained-release indapamide combination represents a modern and effective therapeutic option in the treatment of arterial hypertension.

Naproxen – known and unknown faces of a non-steroidal anti-inflammatory drug in clinical practice. Part I

2025-10-28T13:04:55+01:00

Naproxen is a well-known, prescription and over-the-counter nonsteroidal anti-inflammatory drug (NSAID), whose analgesic, anti-inflammatory, and antipyretic properties are used in the treatment of numerous pain syndromes, both acute and chronic. Its pharmacological activity includes, in addition to inhibiting cyclooxygenases, other multifaceted mechanisms of action, including blocking purine receptors and antiviral effects confirmed in in vitro and human studies.

Numerous clinical studies have confirmed its effectiveness in the treatment of conditions such as rheumatoid arthritis, osteoarthritis, gout, nonspecific low back pain, primary menstrual pain, headaches, and fever. Its relatively rapid analgesic effect, long half-life, and well-established safety profile among NSAIDs make it an effective drug used in everyday medical practice. This paper presents key aspects of naproxen, including its mechanisms of action, possible side effects, efficacy and safety in pain relief in many conditions, as well as in the treatment of fever and colds.

Solifenacin in the treatment of overactive bladder syndrome: efficacy, safety and the relevance of clinical diagnosis

2025-10-28T13:19:29+01:00

Solifenacin is a well-established therapeutic option for patients with overactive bladder syndrome. Anticholinergic drugs reduce the severity of urgency, the number of urgency incontinence episodes, and decrease the frequency of urination, which is crucial for improving the quality of life of patients with overactive bladder syndrome. Due to its more selective action on M₃ muscarinic receptors and low affinity for other muscarinic receptors, solifenacin is associated with fewer adverse effects than oxybutynin and tolterodine. Solifenacin is also relatively well tolerated by elderly individuals.

Why we choose fenofibrate? Fenofibrate in long-term therapy – larger packages, greater benefits for patients with atherogenic dyslipidemia

2025-10-28T13:35:06+01:00

Fenofibrate remains an important drug in the treatment of dyslipidemia – the molecule of choice for severe hypertriglyceridemia, as well as a key drug in optimizing the pharmacotherapy of atherogenic dyslipidemia, especially in patients with type 2 diabetes. According to polish experts, when additional TG reduction is indicated in patients already taking a statin, the rationale for using a fibrate instead of omega-3 fatty acids is, among other things, practical considerations – the drug’s availability, simple dosing regimen, and affordable price. All these factors favor therapeutic adherence, which is also improved by the drug’s availability in multi-tablet packages. These seemingly trivial, yet very practical factors complement the value of a molecule with very beneficial pleiotropic effects, crucial especially in the presence of metabolic disorders.

The place of ranolazine in modern pharmacotherapy of chronic coronary syndrome. Own experience

2025-10-28T13:58:47+01:00

Ranolazine is an antianginal drug with a multifaceted mechanism of action that complements the effects of conventional pharmacotherapy for chronic coronary syndrome. The primary mechanism of its action stems from the inhibition of the late sodium current in the cardiomyocyte cell membrane. This results in improved myocardial relaxation and compliance, thereby reducing the frequency of observed arrhythmias. The specific antiarrhythmic mechanism of ranolazine prolongs the action potential duration and decreases the electrical excitability of cardiac muscle cells. Additionally, ranolazine exerts a cardioprotective effect under ischemic conditions. It inhibits β-oxidation of fatty acids, leading to a predominance of glucose metabolism. The drug is well-tolerated by patients, and its efficacy led to its inclusion in 2018 in the classification of medications used for supraventricular and ventricular arrhythmias.

Profiles of patients who may benefits of combination therapy with telmisartan, amlodipine and hydrochlorothiazide

2025-10-28T14:21:06+01:00

Optimal blood pressure control reduces cardiovascular risk, morbidity, and mortality. Most patients require combination antihypertensive therapy to achieve target blood pressure. The basic three medications in the initial treatment of hypertension are angiotensin receptor antagonists, calcium channel blockers, and thiazide diuretics. Combinations of medications can have a synergistic effect, and lower doses reduce the risk of adverse effects, which translates into treatment persistence. When selecting therapy, it is important to adjust the medication to the patient’s profile to achieve the greatest benefit. Combination therapy with telmisartan, amlodipine, and hydrochlorothiazide is recommended for patients at high cardiovascular risk, with metabolic syndrome, impaired carbohydrate metabolism, cognitive impairment, and osteoporosis.

Non-obvious profiles of patients who can additionally use famotidine

2025-10-28T14:50:16+01:00

Famotidine, a third-generation H₂ blocker, inhibits hydrochloric acid secretion by competitively blocking histamine H₂ receptors in the gastric parietal cell wall. It is primarily used to treat symptomatic gastroesophageal reflux disease, but its use is not always considered in dyspepsia, prior to a planned gastroscopy with a urease test, and in patients with medical conditions and polypharmacy.

Cilostazol in clinical practice

2025-10-28T14:59:06+01:00

This article presents the pharmacological and clinical properties of cilostazol. The pharmacology, mechanism of action, pharmacokinetics, dosing guidelines, side effects, and possible adverse reactions are discussed. Its usefulness in reducing the symptoms of peripheral vascular disease associated with atherosclerosis obliterans is emphasized, including increasing the distance of intermittent claudication during conservative treatment. Two case studies of patients with peripheral vascular disease are described, illustrating the practical application of cilostazol in specific clinical situations. In summary, cilostazol can be described as a valuable drug, complementing the pharmacological treatment of peripheral vascular disease symptoms, with clinically proven efficacy.

Profiles of patients who may benefit from pregabalin therapy

2025-10-28T15:06:46+01:00

Pregabalin is a medication that acts on calcium channels in the nervous system and exhibits anxiolytic, analgesic, and anticonvulsant effects. Unlike benzodiazepines, it does not cause addiction or sedation, and its therapeutic effect occurs rapidly – often within a few days. It is approved for the treatment of epilepsy, neuropathic pain, and generalized anxiety disorder (GAD). Pregabalin is particularly effective in patients with somatic symptoms of anxiety, insomnia, chronic pain, or after alcohol detoxification. It is well tolerated in older adults and does not cause significant drug interactions. Its dosage should be adjusted based on renal function. Pregabalin is a valuable alternative or adjunct therapy for patients in whom SSRIs/SNRIs are ineffective or poorly tolerated.