Diuretic drugs that inhibit the process of sodium reabsorption in the renal tubules. Application of the substance Hydrochlorothiazide. Indications for use

Gross formula

Pharmacological group of the substance Hydrochlorothiazide

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Hydrochlorothiazide

White or yellowish crystalline powder. Slightly soluble in water, sparingly soluble in methanol, insoluble in ether, freely soluble in alkaline solutions. Molecular mass 297,72.

Pharmacology

Reduces the reabsorption of sodium and chlorine ions (to a lesser extent - potassium and bicarbonates) in the proximal tubules of the kidneys, increases the excretion of magnesium ions, reduces - calcium ions, uric acid. Inhibits reactivity vascular wall in relation to the vasoconstrictive effects of mediators due to a decrease in the concentration of sodium ions in the cytoplasm of vascular myocytes, reduces BCC, lowers blood pressure.

Incompletely, but rather quickly absorbed from the gastrointestinal tract. In the blood, 40-60% binds to proteins. Penetrates through the hematoplacental barrier and into breast milk. Excreted by the kidneys. The diuretic effect develops after 30-60 minutes, reaches a maximum after 4-6 hours, and persists for 6-12 hours.

Application of the substance Hydrochlorothiazide

Arterial hypertension (monotherapy or in combination with other antihypertensive drugs), edematous syndrome of various origins (chronic heart failure, nephrotic syndrome, premenstrual syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, treatment with corticosteroids), control of polyuria (mainly in nephrogenic diabetes insipidus), prevention of stone formation in urinary tract in predisposed patients (reduction of hypercalciuria).

Contraindications

Hypersensitivity (including to other sulfonamides), anuria, severe renal (Cl creatinine - less than 30 ml / min) or liver failure, difficult-to-control diabetes mellitus, Addison's disease, gout, childhood(up to 3 years).

Application restrictions

Hypokalemia, hyponatremia and hypercalcemia, ischemic heart disease, simultaneous reception cardiac glycosides, liver and kidney dysfunction, pregnancy, elderly age.

Use during pregnancy and lactation

Stop during treatment breast-feeding.

Side effects of hydrochlorothiazide

Electrolyte imbalance

Hypokalemia, hypomagnesemia, hypercalcemia and hypochloremic alkalosis: dry mouth, thirst, irregular rhythm heart, mood or mental changes, muscle cramps and pain, nausea, vomiting, unusual tiredness or weakness. Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma.

Hyponatremia: confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps.

Metabolic phenomena: hyperglycemia, glucosuria, hyperuricemia with the development of an attack of gout. Treatment with thiazides may reduce glucose tolerance, and latent diabetes mellitus may manifest. At high doses, serum lipid levels may increase.

From the digestive tract: cholecystitis or pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia.

From the side of cardio-vascular system and blood (hematopoiesis, hemostasis): arrhythmias, orthostatic hypotension, vasculitis; very rarely - leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.

From the side nervous system and sense organs: dizziness, blurry vision (temporarily), headache, paresthesia.

Reactions hypersensitivity: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome(including pneumonitis and non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.

Others: decrease in potency renal function, interstitial nephritis.

Updating information

The risk of developing acute transient myopia and acute angle-closure glaucoma

In the post-registration period, information has emerged that hydrochlorothiazide can cause acute transient myopia and acute angle-closure glaucoma. Symptoms of the development of these ADRs include decreased vision, eye pain and may develop hours or weeks after the start of the drug. Angle-closure glaucoma can lead to complete loss of vision. With the development of complications, it is recommended to stop taking hydrochlorothiazide. Raise intraocular pressure may require surgery.

[Updated 14.02.2012 ]

Interaction

The simultaneous use of hydrochlorothiazide with lithium salts should be avoided (the renal clearance of lithium decreases, its toxicity increases).

It should be used with caution with antihypertensive drugs (their action is potentiated, it may be necessary to adjust the dose), cardiac glycosides (hypokalemia and hypomagnesemia, associated with the action of thiazide diuretics, can increase the toxicity of digitalis), amiodarone (its use simultaneously with thiazide diuretics can lead to increased risk of arrhythmias associated with hypokalemia), oral hypoglycemic agents (their effectiveness decreases, hyperglycemia may develop), corticosteroids, calcitonin (increase potassium excretion), NSAIDs (may weaken the diuretic and hypotensive effect of thiazides), non-depolarizing muscle relaxants (their effect may increase), amantadine (clearance of amantadine may be reduced by hydrochlorothiazide, leading to increased plasma concentrations of amantadine and possible toxicity), cholestyramine (reduces absorption of hydrochlorothiazide), ethanol, barbiturates, and narcotic analgesics, which enhance the effect of orthostatic hypotension.

Thiazides can reduce plasma levels of protein-bound iodine.

Before performing function analyzes parathyroid glands thiazides should be discontinued. Serum bilirubin concentration may be elevated.

Overdose

Symptoms: dehydration, severe electrolyte disturbances, confusion, dry mouth, lethargy, muscle weakness, drowsiness, tachycardia, hypotension, oliguria, decreased blood pressure, shock.

Treatment: induction of vomiting, gastric lavage, intravenous administration of fluids, electrolytes, symptomatic therapy. The specific antidote is unknown.

Routes of administration

inside.

Substance Precautions Hydrochlorothiazide

With prolonged course treatment, it is necessary to carefully monitor clinical symptoms disorders of water and electrolyte balance, primarily in patients of the group increased risk: patients with diseases of the cardiovascular system and impaired liver function; when severe vomiting or if signs of fluid and electrolyte imbalance appear, such as dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pain or convulsions, muscle weakness, hypotension, oliguria, tachycardia, gastrointestinal complaints.

Hypokalemia, especially in case of increased loss of potassium (increased diuresis, long-term treatment) or simultaneous treatment digitalis glycosides or corticosteroid drugs, can be avoided by the use of potassium-containing drugs or food, rich in potassium(fruits vegetables). Thiazides have been shown to increase urinary excretion of magnesium, which may lead to hypomagnesemia.

With reduced renal function, control of creatinine clearance is necessary. In patients with impaired renal function, the drug may cause azotemia, and cumulative effects may also develop. If impaired renal function is evident, discontinuation of the drug should be considered upon the onset of oliguria.

In patients with impaired liver function or progressive liver disease, thiazides are prescribed with caution, since a slight change in the water and electrolyte balance, as well as serum ammonium levels, can cause hepatic coma.

Hypertension is dangerous because it does not always make itself felt clearly severe symptoms. A person may not take changes in his condition seriously enough, although increased pressure on the vascular walls is fraught with heart attacks and strokes. Therefore, at the first sign of illness, it is important to visit a doctor.

At initial stage hypertension is often prescribed hydrochlorothiazide. It is a thiazide diuretic medium duration action, which, in addition to a diuretic, also has a hypotensive effect. It is used as a first-line drug for a small level of pressure increase, when the possibilities to normalize it without the use of medicines have been exhausted. average price Hydrochlorothiazide - 70-80 rubles.

Release form and composition

Produced in tablets - 20 pieces per pack. active substance is hydrochlorothiazide (25 or 100 mg per tablet).

medicinal properties

The diuretic effect appears after 2 hours, reaches its peak after 4 hours and lasts 12 hours. high blood pressure. It also reduces polyuria (excessive urine production) in diabetes insipidus. May reduce intraocular pressure in patients with glaucoma.

Indications

Doses and methods of application

The instructions for use of Hydrochlorothiazide say that the tablets are drunk before meals. Dosages are selected by the doctor, based on the specific case.

adults

Hypertension: 25-50 mg per day as a single dose (as part of monotherapy or together with other medications that lower blood pressure). Sometimes 12.5 mg is enough. You need to use the minimum effective dose selected by a doctor, but it should not be more than 100 mg per day.

It may be necessary to reduce the doses of other antihypertensive agents to prevent an excessive decrease in pressure. Hypotensive action occurs in 3-4 days, and the optimal effect should be expected 3-4 weeks. After the abolition of the remedy, the achieved effect lasts for 1 week.

Edema: 25-100 mg 1 time per day or every other day, then a decrease to 25-50 mg is acceptable. AT severe cases sometimes 200 mg per day is required.

PMS: 25 mg per day. Tablets are drunk before the onset of menstruation.

Diabetes insipidus: 50-150 mg per day, divided into several doses.

The dosage is determined based on the weight of the child. Usually this is a single dose of 1-2 mg per 1 kg or 30-60 mg per 1 sq. m of body surface per day. The dose for children under 2 years old per day is 12.5-37.5 mg, for children 2-12 years old - up to 100 mg.

Side effects

Gastrointestinal: pancreatitis, cholestatic jaundice, cholecystitis, weight loss, constipation or diarrhea.

Cardiovascular system and blood: arrhythmias, vasculitis, hypotension, extremely rarely - anemia, leukopenia.

Electrolyte imbalance: changes in sodium, magnesium, calcium and potassium levels, accompanied by convulsions, lethargy, cramps and muscle pain, slow thinking, lethargy, anxiety, thirst, arrhythmia, mood swings, confusion, nausea, vomiting; possible hypochloremic alkalosis with subsequent hepatic coma/encephalopathy.

Hypersensitivity reactions: purpura, photosensitivity, urticaria, anaphylactic shock.
CNS and sensory organs: blurry vision (normalized after discontinuation of the drug), paresthesia, headaches and dizziness.

There may also be malfunctions in the functioning of the kidneys and a decrease in potency.

Contraindications

During lactation and in the 1st trimester of pregnancy, the drug is not prescribed, in the 2nd and 3rd it is used with caution.

Interaction with other drugs

The diuretic effect of hydrochlorothiazide is enhanced when it is taken with drugs that intensely bind proteins. These are non-steroidal anti-inflammatory drugs, Clofibrate, indirect anticoagulants.

The hypotensive effect is enhanced when combined with beta-blockers, barbiturates, tricyclic antidepressants, phenothiazines, ethyl alcohol.

Under the action of the drug, the neurotoxicity of salicylates increases, the excretion of quinidine and the effectiveness of birth control pills. It also weakens oral medication for hypoglycemia, epinephrine and gout medications.

In combination with hydrochlorothiazide, it is possible to increase the side effects of cardiac glycosides, the neuro- and cardiotoxic effects of Li + drugs and peripheral muscle relaxants.

The combination with Methyldopa is fraught with hemolysis.

special instructions

At first, you can not drive a car and do work that requires high concentration attention.
With prolonged use of Hydrochlorothiazide, it is necessary to monitor the violations of the water and electrolyte balance, especially with a predisposition.

Risk factors are liver failure, heart and vascular disease, thirst, dry mouth, severe vomiting, drowsiness, anxiety, fatigue, lethargy, hypotension, muscle cramps, pain and weakness, tachycardia, oliguria, problems with the gastrointestinal tract.

To avoid hypokalemia, along with hydrochlorothiazide, you need to take potassium supplements or eat vegetables and fruits rich in this element. This is especially important with long-term treatment and the simultaneous use of digitalis glycosides or corticosteroids.

Hydrochlorothiazide may cause impaired glucose tolerance. With long-term treatment of latent or manifesting diabetes mellitus, it is important to regularly check carbohydrate metabolism.

When taking thiazides, the excretion of magnesium in the urine increases, which is fraught with hypomagnesemia. With a decrease in kidney function, creatinine clearance should be observed. The drug can provoke azotemia. If oliguria occurs, it is recommended to stop treatment.

Analogues

If hydrochlorothiazide is not suitable, you can choose similar preparations with the same active ingredient:

There are also a number combined drugs. The combination + hydrochlorothiazide is included in Blocktran GT, Gizortana, Lozap plus, Losartan-N Richter.

Valsartan and hydrochlorothiazide active ingredients Valsacora, Vanatex Combi, Co-Diovan, Duopress.
In combination with dihydralazine, hydrochlorothiaz is included in Adelfan-Ezidrex.

The combination of hydrochlorothiazide + is present in Berlipril plus, Prilenap, Enam N, Co-renitek, Renipril GT, Enalapril N, Enafarm-N.

Active substances and hydrochlorothiazide are included in Coaprovel and Ibertan Plus.

Storage

A dark, dry, inaccessible place for children with a temperature of no more than +25 degrees.

Analogues (generics, synonyms)

Vetidrex, Hydrex, Hydril, Hydro-Diurivas, Hydrodiuril, Hydro-Saluric, Hydrosaluretal, Hydrothiazide, Hydrotide, Hydrochlorothiazide, Hydrochlorothiazide, Hydrochlorothiazide, Hypothiazide, Divaugan, Dihydran, Dihydrochlorothiazide, Dihydrochlorothiazide, Dihydrochlorurite, Disalunil, Disalunil, Di, Dichlorothiazide, Doclicid, Idrodiovis, Idroniagar, Idrorenil, Hydrochlorazide, Neo-Diuresal, Neo-Mincil, Neo-Sularetik, Neotride, Neoflumen, Neo-Chloruril, Nefrix, Novodiurex, Oretic, Panurin, Udor, Unazid, Urodiazine, Urodiacin, Urosil, Ehydride novum , Ezidrex, Ezidrix, Ezodrin,

Recipe

Rp: Dichlotiazidi 0.025
D.t. d. No. 20 in tab.
S. 1 tablet 1 time per day, in the morning.

pharmachologic effect

Medium strength thiazide diuretic. Reduces the reabsorption of Na + at the level of the cortical segment of the loop of Henle, without affecting its section passing into medulla kidneys, which determines a weaker diuretic effect in comparison with furosemide.

It blocks carbonic anhydrase in the proximal convoluted tubules, increases the excretion of K + in the urine (in the distal tubules Na + is exchanged for K +), bicarbonates and phosphates. It practically does not affect CBS (Na + is excreted either together with Cl- or with bicarbonate, therefore, with alkalosis, the excretion of bicarbonates increases, with acidosis - chlorides).

Increases excretion of Mg2+; delays Ca2+ ions in the body and excretion of urates. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours, lasts 10-12 hours. The effect decreases with a decrease in speed glomerular filtration and stops when its value is less than 30 ml / min. Patients do not diabetes has an antidiuretic effect (reduces the volume of urine and increases its concentration). It lowers blood pressure by reducing the BCC, changing the reactivity of the vascular wall, reducing the pressor effect of vasoconstrictor drugs (epinephrine, norepinephrine) and increasing the depressant effect on the ganglia.

Mode of application

To reduce blood pressure: inside, 25-50 mg / day, while slight diuresis and natriuresis are noted only on the first day of admission (prescribed for a long time in combination with other antihypertensive drugs: vasodilators, ACE inhibitors, sympatholytics, beta-blockers).
When the dose is increased from 25 to 100 mg, a proportional increase in diuresis, natriuresis and a decrease in blood pressure are observed.
In a single dose of more than 100 mg - an increase in diuresis and a further decrease in blood pressure are insignificant, there is a disproportionately increasing loss of electrolytes, especially K + and Mg2 +. Increasing the dose over 200 mg is not advisable, because. diuresis does not increase.

In case of edematous syndrome (depending on the condition and reaction of the patient), it is prescribed in a daily dose of 25-100 mg, taken once (in the morning) or in 2 doses (in the first half of the day). Elderly people - 12.5 mg 1-2 times a day. Children aged 2 months to 14 years - 1 mg / kg / day. Maximum dose for children under the age of 6 months - 3.5 mg / kg / day, up to 2 years - 12.5-37.5 mg / day, 3-12 years old - 100 mg / day, divided into 2-3 doses.
After 3-5 days of treatment, it is recommended to take a break for 3-5 days.
As a maintenance therapy in the indicated dose, it is prescribed 2 times a week.
When using an intermittent course of treatment with admission after 1-3 days or within 2-3 days with a subsequent break, the decrease in effectiveness is less pronounced and side effects develop less frequently.
To reduce intraocular pressure, 25 mg is prescribed 1 time in 1-6 days; the effect occurs after 24-48 hours. In diabetes insipidus - 25 mg 1-2 times a day with a gradual increase in dose ( daily dose- 100 mg) until reaching therapeutic effect(reduction of thirst and polyuria), further dose reduction is possible.

Indications

Contraindications

severe liver failure, diabetic glomerulosclerosis, chronic diseases kidneys in the chronic stage kidney failure With hypoisostenuria and azotemia, oliguria and anuria in the first 3 months of pregnancy. Conditionally contraindicated in patients with gout and diabetes mellitus. It is necessary to appoint with caution with reduced tolerance to carbohydrates.

Side effects

arterial hypertension, congestive heart failure, diabetes insipidus, cirrhosis of the liver with portal hypertension and edematous-ascitic syndrome, glaucoma, nephritis, nephrosis; rarely - toxicosis of pregnant women.

Release form

Tablets of 0.025 and 0.1 g.

ATTENTION!

The information on the page you are viewing was created for informational purposes only and does not promote self-treatment in any way. The resource is designed to familiarize healthcare professionals with additional information about certain medicines, thereby increasing the level of their professionalism. The use of the drug Dichlothiazide" in without fail provides a consultation with a specialist, as well as his recommendations on the method of application and dosage of the medicine you have chosen.

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DIOREGENT DRUGS THAT INDIRE THE PROCESS OF SODIUM REABsorption IN THE RENAL TUBULES

The group of diuretic drugs that inhibit the reverse process of sodium absorption in the renal tubules includes mercury diuretics, cyclomethiazide, dichlothiazide, furosemide, brinaldix, brinaldix.

Mercury diuretics (such as Mercusal, Novurite, Promeran) are essentially not found in medical practice its use due to high toxicity, despite the certainly strong diuretic effect.

DICHLOTHIAZIDE (pharmacological analogues:hypothiazide ) has a high diuretic activity and low toxicity. The diuretic effect begins after 30-40 minutes and lasts an average of 8-10 hours. Dichlothiazide reduces the reabsorption of chloride and sodium ions in the renal tubules, and also reduces the reabsorption of other chemicals, such as bicarbonate and potassium. This exposure to dichlothiazide can lead to hypokalemia, which must be eliminated by the introduction of potassium preparations, or special diet, rich in products containing potassium (prunes, dried apricots, potatoes, etc.). Side effects when using dichlothiazide: weakness, dyspepsia, delayed release of salts (urates) are sometimes observed. The latter can lead to gout or its exacerbation. Dichlothiazide is contraindicated in exacerbation of gout, with insufficient kidney function. Release form of dichlothiazide: tablets of 0.025 g and 0.1 g.

An example of a dichlothiazide recipe in Latin:

Rep.: Tab. Dichlothiazidi 0.025 N. 20

D.S. 1-2 tablets per day (in severe cases, the dose can be increased to 8 tablets in 2 divided doses).

Rep.: Tab. Hypothiazidi 0.1 N. 20

D.S. 1/2 each ~ 1 tablet per day (in severe cases - no more than 2 tablets per day).

CYCLOMETHIAZIDE- the drug in its action, side effects, as well as contraindications for use is similar to dichlothiazide. Release form of cyclomethiazide: tablets of 0.0005 g. List B.

An example of a cyclomethiazide prescription in Latin:

Rep.: Tab. Cyclomethiazidi 0.0005 N. 20

D.S. By? - 1 tablet per day, in severe cases - no more than 4 tablets per day.

OXODOLIN (pharmacological analogues: hygroton ) - in its own way chemical action very close to the drug dichlothiazide. Oxodoline has the same contraindications and side effects for use. The diuretic effect of oxodoline occurs on average after 2-4 hours and lasts up to 3 days. Oxodoline release form: tablets of 0.05 g. List B.

An example of an oxodoline recipe:

Rep.: Tab. Oxodolini 0.05 N. 50

D.S. Take 1 to 2 tablets per dose 2 times a day, when the effect is achieved - 1-2 tablets 1 time in 2-3 days.

FUROSEMIDE (pharmacological analogues:lasix, fruzix, furantril, furorese ) - inhibits the reabsorption of sodium and water ions, as well as potassium and chlorine. Furosemide can be administered intravenously (for poisoning, cerebral edema, etc.). Side effects when using furosemide: skin rashes, dyspepsia. Contraindications to the use of furosemide: impaired renal function, pregnancy. Furosemide release form: tablets of 0.04 g; ampoules of 2 ml of 1% solution. Furosemide is produced abroad in the form of preparations: "Furose-250" (1 ampoule of the infusion solution contains 250 mg of furosemide) and "Furosemide-500" (1 ampoule contains 500 mg of furosemide). List B.

Recipe Example furosemide in latin:

Rp.: Sol. Furosemidi (Lasicis) 1% 2ml

D.t. d. N. 5 in amp.

S. 1-4 ml intravenously or intramuscularly.

For a better understanding of the action of modern diuretics, a classification of diuretics is recommended, which takes into account not only the mechanism, but also the localization of their action.

I. By localization and mechanism of action:

1. Means acting at the level of cells of the renal tubules.

2. Means acting at the level of the apical membrane.

Competing for the sodium transporter, or non-competitive aldosterone antagonists - triamterene, amiloride.

· Competing aldosterone antagonists - spironolactone, eplerenone.

3. Means acting at the level of the basement membrane.

Inhibitors of carbonic anhydrase - diacarb.

Thiazide diuretics - hydrochlorothiazide, cyclomethiazide.

Thiazide-like diuretics - chlorthalidone, clopamide, indapamide.

· Loop diuretics- furosemide, ethacrynic acid, bumetonide, torasemide.

4. Osmotically active diuretics - mannitol, urea.

5. Drugs that increase blood circulation in the kidneys - xanthines, aminophylline, aminophylline, etc.

6. Drugs medicinal plants- horsetail, bearberry leaves, birch buds, orthosiphon leaves, lingonberry leaves, leaves and stems of lespedeza capitate, martyr leaves, strawberries, etc.

FROM clinical point Of practical importance when choosing a drug are the strength, speed of onset and duration of action. Therefore, diuretics are classified as follows.

II. By strength of action:

1. Strong diuretics - furosemide (lasix), torasemide (trifas), ethacrynic acid (uregit), clopamide (brinaldix), osmodiuretics (mannitol, urea), etc.

2. Medium diuretics - thiazides: hydrochlorothiazide (hypothiazide, dichlothiazide), cyclomethiazide and thiazide-like - chlorthalidone (oxodoline, hygroton), etc.

3. Weak diuretics - spironolactone (veroshpiron, aldactone), diacarb (acetazolamide), triamterene (pterofen), amiloride, xanthine aminophylline (eufillin), medicinal plant preparations (bearberry leaves, orthosiphon leaves, Birch buds and etc.).

III. According to the speed of the onset of the diuretic effect:

1. Fast (emergency) action (30-40 min) - furosemide, torasemide, ethacrynic acid, mannitol, urea, triamterene.

2. Medium action (2-4 hours) - diacarb, eufillin, amiloride, cyclomethiazide, clopamide, chlorthalidone, etc.

3. Slow action (2-4 days) - spironolactone, eplerenone.

IV. According to the duration of the diuretic effect.

1. short action(4-8 hours) - furosemide, torasemide, ethacrynic acid, mannitol, urea, etc.

2. Medium duration(8-14 hours) - diacarb, triamterene, hydrochlorothiazide, clopamide, eufillin, etc.

3. Long lasting(several days) - chlorthalidone, spironolactone, eplerenone.

Diuretics acting at the level of renal tubular cells Drugs that interfere with sodium transport across the apical membrane of renal tubular cells include triamterene, amiloride, spironolactone, eplerenone. They operate at the level distal nephron. These are drugs that reduce the processes of physiological reabsorption of sodium and water.

The action of diuretics can be seen in terms of their pharmacodynamic effects. decline blood pressure is associated with two mechanisms: a decrease in sodium levels and an effect on blood vessels. In a similar way, arterial hypertension can be stopped by reducing the volume of fluid content and maintaining long time vascular tone.

A decrease in myocardial oxygen demand with the use of diuretics is associated with relaxation of myocardial cells, a decrease in platelet adhesion, an improvement in microcirculation in the kidneys, and a decrease in the load on the left ventricle of the heart. Some diuretics (Manit) can not only increase the excretion of fluid, but also increase the osmolar pressure of the interstitial fluid. Due to the properties of diuretics to relax smooth muscle bronchi, arteries, biliary tract, drugs exhibit an antispasmodic effect.

Rp: Dichlotiazidi 0.025
D.t. d. No. 20 in tab.
S. 1 tablet 1 time per day, in the morning.