From the Guidelines
Chlorpromazine is the most effective medication for treating intractable hiccups, as evidenced by its use in various clinical settings 1. When it comes to treating hiccups, there are several approaches that can be taken. For simple, acute hiccups, techniques like holding your breath for 10-20 seconds, drinking a glass of cold water quickly, gargling with ice water, or breathing into a paper bag for 1-2 minutes can be effective. These methods work by either interrupting the hiccup reflex or stimulating the vagus nerve, which helps regulate the diaphragm spasms causing hiccups.
For more persistent hiccups, other remedies can be tried, such as swallowing a teaspoon of granulated sugar dry or sipping water from the opposite side of a glass by bending forward. However, if hiccups last longer than 48 hours, it is essential to seek medical attention, as this could indicate an underlying medical condition that needs to be addressed.
In the context of medical treatment, chlorpromazine, a phenothiazine, has been used effectively to treat nausea, vomiting, and intractable hiccups 1. Its mechanism of action, although not fully understood in the context of hiccups, suggests that it can help alleviate symptoms by affecting the central nervous system and possibly reducing nerve irritation or relaxing the diaphragm.
It's crucial to note that while other medications like baclofen or metoclopramide may also be used for hiccups, the use of chlorpromazine is highlighted in clinical guidelines due to its efficacy in treating intractable cases 1. Therefore, for patients suffering from persistent or severe hiccups, chlorpromazine should be considered as a treatment option under the guidance of a healthcare provider.
From the FDA Drug Label
Intractable Hiccups– 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, parenteral therapy is indicated. If symptoms persist for 2-3 days after trial with oral therapy, give 25 to 50 mg (1-2 mL) IM. Should symptoms persist, use slow IV infusion with patient flat in bed: 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline. Treatment for intractable hiccups with Chlorpromazine is 25 mg to 50 mg orally t.i.d. or q.i.d. If symptoms persist, parenteral therapy may be indicated, with a dose of 25 to 50 mg IM. 2 3
From the Research
Hiccup Treatment Options
- Hiccups are a common and usually transient condition, but they can be persistent and intractable in some cases, requiring medical attention 4.
- The approach to managing hiccups involves identifying and treating underlying causes, as well as using therapeutic interventions to resolve the hiccups 4.
Non-Pharmacological Interventions
- Vagal maneuvers, such as carotid sinus massage, Valsalva maneuver, and stimulation of the ear/auditory canal, can be effective in terminating acute hiccups 5.
- These maneuvers work by increasing efferent vagal activity, which can help to stop the hiccups 5.
Pharmacological Treatments
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups, but other pharmacologic treatments have been proposed for intractable and persistent hiccups 6.
- A systematic review of pharmacologic treatments for intractable and persistent hiccups found that baclofen, gabapentin, and metoclopramide were effective in treating hiccups, but there is limited evidence to support the use of one agent over another 6.
- Baclofen and gabapentin may be considered as first-line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve 7.
Surgical Interventions
- In rare cases, surgical intervention may be necessary to treat intractable hiccups, such as phrenic nerve crushing, blockade, or pacing 8.
- Vagus nerve stimulation (VNS) is a novel surgical option for the treatment of intractable hiccups, with some studies showing significant improvement in symptoms following VNS insertion 8.