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. INTRACTABLE HICCUPS 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.
Medications for synchronous diaphragmatic flutter (hiccups):
- Chlorpromazine (PO) can be used at a dosage of 25 mg to 50 mg t.i.d. or q.i.d.
- If symptoms persist, parenteral therapy with chlorpromazine (IM) 25 to 50 mg (1-2 mL) can be used.
- In severe cases, slow IV infusion with chlorpromazine 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline can be used 1, 2.
From the Research
Medications for Synchronous Diaphragmatic Flutter (Hiccups)
- Various medications have been used to treat hiccups, including chlorpromazine, metoclopramide, baclofen, gabapentin, and others 3, 4, 5, 6, 7
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups, but it has many side effects 4, 6
- Baclofen and gabapentin are supported by small randomized, placebo-controlled trials and may be considered as first-line therapy for persistent and intractable hiccups 5
- Metoclopramide and chlorpromazine may be used as alternative options 5
- Other medications such as amitriptyline, haloperidol, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid have also been reported to be successful in treating hiccups, but the evidence is limited 4
- The choice of medication should be individualized based on the patient's underlying comorbidities, etiology of hiccups, and the properties of the drugs 4
Pharmacological Treatment Options
- Dopamine-blocking medications, such as chlorpromazine and haloperidol, have been used to treat hiccups 4, 7
- Baclofen, a muscle relaxant, has been shown to be effective in treating hiccups 4, 5, 7
- Gabapentin, an anticonvulsant, has also been used to treat hiccups 4, 5, 7
- Metoclopramide, a prokinetic agent, has been used to treat hiccups, especially those associated with gastroesophageal reflux disease 3, 4, 5