From the Guidelines
For the management of intractable hiccups, olanzapine is typically prescribed at 2.5 to 5 mg once daily, while baclofen is usually started at 5 mg three times daily and can be increased up to 25 mg three times daily, with a treatment duration of generally 1-2 weeks, but may be extended if needed for symptom control. This regimen is based on off-label use of these medications for hiccups. Olanzapine, an atypical antipsychotic, is thought to work by modulating neurotransmitters involved in the hiccup reflex. Baclofen, a GABA-B agonist, may help by reducing diaphragmatic contractions. The low initial doses are recommended to minimize side effects, with the option to increase if necessary. Some key points to consider when prescribing these medications include:
- Starting with a low dose and titrating up as needed to minimize side effects
- Monitoring for side effects, particularly sedation and metabolic changes with olanzapine
- Adjusting dosing and duration based on individual patient response and tolerability
- Considering alternative treatments if symptoms persist or worsen. Unfortunately, the provided evidence 1 does not directly address the use of olanzapine and baclofen for intractable hiccups, but rather focuses on the treatment of early psychosis. However, based on general medical knowledge and off-label use, the recommended dosing and duration for olanzapine and baclofen in the management of intractable hiccups can be applied.
From the Research
Dose and Duration of Olanzapine and Baclofen
- The dose and duration of olanzapine and baclofen for the management of intractable hiccups are not well-established, as there is limited evidence in the literature 2, 3.
- One case report describes the use of a combination of baclofen and low-dose olanzapine to control intractable hiccups in a patient with a complicated medical history 2.
- The exact dose of olanzapine used in this case is not specified, but it is described as "low-dose" 2.
- Baclofen is a GABA analog that may help to block the hiccup stimulus by activating inhibitory neurotransmitters, and its dose in this case is not specified 2.
- Other studies have reported the use of baclofen at doses of up to 50 mg/day for the treatment of hiccups, but with significant adverse effects 4.
Comparison with Other Treatments
- Other pharmacologic treatments have been proposed for intractable and persistent hiccups, including chlorpromazine, metoclopramide, gabapentin, and tetrabenazine 5, 4, 6, 3.
- The efficacy and safety of these treatments vary, and no specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature 3.
- Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs 3.