What is the treatment for a prolonged cough inducing hiccups?

From the Guidelines

Prolonged cough causing hiccups should be treated by addressing the underlying cough with an empiric trial of medical antireflux therapy, including dietary and lifestyle modifications, acid suppression therapy, and prokinetic therapy, as recommended by the ACCP evidence-based clinical practice guidelines 1. To manage this condition, the following steps can be taken:

• Identify and treat the underlying cause of the cough, which may include gastroesophageal reflux disease (GERD) 1.
• Implement an intensive medical treatment regimen, including:
  • An antireflux diet with no more than 45g of fat in 24 hours and avoidance of coffee, tea, soda, chocolate, mints, citrus products, including tomatoes, or alcohol 1.
  • Acid suppression with a proton pump inhibitor (PPI) 1.
  • Prokinetic therapy, such as metoclopramide, to enhance gastric emptying and reduce reflux 1.
• Assess the response to these therapies within 1 to 3 months and adjust the treatment plan as needed 1.
• If the cough persists despite maximal medical therapy, consider antireflux surgery, especially if the patient meets specific criteria, including a positive 24-hour esophageal pH-monitoring study and a clinical profile suggesting GERD as the likely cause of the cough 1. It is essential to note that the treatment approach may vary depending on the individual patient's response to therapy and the presence of comorbid conditions, such as obstructive sleep apnea or other factors that may influence GERD management 1.

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.

Treatment for Intractable Hiccups:

• Oral dosage: 25 mg to 50 mg t.i.d. or q.i.d.
• If symptoms persist, parenteral therapy may be indicated, with IM dosage of 25 to 50 mg (1-2 mL) or slow IV infusion of 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline 2 3. Note: Prolonged cough is not directly addressed in the provided drug labels as a cause of hiccups. The treatment mentioned is for intractable hiccups in general.

From the Research

Prolonged Cough Causing Hiccups

• A prolonged cough can be a symptom of various underlying conditions, including gastroesophageal reflux disease (GERD) 4, 5.
• Hiccups can be a sign of an underlying pathology, and the most common cause involves GERD 4.
• The relationship between cough and hiccups is complex, and any disruption along the reflex arc between peripheral receptors and the brainstem may produce hiccups 4.

Treatment Options

• First-line therapy for hiccups should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation 4.
• For chronic cough, treatment should focus on identifying and addressing the underlying cause, such as GERD, asthma, or upper airway cough syndrome 6, 7.
• In patients with refractory chronic cough, a trial of gabapentin, pregabalin, and/or speech therapy may be warranted 6.
• For patients with GERD and persistent symptoms on PPIs, expert esophagologists recommend invasive therapy only in the presence of abnormal reflux burden, with or without hiatal hernia, or regurgitation with positive symptom-reflux association and a large hiatus hernia 8.

Management of GERD

• The American College of Gastroenterology recommends updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management 5.
• Management options for patients with GERD and persistent symptoms on PPIs include laparoscopic fundoplication, magnetic sphincter augmentation, and non-invasive pharmacologic or behavioral therapies 8.