What are the medications for singultus (hiccups)?

From the Guidelines

Chlorpromazine is the most effective medication for treating hiccups, particularly for persistent cases, due to its ability to interrupt the hiccup reflex arc, as noted in the study published in Pediatrics 1. When considering medication for hiccups, it's essential to weigh the potential benefits against the risks, especially in terms of morbidity, mortality, and quality of life.

• For brief episodes of hiccups, simple remedies like holding your breath, drinking water quickly, or breathing into a paper bag often work and are recommended as the first line of treatment.
• If hiccups persist beyond 48 hours, medical attention is recommended to rule out any underlying conditions that may be causing the hiccups.
• Chlorpromazine, a phenothiazine, has been used to treat nausea/vomiting and intractable hiccups, as mentioned in the study 1, and is the only FDA-approved medication for this purpose.
• The typical dose of chlorpromazine for hiccups is 25-50 mg intravenously or intramuscularly, although this may vary depending on the individual case and the healthcare provider's judgment.
• Other medications, such as baclofen, metoclopramide, or gabapentin, may also be used to treat hiccups, but their use is not as well-established as chlorpromazine, and they may have different side effect profiles, as noted in various studies 1.
• It's crucial to consult a healthcare provider before taking any medication for persistent hiccups, as they may indicate an underlying condition requiring specific treatment, and to discuss the potential risks and benefits of treatment, including the risk of QTc prolongation associated with certain antipsychotics, as highlighted in the study 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.

The medication for hiccups is Chlorpromazine with a dosage of 25 mg to 50 mg taken three to four times a day. If symptoms persist for 2 to 3 days, parenteral therapy is indicated 2.

From the Research

Medication Options for Hiccups

• Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
• Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include:
  • Amitriptyline
  • Baclofen
  • Gabapentin
  • Haloperidol
  • Metoclopramide
  • Midazolam
  • Nifedipine
  • Nimodipine
  • Orphenadrine
  • Valproic acid 3
• Gabapentin has been shown to be effective in treating persistent or intractable hiccups, with positive outcomes reported in all cases 4
• Baclofen has been studied as a treatment for hiccups, but its effectiveness is uncertain, with only 35% of patients experiencing hiccup palliation 5

Efficacy and Safety of Medications

• The efficacy of medications for hiccups is often difficult to determine due to the lack of high-quality studies 6
• Gabapentin is generally well-tolerated, with only minor adverse effects reported 4
• Baclofen has been associated with adverse events, including drowsiness, in some patients 5
• The safety and efficacy of other medications for hiccups, such as chlorpromazine, are not well-established 3

Treatment Approaches

• Treatment of hiccups should be directed at the underlying cause whenever possible 7
• Lifestyle changes, physical maneuvers, pharmacotherapy, and surgical intervention may be considered for treating hiccups 7
• There are no formal guidelines for the treatment of hiccups, and most methods are based on case reports and anecdotal evidence 7