From the Guidelines
To stop hiccups, chlorpromazine, a phenothiazine, can be used to treat intractable hiccups, as mentioned in the study 1. When considering treatment options for hiccups, it's essential to prioritize methods that are safe, effective, and supported by evidence.
- Holding your breath for 10-20 seconds can help reset your diaphragm's rhythm.
- Drinking a glass of cold water quickly or gargling with ice water may also be effective.
- Breathing into a paper bag for a minute or placing a teaspoon of sugar under your tongue to stimulate the vagus nerve can help resolve hiccups. For persistent hiccups, the Valsalva maneuver, which involves holding your nose closed while attempting to exhale with your mouth shut, can be tried. Hiccups occur when your diaphragm involuntarily contracts while your vocal cords simultaneously close, causing the characteristic "hic" sound. Most hiccup episodes resolve within a few minutes, but if they persist for more than 48 hours, you should seek medical attention as this could indicate an underlying condition. In rare cases of prolonged hiccups, doctors might prescribe medications like chlorpromazine (25-50mg), as mentioned in the study 1, baclofen (5-10mg three times daily), or metoclopramide (10mg) to help resolve them. It's crucial to note that while the study 1 discusses the use of chlorpromazine for intractable hiccups, it also highlights the importance of monitoring patients who receive antipsychotics due to potential cardiac adverse effects, such as QTc prolongation. Therefore, any treatment decision should be made with caution and under medical supervision, prioritizing the patient's safety and well-being.
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.
To stop hiccups, the recommended dosage of chlorpromazine is 25 mg to 50 mg taken three or four times a day. If hiccups persist for 2 to 3 days, consider parenteral therapy 2.
From the Research
Methods to Stop Hiccups
- Vagal maneuvers, such as the oculo-cardiac reflex, carotid sinus massage, Valsalva maneuver, stimulation of the ear/auditory canal, ice ingestion, and induction of emesis, can be effective in terminating bouts of acute hiccup 3
- Drinking cold water, induction of emesis, carotid sinus massage, or Valsalva maneuver may work by over stimulating the Vagus nerve 4
- Pharmacotherapy with baclofen, gabapentin, and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide can be used as second-line treatment 4
Vagus Nerve Stimulation
- Vagus nerve stimulation has been reported as a novel surgical option for the treatment of intractable hiccups, with varying degrees of success 4, 5, 6
- A case report showed significant improvement in symptoms following VNS insertion in an 85-year-old gentleman with a 9-year history of intractable hiccups 4
- However, another case report highlighted that vagal nerve stimulation is not effective in all patients with central idiopathic intractable hiccups 5