From the Guidelines
Hiccups can be effectively treated with chlorpromazine, which has been shown to be a viable option for intractable hiccups. According to the study 1, chlorpromazine, a phenothiazine, can be used to treat nausea/vomiting and intractable hiccups. The treatment options for hiccups include:
- Simple home remedies such as drinking a glass of cold water quickly, holding your breath for 10-20 seconds, breathing into a paper bag for a few minutes, gargling with ice water, or pulling gently on your tongue
- Medications like chlorpromazine (25-50mg orally or intramuscularly) for persistent hiccups lasting more than 48 hours
- Other medications such as metoclopramide, baclofen, or gabapentin may also be considered, but chlorpromazine is a recommended option due to its effectiveness in treating intractable hiccups 1 It's essential to seek medical attention for prolonged hiccups as they may indicate an underlying condition that requires specific treatment.
The study 1 highlights the importance of monitoring patients who receive antipsychotics, including chlorpromazine, due to potential cardiac adverse effects such as QTc prolongation. However, in the context of treating hiccups, the benefits of chlorpromazine may outweigh the risks, and close clinical observation is recommended.
In rare cases of intractable hiccups lasting months, nerve blocks or surgical interventions might be considered, but chlorpromazine should be tried first due to its efficacy and relatively safer profile compared to more invasive procedures 1.
From the FDA Drug Label
For relief of intractable hiccups 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.
Treatment options for hiccups include chlorpromazine (PO) 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist, parenteral therapy may be necessary 2.
From the Research
Treatment Options for Hiccups
- Initial remedies for hiccups include drinking cold water, induction of emesis, carotid sinus massage, or Valsalva manoeuvre, which work by over stimulating the Vagus nerve 3, 4
- Pharmacotherapy with baclofen, gabapentin, and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second-line treatment 3, 5, 6
- Medical refractory cases may involve unconventional therapies such as hypnosis, massages, and acupuncture 3
- Surgical intervention, although rare, may involve phrenic nerve crushing, blockade, or pacing, as well as Vagus nerve stimulator (VNS) placement 3, 7
Pharmacological Interventions
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 5
- Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 5
- Baclofen, gabapentin, and metoclopramide have been studied in a prospective manner, with baclofen and metoclopramide being studied in randomized controlled trials 5, 6
Vagal Maneuvers
- 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 hiccups 4
- These maneuvers work by increasing efferent vagal activity 4