From the Guidelines
The best treatment for hiccups is to try simple physical maneuvers first, such as holding your breath for 10-20 seconds, drinking a glass of cold water quickly, gargling with ice water, breathing into a paper bag for a few minutes, or pulling gently on your tongue. These techniques work by interrupting the hiccup reflex or stimulating the vagus nerve, which can reset the diaphragm spasms causing hiccups. For persistent hiccups lasting more than 48 hours, medication options include baclofen (5-10 mg three times daily), chlorpromazine (25-50 mg), or metoclopramide (10 mg) 1. However, the study by the american gastroenterological association 1 does not directly address the treatment of hiccups, and therefore, the treatment options are based on general medical knowledge.
Some key points to consider when treating hiccups include:
- Most hiccup episodes are brief and self-limiting, typically resolving within minutes to hours without treatment
- If hiccups persist for more than 48 hours or recur frequently, it's essential to see a doctor as they could indicate an underlying medical condition requiring specific treatment
- Simple physical maneuvers should be tried first, as they are non-invasive and often effective
- Medication options should be considered for persistent hiccups, but only under the guidance of a healthcare professional.
It's worth noting that the provided study 1 focuses on the management of gastroesophageal reflux disease and does not provide direct guidance on the treatment of hiccups. Therefore, the recommended treatment options are based on general medical knowledge and may not be supported by the specific study cited.
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.
The best treatment for intractable hiccups is chlorpromazine 25 mg to 50 mg t.i.d. or q.i.d. orally. If symptoms persist for 2 to 3 days, parenteral therapy may be indicated, with 25 to 50 mg IM or slow IV infusion 2 3. Key points:
- Initial treatment: 25 mg to 50 mg t.i.d. or q.i.d. orally
- Parenteral therapy: 25 to 50 mg IM or slow IV infusion if symptoms persist
- Caution: Monitor blood pressure closely during parenteral administration.
From the Research
Treatment Options for Hiccups
- The treatment of hiccups should be directed at the underlying cause whenever possible 4, 5, 6.
- For persistent hiccups, first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation 4.
- If symptoms persist, other etiologies such as central causes need to be explored 4.
- Pharmacologic treatments that have been proposed for intractable and persistent hiccups include:
- Chlorpromazine, which is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 7.
- Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid, which have been found to be successful in treating hiccups in some studies 7.
- Non-pharmacological approaches such as nerve blockade, pacing, acupuncture, and measures to hold breathing have also been successful in treating hiccups 5, 8.
- Lifestyle changes and physical maneuvers may also be considered as treatment modalities for hiccups 6.
Etiologies of Hiccups
- Hiccups can be caused by a variety of factors, including:
- Gastroesophageal reflux disease (GERD) 4, 5, 6.
- Central causes such as stroke, space occupying lesions, and injury 5.
- Peripheral causes such as tumors, myocardial ischemia, herpes infection, and applied instrumentations on the human body 5.
- Drugs such as anti-parkinsonism drugs, anesthetic agents, steroids, and chemotherapies 5.