From the Guidelines
Hiccups can be effectively treated with dopamine receptor antagonists, such as prochlorperazine, haloperidol, metoclopramide, or olanzapine, which should be titrated to maximum benefit and tolerance. For persistent hiccups, treatment options may vary, but the primary goal is to alleviate symptoms and address any underlying causes.
- Simple home remedies, such as drinking a glass of cold water quickly, holding your breath, or gargling with ice water, may help reset the diaphragm's normal rhythm.
- If hiccups persist, medications like dopamine receptor antagonists can be used, as suggested by the study 1.
- In some cases, adding a 5-HT3 antagonist, anticholinergic agent, antihistamine, or cannabinoid may be necessary, as outlined in the palliative care guidelines 1.
- It's essential to address any underlying causes of hiccups, such as gastroesophageal reflux, certain medications, or metabolic disorders, to prevent recurrence.
- For severe or intractable cases, nerve blocks or surgical interventions might be considered, but these options should be explored under the guidance of a healthcare provider.
- The treatment approach should prioritize the patient's quality of life, morbidity, and mortality, and the chosen treatment should be based on the most recent and highest-quality evidence available, such as the study published in the Journal of the National Comprehensive Cancer Network 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 treatment option for intractable hiccups is chlorpromazine 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
Treatment Options for Hiccups
- Hiccups can be treated with various methods, including lifestyle changes, physical maneuvers, pharmacotherapy, and surgical intervention 3
- Pharmacologic treatments for intractable and persistent hiccups include chlorpromazine, amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 4
- 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 5
- Vagus nerve stimulation (VNS) is a novel surgical option for the treatment of intractable hiccups, with some cases reporting significant improvement in symptoms 6, 7
- The treatment of hiccups should be directed at the underlying cause whenever possible, and a detailed history and thorough physical examination may provide clues for the etiology of the hiccups 3
Pharmacologic Treatments
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 4
- Baclofen, gabapentin, and metoclopramide have been studied in prospective manner and randomized controlled trials for the treatment of intractable and persistent hiccups 4
- Other pharmacologic agents, such as amitriptyline, haloperidol, and valproic acid, have been reported to be successful in treating hiccups, but the evidence is limited 4
Surgical Interventions
- Vagus nerve stimulation (VNS) is a surgical option for the treatment of intractable hiccups, with some cases reporting significant improvement in symptoms 6, 7
- Phrenic nerve blockade, crush injury, or percutaneous phrenic nerve pacing are other surgical interventions that have been reported to be successful in treating intractable hiccups 7