From the Guidelines
For persistent hiccups, the most effective treatment approach is to titrate dopamine receptor antagonist medications, such as prochlorperazine, haloperidol, metoclopramide, or olanzapine, to maximum benefit and tolerance. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of these medications in managing persistent hiccups 1.
When considering treatment options, it's crucial to prioritize medications that can effectively reduce the frequency and severity of hiccups, thereby improving the patient's quality of life. Dopamine receptor antagonists are a key class of medications for this purpose, as they can help modulate the neural pathways involved in the hiccup reflex.
Some key points to consider when using these medications include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for potential side effects, such as extrapyramidal symptoms or sedation
- Considering the addition of other medications, such as 5-HT3 antagonists (e.g., ondansetron) or anticholinergic agents (e.g., scopolamine), if the initial treatment is not effective 1
- In severe cases, corticosteroids (e.g., dexamethasone) may also be considered as an adjunctive treatment
It's essential to work closely with a healthcare provider to determine the best treatment approach for persistent hiccups, as the underlying cause and individual patient factors can influence the choice of medication and dosage. By prioritizing evidence-based treatments and carefully monitoring patient response, it's possible to effectively manage persistent hiccups and improve patient outcomes.
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 for persistent hiccups is chlorpromazine 25 mg to 50 mg t.i.d. or q.i.d. 2. If symptoms persist for 2 to 3 days, parenteral therapy is indicated.
- The recommended dosage is 25 mg to 50 mg, taken three or four times a day.
- If the hiccups persist, a different route of administration, such as parenteral therapy, may be necessary 2.
From the Research
Treatment Options for Persistent Hiccups
- Pharmacotherapy: Various drugs have been proposed for the treatment of persistent hiccups, including chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics, and lidocaine 3, 4.
- Non-pharmacological approaches: Nerve blockade, pacing, acupuncture, and measures to hold breathing have been found to be successful in treating hiccups 3, 5.
- Alternative medicines and remedies: Although their effects are uncertain, alternative medicines and remedies are convenient options for treating hiccups 3.
Specific Treatment Strategies
- For central causes of persistent hiccups, baclofen is the drug of choice, while metoclopramide is recommended for peripheral causes 6.
- Midazolam may be useful in cases of terminal illness 6.
- Interventional procedures such as vagal or phrenic nerve block or stimulation should be considered in patients who are refractory to medications 6.
- Vagus nerve stimulation (VNS) is a novel surgical option for the treatment of intractable hiccups, with some cases reporting significant improvement in symptoms 7.
Emerging Techniques
- The Hiccup relief using Active Prolonged Inspiration (HAPI) technique, which combines phrenic and vagal nerve stimulation with transient hypercapnia, has been found to be effective in eliminating hiccups 5.
- Further studies are needed to validate the effectiveness of this technique and other emerging treatments for persistent hiccups.