From the Guidelines
Hiccups can be effectively treated with medications such as chlorpromazine, baclofen, gabapentin, or metoclopramide, which work by reducing diaphragm irritability or affecting the neural pathways involved in the hiccup reflex. For mild, short-term hiccups, simple home remedies can be tried, including breathing into a paper bag, holding your breath, gargling with ice water, sipping cold water slowly, or stimulating the back of your throat with a spoon. Physical maneuvers such as pulling on your tongue, applying gentle pressure on your diaphragm, or performing a Valsalva maneuver may also help.
Treatment Options
- Chlorpromazine (25-50mg orally or intramuscularly) is the only FDA-approved medication specifically for hiccups 1.
- Other options include baclofen (5-10mg three times daily), gabapentin (300-900mg daily in divided doses), or metoclopramide (10mg orally or intravenously) 1.
- According to the palliative care guidelines, dopamine receptor antagonists such as prochlorperazine, haloperidol, metoclopramide, or olanzapine can be used to treat hiccups, and if necessary, a 5-HT3 antagonist like ondansetron can be added 1.
Important Considerations
- Persistent hiccups lasting more than 48 hours may indicate an underlying medical condition that requires treatment, so it is essential to consult a healthcare provider if hiccups last more than 48 hours or recur frequently.
- When using antipsychotics like chlorpromazine, it is crucial to monitor patients for potential cardiac adverse effects, such as QTc prolongation, which can lead to dysrhythmias like torsades de pointes 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. 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.
Treatment options for hiccups include:
- Oral chlorpromazine 25 mg to 50 mg t.i.d. or q.i.d.
- Parenteral therapy with 25 to 50 mg IM if symptoms persist for 2 to 3 days
- Slow IV infusion with 25 to 50 mg in 500 to 1000 mL of saline if symptoms persist 2 3
From the Research
Treatment Options for Hiccups
The treatment options for hiccups can be broadly categorized into pharmacological and non-pharmacological approaches.
- Pharmacological Approaches:
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 4.
- Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include baclofen, gabapentin, metoclopramide, and midazolam 5, 4.
- Baclofen has been found to be effective in treating chronic hiccup, with a long-term complete resolution or a considerable decrease in hiccups in 28 of the 37 patients studied 6.
- Non-Pharmacological Approaches:
- Nerve blockade, pacing, acupuncture, and measures to hold breathing are also successful in treating hiccups 7.
- Vagus nerve stimulation (VNS) is a novel surgical option for the treatment of intractable hiccups, with a case report showing significant improvement in symptoms following VNS insertion 8.
- Other non-pharmacological approaches include drinking cold water, induction of emesis, carotid sinus massage, or Valsalva maneuver, which seem to work by over-stimulating the Vagus nerve 8.
Causes of Hiccups
Hiccups can be caused by a variety of factors, including:
- Central Causes: stroke, space-occupying lesions, and injury 7.
- Peripheral Causes: lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease, and applied instrumentations on the human body 7.
- Drugs: anti-parkinsonism drugs, anesthetic agents, steroids, and chemotherapies 7.