From the FDA Drug Label
TABLE 1 Gabapentin Tablets Dosage Based on Renal Function Renal Function Creatinine Clearance (mL/min) Total Daily Dose Range (mg/day) Dose Regimen (mg) ... Post-Hemodialysis Supplemental Dose (mg)b Hemodialysis 125b 150b 200b 250b 350b
The best approach to manage hiccups in a patient with impaired renal function undergoing dialysis is not directly addressed in the provided drug label for gabapentin. Hiccups management is not mentioned in the label, and gabapentin is not indicated for the treatment of hiccups. The label provides dosage adjustments for patients with renal impairment, but it does not provide guidance on managing hiccups in these patients 1.
From the Research
Managing hiccups in dialysis patients with impaired renal function requires careful medication selection and dosing adjustments, with a focus on non-pharmacological methods and reduced doses of pharmacological agents to minimize toxicity and adverse effects. The best approach begins with non-pharmacological methods like:
- Breath holding
- Drinking cold water
- Stimulating the posterior pharynx If these fail, pharmacological options include:
- Baclofen at a reduced dose of 5mg once or twice daily (instead of the standard 10mg three times daily), with careful monitoring for CNS side effects 2, 3
- Gabapentin can be used at 100-300mg after each dialysis session, as it is removed by dialysis 4, 5
- Chlorpromazine may be considered at 10-25mg orally or intramuscularly with dose reduction and careful monitoring 4, 5
- Metoclopramide can be used at 5mg twice daily with reduced dosing 4, 5 These medications require adjustment because renal impairment leads to drug accumulation and potential toxicity. Avoid medications with significant renal clearance like haloperidol when possible. Treatment should be individualized based on the patient's dialysis schedule, residual renal function, and comorbidities, with close monitoring for adverse effects and drug interactions with other medications commonly used in dialysis patients. A recent study published in 2021 6 also suggests considering alternative treatments like Vagus nerve stimulation for intractable hiccups, although this may not be suitable for all patients. Overall, the goal is to minimize morbidity, mortality, and improve quality of life for dialysis patients with hiccups.