What are the treatment options for hiccups?

From the Guidelines

Hiccups should be treated with dopamine receptor antagonists, such as prochlorperazine, haloperidol, metoclopramide, or olanzapine, as the first line of treatment, titrating to maximum benefit and tolerance. This approach is based on the most recent and highest quality evidence available, including the study published in the Journal of the National Comprehensive Cancer Network in 2016 1. For persistent hiccups, additional interventions can be considered, including the addition of a 5-HT3 antagonist, such as ondansetron, an anticholinergic agent, an antihistamine, or a cannabinoid.

Some key points to consider when treating hiccups include:

• Identifying and addressing any underlying causes, such as gastroesophageal reflux or medication side effects
• Using medication to reduce diaphragm irritability or affect central nervous system pathways involved in hiccups
• Considering alternative approaches, such as nerve blocks or surgical interventions, for intractable hiccups
• The importance of titrating medication to maximum benefit and tolerance, as recommended in the study published in 2016 1

In terms of specific medication options, the study published in 2016 1 recommends titrating dopamine receptor antagonists, such as prochlorperazine, haloperidol, metoclopramide, or olanzapine, to maximum benefit and tolerance. If hiccups persist, additional medications, such as 5-HT3 antagonists, anticholinergic agents, antihistamines, or cannabinoids, can be considered.

It's worth noting that the treatment of hiccups should prioritize reducing morbidity, mortality, and improving quality of life, and treatment decisions should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.

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 hiccups is chlorpromazine with a dosage of 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 physical maneuvers, drug therapy, and alternative approaches 3, 4, 5, 6, 7
• Physical maneuvers that stimulate the uvula or pharynx, or disrupt diaphragmatic rhythm, can help speed the end of a bout of hiccups 3
• Drug therapy, such as chlorpromazine and metoclopramide, is often necessary for more intractable hiccups 3, 4, 5, 6
• Other treatment options include:
  • Baclofen, gabapentin, and serotonergic agonists for central causes of hiccups 4, 5, 6
  • Nerve blockade, pacing, and acupuncture for persistent hiccups 4, 5, 7
  • Holding breathing and other non-pharmacological approaches 4, 5
  • Alternative medicines and remedies, although their effectiveness is uncertain 4

Pharmacologic Interventions

• Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 6
• Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include:
  • Amitriptyline, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 6
  • Baclofen, gabapentin, and metoclopramide have been studied in prospective manner and randomized controlled trials 6

Alternative Approaches

• Extracranial acupuncture has been reported to be effective in treating intractable or persistent hiccups in two case reports 7
• Traditional Chinese acupuncture has also been used to treat hiccups, although its effectiveness is uncertain 7