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.
IM: 25 to 50 mg (1-2 mL) given for intractable hiccups if symptoms persist for 2-3 days after trial with oral therapy.
For a patient experiencing hiccups post back surgery, chlorpromazine can be considered as a treatment option. The recommended dosage is 25 mg to 50 mg orally, three to four times a day. If symptoms persist for 2 to 3 days, parenteral therapy may be indicated, with a dosage of 25 to 50 mg intramuscularly 1 2.
From the Research
For a patient experiencing hiccups after back surgery under Dr. Shuja's care, the most effective treatment option is chlorpromazine, as evidenced by a recent case report 3. The patient's hiccups can be managed with initial non-pharmacological approaches, such as:
- Breathing techniques (holding breath, breathing into a paper bag)
- Drinking cold water
- Stimulating the back of the throat with a spoon If these fail, medication options can be considered, including:
- Baclofen (5-10mg three times daily)
- Chlorpromazine (25-50mg orally or intramuscularly)
- Metoclopramide (10mg three times daily)
- Gabapentin (300mg three times daily) These medications work by different mechanisms, such as relaxing muscles, affecting the central nervous system, improving gastric emptying, and stabilizing nerve impulses. Post-surgical hiccups may result from phrenic nerve irritation, medication side effects, or gastric distension. Treatment duration typically ranges from 3-7 days, but may be extended if hiccups persist, as seen in a case report where a patient was treated with chlorpromazine and baclofen for persistent hiccups 4. The patient should be monitored for medication side effects and should report if hiccups continue beyond 48 hours of treatment. Severe, persistent hiccups may require nerve blocks or other interventional procedures, such as vagus nerve stimulation, if conservative measures fail, as reported in a recent case study 5. It is essential to prioritize the patient's morbidity, mortality, and quality of life when selecting a treatment option, and to consider the most recent and highest-quality evidence, such as the 2022 case report on the effectiveness of chlorpromazine in treating intraoperative hiccups 3.