From the FDA Drug Label
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. Follow blood pressure closely.
The causes of synchronous diaphragmatic contractions (hiccups) are not specified in the label. The treatment for intractable hiccups is:
- 25 to 50 mg (1-2 mL) IM if symptoms persist for 2-3 days after trial with oral therapy
- Slow IV infusion with patient flat in bed: 25 to 50 mg (1-2 mL) in 500 to 1000 mL of saline if symptoms persist, with close monitoring of blood pressure 1
From the Research
For most cases of hiccups, simple home remedies such as drinking a glass of cold water quickly, holding your breath for 10-20 seconds, breathing into a paper bag for a few minutes, gargling with ice water, or having someone startle you can be effective, but if hiccups persist beyond 48 hours, medical attention is necessary to rule out underlying conditions and consider pharmacologic interventions like baclofen, chlorpromazine, or metoclopramide 2.
Causes of Hiccups
Hiccups are involuntary contractions of the diaphragm followed by sudden closure of the vocal cords, producing the characteristic "hic" sound. They can be caused by a variety of factors, including eating too quickly, drinking carbonated beverages, or experiencing stress or excitement. In some cases, hiccups can be a symptom of an underlying medical condition, such as gastroesophageal reflux disease, pneumonia, or a central nervous system disorder.
Treatment of Hiccups
For most cases of hiccups that last less than 48 hours, simple home remedies can be effective. Some options include:
- Drinking a glass of cold water quickly
- Holding your breath for 10-20 seconds
- Breathing into a paper bag for a few minutes
- Gargling with ice water
- Having someone startle you If hiccups persist beyond 48 hours (persistent hiccups) or last more than a month (intractable hiccups), medical attention is necessary. Medications that may help include:
- Baclofen (5-10 mg three times daily)
- Chlorpromazine (25-50 mg)
- Metoclopramide (10 mg) These medications work by either relaxing the diaphragm or blocking the nerve signals causing the hiccups. In severe cases, other treatments such as phrenic nerve block or vagus nerve stimulation may be considered 3.
Importance of Medical Evaluation
Persistent hiccups can sometimes indicate underlying medical conditions, which is why medical evaluation is important for prolonged cases. Avoiding trigger factors like carbonated beverages, alcohol, and spicy foods may help prevent recurrence. A thorough medical evaluation can help identify any underlying conditions that may be contributing to the hiccups, and guide treatment accordingly 4, 5, 6.