What are the medications for hiccups (singultus)?

From the Guidelines

Chlorpromazine is the most effective medication for treating intractable hiccups, as evidenced by its use in clinical practice 1.

Medications for Hiccups

Several medications can be used to treat hiccups, including:

• Chlorpromazine, a phenothiazine that can be used to treat nausea/vomiting and intractable hiccups 1
• Other medications like antipsychotics, antiemetics, and benzodiazepines may also be used, but their effectiveness and safety vary

Treatment Approach

When treating hiccups, it's essential to:

• Identify and address any underlying causes, such as gastroesophageal reflux, medication side effects, or metabolic disorders
• Try non-pharmacological methods like breath holding, drinking cold water, or stimulating the back of the throat for brief hiccup episodes
• Use medications like chlorpromazine as a first-line option for intractable hiccups, with careful monitoring of potential side effects, such as QTc prolongation 1

Important Considerations

• The use of antipsychotics, including chlorpromazine, requires close clinical observation, cardiorespiratory monitoring, pulse oximetry, and/or an electrocardiogram to minimize the risk of adverse effects 1
• The potential risk factors for QT prolongation and dysrhythmia, such as coadministration with other medications, should be carefully evaluated 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.

Medications for hiccups (singultus) include:

• Chlorpromazine (PO): 25 mg to 50 mg t.i.d. or q.i.d. 2
• Chlorpromazine (IM): 25 to 50 mg (1-2 mL) 3 Key points:
• Dosage may be adjusted based on individual response and severity of symptoms
• Parenteral therapy may be indicated if symptoms persist after oral therapy 2, 3

From the Research

Medications for Hiccups

The following medications have been proposed for the treatment of hiccups:

• Chlorpromazine, which is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 4
• Metoclopramide, which has been studied in randomized controlled trials and found to be successful in treating hiccups 4, 5
• Baclofen, which has been studied in prospective and randomized controlled trials and found to be effective in treating hiccups 4
• Gabapentin, which has been found to be successful in treating hiccups in some studies 4, 6
• Amitriptyline, haloperidol, nifedipine, nimodipine, orphenadrine, and valproic acid, which have been found to be successful in treating hiccups in some cases 4
• Risperidone, which has been found to be effective in abolishing intractable hiccups in one case report 7
• Lidocaine, which has been found to be successful in treating intractable hiccups when applied orally 8

Pharmacologic Treatment Options

Pharmacologic treatment options for hiccups include:

• Antipsychotics such as chlorpromazine and risperidone 4, 7
• Anti-emetics such as metoclopramide 4, 5
• Muscle relaxants such as baclofen and gabapentin 4, 6
• Local anesthetics such as lidocaine 8
• Other medications such as amitriptyline, haloperidol, nifedipine, nimodipine, orphenadrine, and valproic acid 4