From the Guidelines
Chlorpromazine is the most effective medication for treating hiccups, with a recommended dose of 25-50mg orally or intramuscularly, due to its anticholinergic and antiemetic properties, as noted in the study 1.
Treatment Options for Hiccups
Several medications can be used to treat persistent hiccups, including:
- Chlorpromazine, which is the only FDA-approved medication specifically for hiccups, with a dose of 25-50mg orally or intramuscularly, as mentioned in the study 1
- Baclofen, which works by reducing nerve impulse transmission, with a dose of 5-10mg three times daily
- Metoclopramide, which helps by increasing gastric emptying and reducing reflux that may trigger hiccups, with a dose of 10mg three to four times daily
- Gabapentin, which may be effective for neurologically-mediated hiccups, with a dose of 300-900mg daily in divided doses
- Benzodiazepines like lorazepam, which can help by reducing anxiety and muscle spasms, with a dose of 0.5-1mg for short-term use
Important Considerations
Before starting any medication, it's essential to identify and address any underlying causes of persistent hiccups, such as gastric distention, metabolic disorders, or medication side effects, as noted in the study 1. Treatment duration varies based on response, but typically continues for several days after hiccups resolve, with gradual tapering to prevent recurrence. The study 1 highlights the importance of monitoring patients who receive antipsychotics, including chlorpromazine, due to potential cardiac adverse effects, such as QTc prolongation.
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.
- Chlorpromazine is used to treat intractable hiccups at a dosage of 25 mg to 50 mg t.i.d. or q.i.d. 2
- The medication should be adjusted based on the individual's response and the severity of their condition.
From the Research
Medications for Hiccups
The following medications have been used to treat hiccups:
- Chlorpromazine, which is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
- Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid, which have been found in the literature to be successful in treating hiccups 3
- Baclofen, gabapentin, and metoclopramide, which were the only agents that were studied in a prospective manner, with baclofen and metoclopramide being studied in randomized controlled trials 3
- Serotonergic agonists, prokinetics, and lidocaine, which have been proposed as pharmacotherapy options for hiccups 4
- Lansoprazole, clonazepam, and dimenhydrinate, which were used in combination to successfully terminate intractable hiccups in a patient with gastritis and reflux esophagitis complicated with myocardial infarction 5
Treatment Approaches
Treatment of hiccups may involve:
- Directing management at the underlying condition, which can be effective in treating persistent and intractable hiccups 6
- Empirical trial of anti-reflux therapy, which may be appropriate if the underlying cause is not known or not treatable 6
- Use of pharmacological agents, such as baclofen, metoclopramide, gabapentin, and chlorpromazine, which may provide benefit in treating hiccups 3, 6
- Non-pharmacological approaches, such as nerve blockade, pacing, acupuncture, and measures to hold breathing, which have been successful in treating hiccups 4